Disparities between mental, medical use reimbursements highlighted
RTI International conducts research
A new study highlights the disparity in out-of-network use and reimbursements between mental health and medical/surgical providers.
Patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical/surgical clinician, according to the study, conducted by nonprofit research institute RTI International. Patients went out of network 8.9 times more often to see a psychiatrist and 10.6 times more often to see a psychologist.
In some New England states, out of network use for psychologists versus medical/surgical specialists was significantly higher. Patients were 39 times more likely to go out of network to see a psychologist in Massachusetts, 29 times more likely in Rhode Island, and 17.5 times more likely in Connecticut. In New Hampshire and Vermont, they were 8.2 and 6.5 times more likely, respectively.
The Mental Health Treatment and Research Institute, a subsidiary of the Bowman Family Foundation, commissioned the research as an update to a 2019 study on reimbursement to mental health vs. physical health providers that was conducted by actuarial firm Milliman.
“The main finding was that we have seen almost no progress in disparities and access since 2013-2021 with only a few minor exceptions,” said Henry T. Harbin, M.D., a psychiatrist, and senior advisor to the Bowman Family Foundation. “When the Milliman research, many insurers said they have been increasing reimbursement rates and adding [mental health providers] to networks. They may have been doing that, but it isn’t moving the needle.”
For psychologists, the takeaway is that they could be more assertive in asking for increased reimbursement rates, he said.
“Professional associations should be actively educating state and federal regulators on the need for greater enforcement on parity and compliance on in network use and access to psychologists,” he says. “This research gives them data to be more effective on enforcing parity both at the state and federal level.”
The study also revealed that in-network office visit reimbursement was 22% higher on average for medical/surgical clinicians than for office visits with behavioral clinicians. Reimbursements for mental health providers was compared with 24 different physician specialties, including allergists, dermatologists, endocrinologists, neurologists, and plastic surgeons.
Study-co-author Tami L. Mark, Ph.D., M.B.A., is distinguished fellow and director of behavioral health financing and quality measurement at RTI International. She said she was surprised, for example] that physician assistants were reimbursed for office visits at an average amount 19% higher than psychiatrists and 23% higher than psychologists.
To evaluate out-of-network use and reimbursement rates across all 50 states, Mark and co-author William Parish, Ph.D, used claims and enrollment data from more than 22 million individuals from 2019 through 2021.
Although there is a shortage of behavioral health professionals, particularly in less urban parts of the county, the shortage cannot explain the disparities in out-of-network use, said Mark.
According to the U.S. Health Resources and Services Administration, as of December 31, 2023, there are 25% more shortage areas for primary care physicians than for mental health providers (8,544 vs. 6,822).
“Nonetheless, our analysis showed that in 2021, there was much lower out-of-network use for primary care physician office visits (2.2%) than for psychiatrist (15.3%) and psychologist (18.2%) office visits,” she said.
“No other specialty had as much out-of-network use as behavioral health clinicians. This is further evidence that health plans can create robust networks that reduce patients’ need to pay high out of-network fees if they are motivated to do so.”
Harbin agreed. “Patients with [mental health] illnesses are getting discriminated against and are bearing a huge financial burden higher than anyone seeking medical or surgical care.”