In some expected and unexpected ways, the year 2012 seemed to be a watershed year for psychiatry. Some might even go so far as to say it was a crisis, which in Chinese meaning, would be both danger and opportunity.
Crucial changes occurred that will greatly influence the organization of services, reimbursement, and diagnosis. It even ended in an exclamation point, as the tragedy in Newtown, Connecticut (see last month's blog, Mass Murder and Psychiatry) punctuated the need for improved mental healthcare services. That also added the question mark of what the role of psychiatry should be for such societal social issues as gun control. Perhaps this was another confirmation, as unwanted as that may have been, that this decade is indeed becoming the decade of the social for psychiatry, as I tentatively predicted in a earlier blog.
With the Supreme Court's blessing of sorts, and President Obama's re-election, it is now clear that healthcare reform will continue to roll out. Although exactly what that will mean for all of psychiatry is not exactly clear, more people will have health and mental healthcare coverage, the private for-profit insurance companies will manage more of those lives, and organized healthcare systems will grow with more integration of health and mental health.
At its best, this Affordable Care Act (ACA) suggests that more people will be able to receive adequate, well-coordinated, and integrated preventive services and care. At its worst, it will be like HMOs on steroids, with more for-profit control of care, despite more governmental controls in place for the worst abuses of managed care.
On January 1, 2013, the Current Procedural Terminology (CPT) codes for reimbursement began. Even so, it appears that many healthcare organizations and private practitioners are scrambling to find out exactly what criteria will meet what new billing codes.
At its best, these new CPT codes will not only increase the low reimbursement for psychiatrists, and bid good riddance to the unpopular 15-minute med check, but also recognize the extra value of counseling and medical expertise of psychiatrists. At its worst, it will lead to inappropriate coding and auditing penalties, and doing even more in less time.
In December 2012, the APA approved the new edition of the DSM, to roll out at the annual meeting in May.
Certainly, DSM-5 has had a massive share of criticism, most cogently presented in a series of Psychiatric Times blogs by the chair of the previous DSM, Dr Allen Frances.
At its best, the DSM-5 will indeed reflect advances in psychiatric understanding of mental disorders, including the relationship between grief and depression that Dr Ronald Pies has discussed in recent Psychiatric Times articles and blogs. At its worst, it will be confusing, misleading, and more of a moneymaker for the APA than a benefit for the public and patients.
These developments, put into motion by separate entities, have the potential to be quite promising for psychiatry. However, adjusting to major changes in systems, reimbursement, and diagnosis in less than a year is quite a challenge, especially for those psychiatrists who have become increasingly burned out in recent years. And there's the rub, so to speak. Will these changes distract us from helping patients get better? Moreover, any advances in treatment are the one crucial aspect of care that's missing in these major changes. How about a Treatment and Statistical Manual, a TSM—maybe next year?
At best, the status quo in treatment will be applied in better ways for recovery. At its worst, the anti-psychiatry critics will have more to criticize.
Challenges for 2013
For the superstitious, these social psychiatric challenges will seem like a sign that this will be an unlucky 13th year of this century. On the other hand, others may feel that we make our own luck. Certainly, scientifically inclined psychiatrists will feel that 2013 can indeed turn out to be a happy new year for psychiatrists. And, Happy New Year to you.