title: Are Psychiatrists Ready for Health Care Reform? Findings From the Study of Psychiatric Practice Under Health Care Reform.
abstract: This study sought to describe the extent to which psychiatrists, prior to insurance expansions under the Affordable Care Act (ACA), reported currently participating or being likely to participate in integrated services delivery models, to assume new roles, to accept new reimbursement structures, and to use electronic health records (EHRs).
  
  
  
  A cross-sectional probability survey of U.S. psychiatrists was fielded from September to December 2013. In total, 2,800 psychiatrists were randomly selected from the AMA Physician Masterfile, and 45% responded. Of these, 93% (N=1,099) reported treating patients, forming the sample.
  
  
  
  Overall, 29% reported practicing in new ACA or integrated models, and 64% reported assuming at least one new role. Forty-two percent reported currently receiving a salary; other capitated and risk-based reimbursement was rarely used. Half (53%) reported current use of EHRs for clinical functions not limited to billing or practice management; only 21% reported participating in the Medicare or Medicaid EHR Incentive Program. Those who reported currently practicing or being very likely to practice in primary care or integrated treatment settings, to assume at least one ACA role, to receive a salary, or to use an EHR were younger and more racially-ethnically diverse and more likely to see Medicaid and public outpatient clinic patients Conclusions: Although substantial proportions of psychiatrists reported current practice in ACA services delivery models and ACA roles, the findings highlight opportunities for workforce development, training, and technical assistance to strengthen participation in these activities. The findings also underscore the need to prepare psychiatrists for merit-based payment reforms and use of EHRs.
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: West
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Clarke
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Farifteh Firoozmand
authors.initials: FF
authors.lastname: Duffy
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Keila D
authors.initials: KD
authors.lastname: Barber
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Eve K
authors.initials: EK
authors.lastname: Mościcki
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Kristin Kroeger
authors.initials: KK
authors.lastname: Ptakowski
authors.affiliation: Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail: jwest@psych.org ). Dr. Clarke is also with the Division of Research, American Psychiatric Association, Arlington, Virginia. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Kroeger Ptakowski and Dr. Levin are with the American Psychiatric Association, Arlington, Virginia.
authors.forename: Saul
authors.initials: S
authors.lastname: Levin
mesh_terms: D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Financing/funding/reimbursement; Mental health systems/hospitals; Public policy issues; Research/service delivery; Service delivery systems