National health reform was supposed to open the doors to mental health services for hundreds of thousands of people who couldn't previously afford to get treatment, but Maryland patients are finding there aren't enough doctors.
A study released Monday by the Mental Health Association of Maryland found that consumers who buy private plans on a state exchange under health reform are supposed to have access to 1,154 psychiatrists. But when researchers tried to call these doctors, they found that only 14 percent were accepting new patients and available for an appointment within 45 days.
While mental health advocates have long heard anecdotes about a shortage of psychiatrists, the state insurance exchange offered a way to take a more detailed look at the issue because the network of doctors is open to the public, unlike with most private plans.
"More people getting insurance is great, but we want to make sure people can access the care they need when they need it," said Adrienne Ellis, director of the parity project at the mental health association.
The lack of psychiatrists could have devastating consequences for people who suffer from depression, bipolar disorder and other mental health illnesses that can affect daily functioning. Wait times will only grow, and mental health advocates worry some patients might get frustrated and not seek care. These patients may wind up in the emergency room or hospital at a greater cost to taxpayers.
"Individuals living with mental illness do not have the luxury of waiting four to six months for mental health treatment," said Jessica Honke, policy and advocacy director for the National Alliance on Mental Illness Maryland. "Long waits for treatment can increase the severity of mental illness and consequently the intensity and costs of the services being provided."
The researchers spent six months calling every provider. They found 57 percent couldn't be reached because phone numbers were disconnected or they no longer practiced at a certain facility. Nineteen percent on the list said they were not psychiatrists.
Five insurers sell plans on the exchange.
CareFirst BlueCross BlueShield, the dominant insurer on the exchange, said in a statement that it does its best to maintain updated doctor lists. The insurer said it provides updates every two weeks to the health exchange and the entity that coordinates the state's electronic medical records system.
"We work on many fronts to keep contact information up-to-date for psychiatrists and all other health care providers in our networks," the insurer said in the statement.
Insurers also say that it can be hard to keep up with constant changes at doctors' practices. Doctors move out of state, die, retire or sell their practices all the time, they say.
Surveys of psychiatrists show that about 50 percent of them don't accept insurance because of the bureaucracy and red tape, and, some say, inadequate payments. There is also a general shortage of psychiatrists, one of the lower-paying specialties in the medical profession.
The head of the Maryland exchange said adequate access to psychiatric care was a problem long before health care reform. Now officials have better data to work on improvements, said Carolyn Quattrocki, the exchange's executive director.
The exchange recently implemented a way for insurers to make corrections to the list of available doctors, Quattrocki said.
But the study by the Mental Health Association of Maryland found that insurers were not always updating their Internet directories every 15 days, as required by state law. Lists went unchanged for two of the health plans for six months last year.
Researchers recommended that insurers on the exchange regularly audit their lists and make the results public. They also called on insurers and the state to publicize a state law that allows patients who can't get care within their network to seek out-of-network care at a reduced cost.
Doctors and others in the health field say that psychiatry is not the only specialty where consumers are having problems getting appointments, citing primary care and dermatology.
The Partnership to Fight Chronic Disease, a coalition of health policy experts and community, business and labor groups, and the state's medical society MedChi plan to hold a briefing Tuesday on what they argue are other needed improvements to the state exchange revealed by data from a public opinion poll. An inaccurate directory was among the findings, said Gene Ransom, head of MedChi.
"It is really nice to give someone an insurance card and say you have insurance, but you need to have access to a real physician, or if it's mental health, a psychiatrist," Ransom said.
He added that there aren't enough checks and balances to make sure provider lists are accurate.
Dr. Steve Daviss, a Baltimore psychiatrist and member of the Maryland Psychiatric Society, said the Affordable Care Act and recent parity laws have made access to mental health care better in some ways. Before those changes, some patients couldn't get coverage at all, or coverage was limited to a small number of visits.
He said psychiatrists have used telemedicine to try to provide services to more people and primary care physicians have taken on some mental health work.