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Review
. 2022 Mar;45(1):161-177.
doi: 10.1016/j.psc.2021.11.014. Epub 2021 Nov 13.

The Impact of COVID-19 on Financing of Psychiatric Services

Laurence H Miller  1 , Joseph Parks  2 , Rebecca Yowell  3
Affiliations
Review

The Impact of COVID-19 on Financing of Psychiatric Services

Laurence H Miller et al. Psychiatr Clin North Am.2022 Mar.

Erratum in

  • Erratum.
    [No authors listed][No authors listed]Psychiatr Clin North Am. 2022 Jun;45(2):xi. doi: 10.1016/j.psc.2022.05.009.Psychiatr Clin North Am. 2022.PMID: 35680248Free PMC article.No abstract available.

Abstract

The onset of the COVID-19 pandemic in early 2020 had a significant impact on the delivery of behavioral health services, with significant short-term and long-range consequences. Intertwined with the delivery of services has been the financial ramifications of the pandemic. The rapid response by governmental agencies to shore up financial support for clinical services, and the swift shift to virtual care provided relief for a broad array of practice settings; however, it did not mitigate the full impact of the pandemic. Effective state, national, and international leadership, communication, and coordination are critical to improve the global response to any pandemic.

Keywords: COVID; Financing; Lessons learned; Psychiatric services; Telehealth; Waiver.

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Conflict of interest statement

Disclosure The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Changes in the provision of mental health services.
Fig. 2
Fig. 2
A) Overall Medicare physician fee schedule spending January to September 2020 as compared with expected spending. (B) Medicare physician fee schedule spending by place of service as compared with expected spending. Evaluation/Management (E/M).
Fig. 3
Fig. 3
A) Mental health services for children under age 19 during COVID-19. Preliminary 202 data show that mental health services for children under age 19 decreased starting in March and continue to be substantially below prior years’ levels through October. Mental health services among children under 19 years decreased from 145 per 1000 in February to a low of 72 per 1000 beneficiaries in October 2020. Note: These data are preliminary Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on December T-MSIS submissions with services through the end of November. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for November are incomplete, results are only presented through October 31, 2020. (B) Mental health services for adults during COVID-19. Preliminary 2020 data show mental health services for adults ages 19 to 64 decreased through May and have not rebounded to prior years’ levels through October. Mental health services among adults ages 19 to 64 decreased from 176 per 1000 beneficiaries in February 2020 to a low of 100 per 1000 beneficiaries in October 2020. Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on December T-MSIS submissions with services through the end of November. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for November are incomplete, results are only presented through October 31, 2020. (C) Substance use disorder services for adults during COVID-19. Preliminary 2020 data show SUD services for adults age 19 to 64 decreased starting in March, increased in June, and are still below 2019 levels through October. Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on December T-MSIS submissions with services through the end of November. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for November are incomplete, results are only presented through October 31, 2020. We compare SUD service use in 2020 with 2019 only. Coverage of SUD treatment services has increased dramatically over the past 3 years with the implementation of several 1115 demonstrations. As a result, we do not compare treatment rates in 2020 to treatment rates in 2018 and 2017, when coverage of services was generally lower. Additionally, as of January 1, 2020, Medicare Part B pays Opioid Treatment Programs through bundled payments for opioid use disorder. This change in coverage may impact results for dually eligible beneficiaries. SUD services for adults ages 19 to 64 decreased from about 92 per 1000 beneficiaries in February 2020 to a low of 57 per 1000 beneficiaries in October 2020.
Fig. 4
Fig. 4
Comparison of average lengths of stay before COVID-19 and during COVID-19.
Fig. 5
Fig. 5
Comparison of patient discharges before COVID-19 and during COVID-19.
Fig. 6
Fig. 6
Pandemic phases of preparedness.
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References

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