Maine legislators will be considering two separate budget proposals, one of which, as written, makes substantial cuts to reimbursement rates for psychiatric services. The cuts called for in the budget backed by House Republicans and Gov. LePage will make it much more difficult for agencies to afford to provide psychiatric medical services for MaineCare recipients.

Psychiatric services are already in short supply, and in the last several years this has been getting steadily worse.

To begin with, there is a growing shortage of medical doctors in Maine in general. Psychiatrists are medical doctors who specialize in treating mental illness and are employed by hospitals, agencies and clinics, or can be self-employed in private practice.

Maine’s workforce is aging; our psychiatrists are no exception. Indeed, for every working psychiatrist in Maine under age 50, there are 3.5 over age 50. Many older psychiatrists provide only part-time clinical services, and many are in partial retirement.

All of this contributes to a shrinking psychiatric workforce and heightens the need to attract more young doctors to Maine. Sadly, we have trouble recruiting psychiatrists to Maine. Most job opportunities in psychiatry rely on public funding, and policies like the House Republicans’ proposed budget scare candidates away from Maine.

Compared to commercial health insurance plans, Maine-Care has a higher percentage of patients with mental health disorders. Cuts to MaineCare hurt patients and psychiatric physicians alike. When the word on the street is that an unfriendly practice environment exists in Maine, psychiatric physicians will simply go elsewhere, depriving Maine of necessary psychiatric services.

The House Republicans’ budget would deal a devastating blow to our mental health system by slashing MaineCare payments to mental health agencies for medication treatment services.

Payments for these services – including appointments to monitor or change a patient’s drug dosage or prescription – would be reduced by well over 50 percent. The claim is that this cut will align rates that agencies are paid with what private-practice psychiatrists are paid.

Unfortunately, most psychiatrists in private practice cannot accept low MaineCare rates, and they limit their practices accordingly. Many of our colleagues have attempted private practice but have not been able to stay in business as MaineCare providers because it costs more to provide the services than MaineCare pays.

The only way the proposed payment cuts will put public agencies on par with private providers is that those cuts will ensure that they, too, are unable to continue providing services to patients who have MaineCare.

Mental health services are desperately needed. A glance at news stories of the inability to access needed psychiatric care and resulting tragedies – at times violent and shocking – shows the truth of that.

Every day, in much of our state, patients and families hear that they must wait months for the next available psychiatric appointment. Shortages predictably increase already-long wait times for appointments and limit needed access. Cuts in payments for agency-provided services might well be the proverbial straw that breaks the camel’s back, turning problematic shortages to catastrophic outcomes owing to an inability to obtain necessary care.

An ounce of prevention is worth a pound of cure; when patients are unable to access outpatient services for treatment, many will become so ill that they require emergency services and inpatient hospital services. That kind of care is much more expensive than outpatient services and is already stretched to capacity, sometimes leaving people stuck in the emergency room for days or even weeks.

Finally, as access to psychiatric services becomes further limited, an increasing number of our patients end up homeless, incarcerated, permanently disabled or deceased as they suffer without psychiatric care.

The fairest way to do this is through a rate-setting study, which we fully support. Rate cuts for psychiatric medication services are neither an effective way to save the state money, nor a responsible way to address the mental health needs of the people in Maine.

Cutting and further fraying Maine’s already strained mental health system will predictably lead to many more human tragedies. It is a bad deal for patients and their families with mental health disorders and a bad deal for psychiatric physicians, who we must instead encourage to come here and provide much-needed services.

We therefore urge our Legislature and our governor not to lower agency rates for psychiatric medication treatment services, but to look more closely at the issue and instead set rates that will improve availability of services.


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