A cynical view is that doctors are too focused on the bottom line, but in fact, a physician in the U.S. Senate is aware of how well-meaning regulations on health spending affects day-to-day behavior in medicine — as, of course, it would in other fields.
Bill Cassidy talked recently about one of the changes he and bipartisan colleagues in the Senate have brought about in mental health treatment.
It sounds innocuous: A patient is seen by a psychiatrist for an episode, but under old Medicaid rules the patient's high blood pressure or other physical ailments might not be attended to, because two physicians could not be paid the same day for the same patient.
As a physician in the LSU hospital system for many years, this offended Cassidy's sense that a patient needs to be seen to in a more comprehensive way.
As a senator, Cassidy led a significant change in mental health policy, including the reimbursement rules, but also embracing government-wide assessment of mental health programs at the federal level.
"Interagency coordination for programs supporting individuals with serious mental illness is lacking," the U.S. Government Accountability Office reported in 2015. If you include matters like homelessness, often a consequence of mental illness, the GAO found more than 100 programs spread across various agencies of the U.S. government.
A new assistant secretary position created by the Cassidy bill in the U.S. Department of Health and Human Services was recently filled by President Donald Trump.
Cassidy told the Press Club of Baton Rouge that mental health issues are common across lines of class, politics, race and location. He said he gets nods of agreement from audiences in both the Lower 9th Ward or in St. Tammany Parish, because families across the state have had relatives or friends suffer from mental illness.
Obviously, funding at the federal and state level are part of the solution for mental health treatment, which can be expensive and beyond the means of many families. But making the system better is a worthy goal: Cassidy said he hopes that worthwhile programs can be expanded as others are fixed or eliminated.
But like the seemingly small matter of physician reimbursement suggests, a lot of what Cassidy wants involves coordination of care. He said that the first incidence of a psychotic episode should be the last, so long as all the problems are addressed then.
"That is my goal," he said of the new law. We hope he achieves it.
The 21st Century Cures Bill just passed into law contains a comprehensive mental health refo…