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2019 (Continued):

  • Medicare Changes Way It Pays Doctors, Helping Advance Integrated Care:

    On November 1, 2019 the Centers for Medicare & Medicaid issued a Final Rule that includes changes to its physician payment policies, payment rates and quality measures for services provided by doctors and other practitioners under the Medicare Physician Fee Schedule effective 1/1/20. This FinalRule includes the following changes beneficial to primary care teams seeking to integrate behavioral health services into their practices:
    — reduces the documentation burden on physicians and other care-team practitioners;
    — broadens the practice role of practitioners who work with physicians as part of care team, e.g. RNs APRNs, PAs, etc;
    — prioritizes treatment of opioid use disorders;
    — adds new payment codes to list of allowed tele-health services, and
    — increases payment for patient care coordination and care management.
    Finalized Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020

  • Kaiser Permanente Launches PHQ-9s in Its Clinics.

    The growing presence of PHQ-9 patient surveys in primary care clinics is an important development and first step on a continuum of change, adding mental health services to patients care in medical settings. On completing the 9-question survey, patients can identify behavioral, emotional, mental health issues to talk to their doctor about. It will be a universal survey so that all patients will be asked to complete it. There is no stigma to its use. We know talking about behavioral problems can be difficult for patients to raise, and for doctors to discuss, so the PHQ-9 gives a science-based impetus for this discussion to begin. The PHQ-9 is a sign it is OK, in fact encouraged, for patients to bring up their behavioral issues with their PCP, e.g. depression, anxiety, phobia, etc. So that physicians can then assess, develop a treatment plan and consult with behavioral specialists as needed to provide behavioral health care. We are redefining health to include behavioral health and the PHQ-9 is an exciting early sign of progress! PHQ – 9 Form

  • July 2019 Medicare/Medicaid (CMS) announced that, starting in January 2020, it will begin paying medical practices for virtual psychotherapy, delivered via video-conferencing, as part of a bundled payment (i.e. per patient per month payment) to physicians for opioid use disorder treatment. CMS also proposes to begin paying medical doctors for substance use disorder services delivered via tele-health, again as part of a bundled payment. And where CMS leads, private commercial insurance companies usually follow in paying for such services.

https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-2

  • New Harris Poll shows majority of Americans now think mental disorders are nothing to be ashamed of and can be treated effectively.
  • In a Harris poll commissioned by the American Psychological Association, it is clear the American public has moved significantly towards greater understand of mental disorders and acceptance of fact that effective treatments exist for behavioral conditions and should be accessed when needed. These changes in U.S. popular opinion reveal two things:
    1. The work of advocacy groups like NHMH and others are having a real effect, and as more Americans seek mental health care, NHMH’s mission becomes all the more critical: to ensure that effective, evidence-based care will in fact be available to them in primary care, when they seek that care.

https://www.apa.org/news/press/releases/2019/05/mental-health-survey

2018:

  • Behavioral health services into primary care was one of the four Chronic Care policies that Medicare implemented through the calendar year 2017 physician fee schedule rule.
  • Congress passed into law The Chronic Care Act of 2018 which includes provisions to pay primary care practices for integrated care services delivered to Medicare patients.

2017:

  • Medicare agreed to pay medical practices for providing some elements of the integrated care model called collaborative care;
  • NHMH persuaded the main federal agency, the Department of Health & Human Services, to hold the first-ever HHS-wide integrated care conference where all federal agencies doing integrated care (e.g. Veterans, Indian Health Services) reviewed findings and best practices;

2016:

  • Federal Government’s Center for Medicare & Medicaid agreed to allow same-day billing for medical practices where patient received physical and behavioral health services in one visit;
  • Congress enacted The 21st Century Cures Act which requires the Asst. Sec. for Mental Health to submit a report every 2 years on inter- and intra-agency coordination efforts across all programs including bi-directional integrated care.

