Federal dollars should be used to screen Medicare beneficiaries for depression and for alcohol misuse under two rules proposed by the Centers for Medicare & Medicaid Services.
CMS cited findings by the U.S. Preventive Services Task Force that there is enough evidence that screening for alcohol misuse and depression are "reasonable and necessary for the prevention of early illness or disability."
The alcohol screening coverage would extend to four face-to-face, behavioral counseling interventions per year for beneficiaries:
- who misuse alcohol but whose levels or patterns of consumption do not meet criteria for impairment, who have a preoccupation with acquisition and/or use, a persistent desire to quit with unsuccessful efforts, or who sustain social, occupational or recreational disability.
- who are competent and alert at the time that counseling is provided
- whose counseling is counseling is furnished by qualified primary care physicians and other primary care practitioners in a primary care setting.
Under the other proposed rule, depression screening would be covered for Medicare beneficiaries in primary care settings. CMS points out that "Among persons older than 65 years, one in six suffers from depression," and the condition is higher in those with co-morbidities including cancer, arthritis, stroke, chronic lung disease and cardiovascular disease, and when stressful events are more frequent.
The decision to propose coverage for depression screening is designed to identify depressed patients in primary care settings to assure accurate diagnoses, effective treatment, and follow-up.
The agency pointed to studies which have found that "the economic burden of depression is substantial and [it is] estimated that the combined U.S. direct and indirect costs of depression were $83.1 billion, including $31.5 billion in direct costs and the remainder in indirect, mostly workplace costs.
Nearly 300 comments posted on the Medicare website indicated support of coverage for alcohol screening.
"We believe that screening tests and questionnaires, education, and motivational interviewing should be included in this covered benefit," wrote Mollie Brooks of the Medicare Strategy Unit of the Mayo Clinic.
"Frequency of coverage should include an annual screening for all patients, and more frequent screening such as once every three months for those individuals at risk or those who display features that are alarming such as alcohol abuse. We believe that coverage rules should apply to several members of the medical team treating the patient to include registered nurses for obtaining questionnaires, mid level providers for education and follow-up, and coverage for MDs providing motivational interviewing and medical interventions."
But Cori Robin, a clinical social worker at Rush University Medical Center, said this rule should not just reimburse primary care providers, but social workers and psychologists as well, who are providing alcohol screening services at Rush "without compensation. Social workers and psychologists are also in a unique position to provide this screening in that they collaborate on a regular basis with client's primary care and specialty doctors for the purpose of continuity of care."
"As is the case with many other professionals, if this funding is not provided for social workers and psychologists, it will become increasingly difficult to provide these much-needed services."
At this writing the two dozen or so comments posted on depression screening were largely favorable as well, including this one from Avani Shah: "Not only can the combination of systematic strategies for depression recognition in primary care and treatment improve care, but it can also lead to a reduction of medical cost."
And this one from David L. Shern, president/CEO of Mental Health America: "Depression screening is easy and inexpensive. With brief clinical oversight, false positives can be easily eliminated. Effectively recognizing and treating depression will help ensure quality of life and may help to reduce overall medical expenditures."
However, Sara Qualls, director of the Gerontology Center at the University of Colorado in Colorado Springs, suggested that CMS's proposal may not go far enough.
"Depression screening should be done as part of every physical evaluation, and at times of change in health status as well as in prevention/wellness planning evaluations," she wrote. "Depression screening is the gateway to evaluation and treatment that benefits health directly as well as having indirect impact on health behaviors that predict onset and management of chronic conditions."
The American Hospital Association supports both rules as well:
"Prevention of illness or disability only occurs when beneficiaries receive an accurate diagnosis, effective treatment and appropriate follow-up," the AHA wrote in a daily news brief last week.
"Evidence supports improved health outcomes for beneficiaries when they receive screening and behavioral counseling to reduce alcohol misuse. We also agree that screening for depression in adults is reasonable and necessary for the prevention or early detection of illness or disability, and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B," the AHA wrote.
Both rules are currently in a comment period, which expires Aug. 18.