Objective: This presentation will review aspects of the current state of Medicare and its influence on psychogeriatric treatment, both specifically and as a part of the general medical care system.
Design: A review of relevant Medicare policy and regulation, and the social and political forces influencing psychogeriatric care.
Results: In the United States, health care availability and accessability for the elderly is largely determined by the policies and administration of the Medicare system. Psychogeriatric treatment is especially influenced by these regulations, including some which are almost 40 years old. The recent, current and ongoing changes in the Medicare system likewise affect provision of service, both by influencing the influx and egress of practitioners to the field, and by their impact on the nature and types of services which can be made available to patients and to their caregivers. Regulations also shape training programs in psychogeriatrics. Mechanisms by which this occurs include reimbursement policies, payment regulations and amounts, record keeping and documentation requirements, limits on types and amount of services permitted, the conflicting motivations of service providers and fiscal intermediaries, and governmental policing efforts to prevent fraud and abuse. The expanding scientific knowledge base and health care services research, future demographics of aging, agist and anti-psychiatric biases, efforts at destigmatization, and multiple domestic political factors, are also components in this complex equation.
A recent payment crisis mobilized physicians to exert political pressure to deal transiently with a defect in the reimbursement calculations, but problems persist in the current system. Projected fiscal needs to provide medical care for the “Baby Boom” generation have not yet being adequately addressed, and the extent to which future psychogeriatric issues will be considered as part of this may depend upon current policies. Possible near future and projected changes and their potential impact will also be discussed.
Conclusion: The availability and quality of future psychogeriatric care will be dependent on current and possible future policy and regulatory changes.
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