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Schizophrenia Second Only To Age as Greatest Risk Factor for COVID-19 Death25-Jan-2021 7:00 PM EST, by NYU Langone Health Contact Patient ServicesNewswise — People with schizophrenia, a mental disorder that affects mood and perception of reality, are almost three times more likely to die from the coronavirus than those without the psychiatric illness, a new study shows. Their higher risk, the investigators say, cannot be explained by other factors that often accompany serious mental health disorders, such as higher rates of heart disease, diabetes, and smoking.Led by researchers at NYU Grossman School of Medicine, the investigation showed that schizophrenia is by far the biggest risk factor (2.7 times increased odds of dying) after age (being 75 or older increased the odds of dying 35.7 times). Male sex, heart disease, and race ranked next after schizophrenia in order. “Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of COVID-19,” says study lead author Katlyn Nemani, MD. “With this newfound understanding, health care providers can better prioritize vaccine distribution, testing, and medical care for this group,” adds Nemani, a research assistant professor in the Department of Psychiatry at NYU Langone Health. The study also showed that people with other mental health problems such as mood or anxiety disorders were not at increased risk of death from coronavirus infection.Since the beginning of the pandemic, experts have searched for risk factors that make people more likely to succumb to the disease to bolster protective measures and allocate limited resources to people with the greatest need. Although previous studies have linked psychiatric disorders in general to an increased risk of dying from the virus, the relationship between the coronavirus and schizophrenia specifically has remained unclear. A higher risk of mortality was expected among those with schizophrenia, but not at the magnitude the study found, the researchers say.The new investigation is publishing Jan. 27 in the journal JAMA Psychiatry. Researchers believed that other issues such as heart disease, depression, and barriers in getting care were behind the low life expectancy seen in schizophrenia patients, who on average die 15 years earlier than those without the disorder. The results of the new study, however, suggest that there may be something about the biology of schizophrenia itself that is making those who have it more vulnerable to COVID-19 and other viral infections. One likely explanation is an immune system disturbance, possibly tied to the genetics of the disorder, says Nemani.For the investigation, the research team analyzed 7,348 patient records of men and women treated for COVID-19 at the height of the pandemic in NYU Langone hospitals in New York City and Long Island between March 3 and May 31, 2020. Of these cases, they identified 14 percent who were diagnosed with schizophrenia, mood disorders, or anxiety. Then, the researchers calculated patient death rates within 45 days of testing positive for the virus.They note that this large sample of patients who all were infected with the same virus provided a unique opportunity to study the underlying effects of schizophrenia on the body.“Now that we have a better understanding of the disease, we can more deeply examine what, if any, immune system problems might contribute to the high death rates seen in these patients with schizophrenia,” says study senior author Donald Goff, MD. Goff is the Marvin Stern Professor of Psychiatry at NYU Langone.Goff, also the director of the Nathan S. Kline Institute for Psychiatric Research at NYU Langone, says the study investigators plan to explore whether medications used to treat schizophrenia, such as antipsychotic drugs, may play a role as well.He cautions that the study authors could only determine the risk for patients with schizophrenia who had access to testing and medical care. Further research is needed, he says, to clarify how dangerous the virus may be for those who lack these resources. Goff is also the vice chair for research in the Department of Psychiatry at NYU Langone.Study funding was provided by NYU Langone.In addition to Nemani and Goff, other NYU Langone researchers included Chenxiang Li, PhD; Esther Blessing, MD; PhD; Narges Razavian, PhD; Ji Chen, MS; and Eva Petkova, PhD. Another study investigator was Mark Olfson, MD, MPH, at Columbia University in New York. ... See MoreSee Less
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NHMH Salutes the Passing of American Scientist Dr. Paul Greengard, a Pioneer in Brain Research and Mental Health Treament. We owe Dr. Greengard a great debt for his incredible, break-through work, and his amazing life of service.

https://www.rockefeller.edu/news/25634-pioneering-neuroscientist-nobel-laureate-paul-greengard-dies-93/

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