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CMS Shows Strong Support for Collaborative Care


The Collaborative Care model received significant recognition when the Centers for Medicare and Medicaid Services (CMS) released their final rule for the 2017 Medicare Fee Schedule last week, and I am delighted. We thank CMS for listening to our input on the rule and responding in such a way.

Collaborative Care Model

APA has a number of resources available to psychiatrists interested in learning how to work within the Collaborative Care Model.

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As many as 40% of all patients seen in primary care settings have a mental illness and the presence of psychiatric comorbidities translates to not only into suffering due to the psychiatric illness, but also worsens outcomes for the other illnesses afflicting the patient. Coding for these services will mean better care for these patients and supports payments for primary care practices and psychiatrists who provide consultation services to primary care physicians in the Collaborative Care Model. According to the new rule, patients cared for by physicians and practitioners providing these services will receive an estimated $140 million in additional benefits in 2017. As more practices adopt the Collaborative Care Model over time, that number could climb even higher.

This is a significant win for our patients seen in primary care settings, who desperately need psychiatric services.

The Collaborative Care Model, developed by doctors at the AIMS Center of the University of Washington, is the only evidence-based model of its kind. The move to provide coverage for the Collaborative Care Model is an important step by CMS, and shows that they recognize the impact of non-face-to-face services, which up to now have been minimally covered. These payment codes represent an enormous vote of confidence in a model that has been proven effective in more than 80 randomized, controlled trials, and is sure to have a positive impact on patient outcomes for years to come.

With this rule, CMS is also supporting a population-based approach to providing necessary services. This approach uses a team consisting of a primary care physician, a psychiatric consultant and a care manager all working together to ensure a group of patients with psychiatric disorders who are being treated in a primary care setting [or practice] are improving. This focus on collaboration among medical professionals is vital to achieving good patient outcomes when in many cases, funding for services can be extremely scarce.

The final rule from CMS also recognizes that many primary care practices are at different levels of readiness to adopt the Collaborative Care Model. With this in mind, CMS has created a new payment code that describes more general care management services, designed to be stepping stone for practices interested in adopting some form of collaborative care, but whom at present lack the infrastructure to do so.

Overall, the changes made to the final rule from the rule that was proposed back in August reflect a commitment by CMS to marshal resources in a way that provides for smarter spending and improved health care service delivery with the goal of a healthier population.

Funding payment for collaborative care services is not just good news for the patients and for the psychiatrists and other medical professionals that work within those models, it is a huge step toward achieving health equity for large swaths of the population that have traditionally been underserved.

APA has a number of resources available to psychiatrists interested in learning how to work within the Collaborative Care Model. You can find those resources, which include access to free online learning modules and live trainings here.

For more information on the Collaborative Care Model, visit the APA’s page on Collaborative Care.

What APA is Doing for You

This blog post is part of an occasional series highlighting how APA advocates on your behalf to support the profession of psychiatry and put our interests before key policymakers.


Post by Maria A. Oquendo, M.D., Ph.D.

Maria A. Oquendo, M.D., Ph.D., is the President of APA. Read Dr. Oquendo's full biography.

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