procedure is explicitly added to the Medicare statute by congressional action), this may not be a major barrier to the performance of psychosocial screening by itself. First, the exemplar organizations described in Chapter 5 (and others identified by the committee but not discussed in this report) all perform screening and more in-depth assessment under a variety of scenarios. These practices provide some evidence of the feasibility of screening under current policies. Second, MA private plans are not restricted to offering services explicitly allowed under Medicare’s FFS statutory provisions. MA plans (especially health maintenance organization [HMO]–type plans, as opposed to preferred provider organizations [PPOs] and private FFS plans) often offer benefits beyond those in FFS Medicare, such as routine health exams, some care coordination, and eyeglasses. Managed care plans in the private sector also often offer additional services. For example, in 2005 Aetna began an initiative offering financial incentives to primary care physicians to identify and care for certain health plan enrollees with depression. Primary care physicians who serve Aetna enrollees are trained in the use of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool, are supplied with care management resources designed to support patients and primary care providers, and have access to mental health specialists for collaborative consultation (Moran, 2006). For every patient identified though screening as positive for symptoms of depression, Aetna pays the physician $15.00.4

Moreover, brief screening for some conditions takes place and is reimbursed as part of Medicare’s FFS payment for office visits. For example, when a nurse takes a patient’s blood pressure at each routine visit, this is essentially screening for hypertension. Similarly, if a primary care provider incorporates depression screening or screening for alcohol misuse into a visit for evaluation or management of physical symptoms or an already documented medical condition, these screening services are included in Medicare’s payment for Evaluation and Management (E/M) services—one of the most commonly delivered health services. Such screening is explicitly identified as a component of E/M services in the Current Procedural Terminology (CPT) codes5 reimbursed by all payers (public and private) (Beebe et al., 2006).

4

Personal communication, Hyong Un, MD, National Medical Director for Behavioral Health, Aetna, March 29, 2007.

5

CPT, maintained by the American Medical Association, is a listing of medical services and procedures (and an accompanying numerical code for each) used by physicians and certain other clinicians (e.g., physician assistants, nurse practitioners, and nurse midwives) to report the services and procedures they perform as part of their claims to insurers for reimbursement. CPT codes are designated by the federal government as the national standard for coding such services.



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