Psychiatrists have been unfairly targeted for control because of a myth that they are breaking the medical budget by doing too much psychotherapy. This has led to numerous restrictions of authorization, cuts in reimbursement and investigations for fraud. The truth is that currently most psychiatrists are forced to spend far too little time doing psychotherapy or even listening to their patients. The myth is based upon false and misleading statistics, collected and interpreted by third party payers and regulatory agencies throughout the USA, that are determined to cut costs wherever possible. The consequences are very inconvenient for psychiatrists, but often disastrous for patients.

How did this error arise? There are plenty of errors in health care data, but this one arises from some simple mistakes in categorizing. Most of the psychotherapy attributed to psychiatrists is actually performed by non-physician therapists who, unfortunately, use the same psychotherapy CPT codes as psychiatric physicians when billing for their services. But for statistical purposes, the absence of accurate coding by discipline is not usually as fatal as it appears to be, since there are often other cues that can be used to identify the profession of the person who submits the bill and is paid for the service. Unfortunately, this distinction is rarely made. Thus, the official statistics suggest that the average psychiatrist must be billing for more therapy hours than is possible. No wonder it’s so hard to get paid and why the US Office of Inspector General and the FBI have been so diligently pursuing psychiatrists for fraud.

You have to wonder why such obvious mistakes haven’t been recognized and corrected by health insurance companies or government agencies. Are they blinded by their wish to reduce costs? In Maryland, there is a State health care regulatory agency that assembles and publishes data from most payers. Fortunately, this agency has recently responded to my criticisms published in TMP and has corrected this categorizing error in its latest report. I am referring to the Maryland Health Care Commission (MHCC), formerly known under the acronym of HCACC. That’s the same agency I’ve persistently criticized in TMP for its use of false and misleading data. (It’s also the one that MPS objects to because of concerns about confidentiality.)

Each year since TMP began this series of articles, the State agency later corrected some of the errors we pointed out. The biggest corrections occurred in the recent report.

Last year, in TMP, I described a May 1999 multidisciplinary professional meeting attended by myself and other representatives of the Maryland Psychiatric Society as well as officials from HCACC (now called MHCC). At this meeting a lively discussion led to HCACC’s promise to correct its statistical errors in future reports. ( See “HATS OFF TO HCACC” TMP, Summer 1999). They appeared to be sincere, but I wasn’t sure what the results would be.

Hoping to update my reports on the subject for the Summer 2000 issue of TMP, I eagerly looked forward to receiving this year’s issue of the MHCC annual report on Practitioner Expenditures & Utilization. It arrived late this year, well after the deadline for TMP’s summer issue. There was just enough time to squeeze this note under the wire for this issue of TMP.

The current MHCC report includes data from a larger number of sources than ever before. There are many improvements and there seem to be fewer errors. Extreme errors of inflated Medicaid mental health care data are now absent. Rather than reporting fanciful statistics as before, MHCC acknowledges that the MCOs providing Medicaid services have never supplied the data. It is a big achievement to have come so far in only a year. Any faults in their report that may exist can be addressed at another time.

The best news is that MHCC kept its promise to revise its categories. For example, the services of psychiatrists are no longer lumped together with those of other mental health workers. Social workers, psychologists, nurse psychotherapists and psychiatrists are listed in separate categories, each with corresponding rates of psychotherapy services. As predicted, most of the payments for psychotherapy went to non-physician therapists. Although the data are still incomplete, it’s a big step in the right direction.

The report also uses improved categories for other medical services, but I won’t go into that, since it is outside the focus of this article.

In pursuing this subject in TMP for the past three years, I have had the encouragement of the officers of the MPS. The MPS probably will continue to have differences of opinion with MHCC and other regulatory agencies, but since we seem destined to live together, we can be appreciative that MHCC is responsive to some of our criticisms and suggestions.

There can’t be many Maryland physicians who consider it a blessing to practice in the only state with its own health regulatory agencies. But I can see benefits that were never thought of by our legislators when they established its agencies. MHCC puts a lot of the data it collects from payers out in the open where you can spot its flaws and challenge them. Similar inaccuracies are believed to exist nationwide, but are usually less accessible to inspection by the public. Let’s spread the word. The reformation of psychotherapy statistics that has begun in Maryland must sweep the country in order to be fully effective, since most payers operate across state lines. The entire nation should benefit from our experience. Once the word gets around, it will be more difficult for payers and regulators everywhere to continue unfair discrimination against those needing help from psychiatrists. Maybe the day will come again when psychiatrists and their patients will be free to engage in psychotherapy without interference.