Am J Psychiatry 1992; 149:1492-1498
Copyright © 1992 by American Psychiatric Association
Psychiatric outpatient practice: patterns and policies
M Olfson and HH Goldman
Department of Psychiatry, Cornell University Medical College, New York, NY.
OBJECTIVE: The purpose of this paper is to explore possible consequences of
recent changes in the Medicare payment schedule for office-based
psychiatric services. METHOD: Psychiatric office visits from the 1985
National Ambulatory Medical Care Survey were categorized in a manner that
approximates commonly used codes of the Physicians' Current Procedural
Terminology. An analysis was conducted of the frequency and clinical
characteristics of various types of services, focusing particularly on
visits of under 20 minutes in length that included a medication
prescription (medication visits) and other visits of 35 minutes or less in
duration (brief visits). RESULTS: Medication visits and brief visits
together accounted for more than one-quarter (27.3%) of all U.S.
psychiatric office visits. The relative risk of receiving these short
visits was greater for patients who paid with public resources, were over
65 years of age, were nonwhite in race (brief visits only), received a
prescription for an antipsychotic medication, or were diagnosed as having a
psychotic disorder. CONCLUSIONS: Short office visits are provided to a
particularly vulnerable patient population. The reduction in Medicare
copayments for medication management services should increase the patient
demand for these short visits. However, where the new Medicare schedule has
lowered physician fees for these services, the financial incentive to
provide short visits will decrease and patient access may become limited.
