Demonstrating Value for Behavioral Health Reimbursement

Changes are underway in reimbursement for behavioral health services. The Centers for Medicare & Medicaid Services (CMS) has launched MIPS, the Merit-based Incentive Payment System, which began to impact reimbursement in 2019. MIPS incentivizes providers with larger payments if they can show client/patient improvement on process and outcome measures.


Value-Based Reimbursement in Behavioral Health | Medicaid Value-Based Purchasing | Better Outcomes Now


While not all therapists are required to participate in MIPS yet – only those who treat more than 200 Medicare beneficiaries or bill Medicare for more than $90,000 – it’s commonly known that, when it comes to reimbursement, CMS is the 800-pound gorilla. And CMS reimbursement is often a prelude to what happens in the private sector.


Value-Based Reimbursement in Behavioral Health: An Evolution

While value-based reimbursement in behavioral health is just taking shape, value-based reimbursement has been around since 2012 in other areas such as skilled nursing facilities, home health, end-stage renal disease, and hospital readmissions. Both Medicare and Medicaid see value-based purchasing initiatives as having the same goal: to provide better care while lowering costs. This clearly marks a shift in CMS reimbursement by paying providers for the quality instead of the quantity of the services delivered.

A recent article in the APA’s Monitor on Psychology cites a 2017 review of 51 studies. The review found that nearly all trials consistently using measurement-based care showed significant improved client/patient outcomes. In contrast, one-time screenings were less effective.

A 2019 JAMA study also cited in the Monitor found that frequent assessments improved outcomes. The Monitor article further states the JAMA study found that “when patient scores are reviewed by the clinician and patient—either independently or, ideally, together during the session—that process benefits patient outcomes, in part because it offers a check to the therapist’s clinical judgment and helps ensure that patients agree that their scores reflect their subjective experience.”


Outcomes Measurement Tools to Play an Increasing Role

One of the tools highlighted in the Monitor is our very own Better Outcomes Now (BON), a web-based software system that allows therapists to administer questionnaires to clients on a tablet, desktop, laptop, or mobile device. BON is an outcome measurement tool that provides real-time clinician and client reports as well as early warning treatment failure alerts.

BON provides a few advantages over some of the other systems – it can be used across orientations and diagnoses, provides data in easy-to-understand graphs, offers an unlimited number of analyses, and can combine couple, family, and group graphs. What’s more, therapists can request a free trial and give BON a test drive with no obligation. Regardless of the system used, measurement tools to determine outcomes will likely play an increasing role in reimbursement as CMS initiatives continue to move forward.


Introducing Psychotherapy Outcome Measures to Your Clients | FREE Infographic | Better Outcomes Now

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