The importance of time in treating mental health in primary care.

TLDR: Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting, and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home.

Abstract: P care plays a critical role in treating mental health conditions, but caring for patients with comorbid mental health and medical conditions increases visit length. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate mental health into primary care. Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting, and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home. Primary care delivers more mental health care than any other health care setting (Regier, Narrow, Rac, Manderscheid, Locke, & Goodwin, 1993). Mental health and physical health conditions are inseparable, yet our health care system treats them as if they should be treated separately (deGruy, 1996; Regier et al., 1993). The existence of depression or another mental health condition with a physical health condition in patients increases the complexity of treatment and costs, often with poor outcomes (Ani, Bazargan, Hindman, Bell, Rodriguez, & Baker, 2009; Lurie, Manheim, & Dunlop, 2009; Moussavi, Chatterji, Verdes, Tandon, Patel, & Ustun, 2007). The current health care business model rewards volume of services. The fee-forservice payment system incentivizes physicians to increase numbers of services as quickly as possible, inherently decreasing incentives for treating complex, time consuming patients. Median primary care visits are 15.7 min covering a median of six topics (Tai-Seale, McGuire, & Zhang, 2007). In primary care, typical mental health discussions last 2 min (Tai-Seale, McGuire, Colenda, Rosen, & Cook, 2007; Fig. 1). According to the National Ambulatory Medical Care Survey (NAMCS), primary care providers spend significantly more time with patients who have recognized Benjamin F. Miller, PsyD, Department of Family Medicine, University of Colorado Denver, School of Medicine; Bridget Teevan, MS, Robert L. Phillips, Jr., MD, MSPH, Stephen M. Petterson, PhD, and Andrew W. Bazemore, MD, MPH, The Robert Graham Center. Correspondence concerning this article should be addressed to Benjamin F. Miller, PsyD, Department of Family Medicine, University of Colorado Denver, School of Medicine, Academic Office 1, Mail Stop F496, 12631 East 17th Avenue, Aurora, CO 80045. E-mail: Benjamin.miller@ucdenver.edu Families, Systems, & Health © 2011 American Psychological Association 2011, Vol. 29, No. 2, 144–145 1091-7527/11/$12.00 DOI: 10.1037/a0023993