SURVIVE, THRIVE OR DIE OUT: MEDICARE AND THE PRACTICE OF GERIATRIC PSYCHIATRY

Our fragile geriatric psychiatric population is at risk due to lack of outpatient clinicians available to take Medicare. PCPs and geriatric internists may be hesitant to accept elderly patients with behavioral problems or history of mental illness without the back up of a geriatric psychiatrist, but patients and families often struggle to find an psychiatrist who takes Medicare. For clinicians, discouraging elements of Medicare include poor reimbursement and the strenuous regulatory requirements of MACRA/MIPS. Geriatric psychiatrists practicing in nursing homes face additional daunting regulatory burdens and hostility towards psychiatric diagnoses and psychotropic medications, particularly antipsychotics. In this session, members of the AAGP Clinical Practice Committee (CPC) will discuss major challenges in Medicare faced by geriatric psychiatrists. CPC Committee Chair Dr. Marie Dewitt will introduce the topic and the speakers. Dr. Maureen Nash will review challenges related to the use of antipsychotics in nursing homes and the Partnership to Improve Dementia Care (the challenges of appropriate prescribing of psychotropic medications like antipsychotics to decrease suffering in those who live in a nursing home). Dr. Chanida Siripraparat will further discuss the use of antipsychotics in nursing homes, with a focus on what AAGP needs to do as an organization to tackle this major problem. Dr. Elliott Stein will provide a brief review of challenges related to in Medicare billing, documentation and coding, including the Medicare Physician Fee Schedule Proposed Rule for 2019 (#MPFS2019) and its proposed Evaluation and Management (E/M) Changes. Dr. Karen Reimers will discuss forensic aspects of Medicare litigation in geriatric psychiatry and summarize curent Medicare advocacy efforts. Dr. Tatyana Shteinlukht will serve as discussant. All speakers will highlight key directions for future advocacy efforts to improve Medicare and promote quality geriatric mental health services in the future. Robust discussion and audience participation will be encouraged.