Decline in Psychiatrists Billing Medicare Part B Sparks Mental Health Access Concerns

Despite an increase in the number of active psychiatrists nationwide, the proportion billing Medicare Part B declined, raising concerns about mental health care access for enrollees.1

The researchers of the JAMA Network Open study highlighted that many older adults and individuals with disabilities enrolled in Medicare have mental health and substance use disorders. However, less than 60% of office-based psychiatrists accept any insurance, let alone government-sponsored insurance like Medicare. Despite 13 consecutive years of growth in medical school graduates matching into psychiatry, little research has examined how many choose to serve Medicare enrollees.

Consequently, the researchers evaluated how the number of psychiatrists providing professional services to adults on Medicare Part B has changed from 2014 to 2022; Medicare Part B covers fees for services across the mental health care spectrum. The study examined nationwide trends and variations by state and geographic region. It also focused on growth rates among active psychiatrists, traditional Medicare enrollees, and the ratio of psychiatrists to Medicare enrollees.

Despite an overall increase in active psychiatrists, the number of those billing Medicare Part B decreased nationwide from 2014 to 2022. | Image Credit: N Lawrenson/peopleimages.com - stock.adobe.com

The number of psychiatrists accepting Medicare was determined using the CMS Medicare Physician & Other Practitioners dataset files, which included all clinicians who submitted over 10 Medicare Part B claims in a year.2 The researchers selected eligible physicians from this dataset based on their specialty and medical degree.1 Also, they compared the number of psychiatrists submitting claims to traditional Medicare Part B with the number of enrollees, using national and state-level data from the Medicare Monthly Enrollment database and the Kaiser Family Foundation, respectively.

To assess trends, the researchers calculated the number of psychiatrists per 100,000 Medicare enrollees by state and region, determining the compound annual growth rate (CAGR) from 2014 to 2022. Additionally, they assessed the proportion of active psychiatrists submitting claims to Medicare Part B at national, regional, and state levels.

The study population consisted of all traditional Medicare Part B enrollees nationwide, with 33,042,936 person-years in 2014 and 29,544,994 person-years in 2022. It also comprised 50,416 professionally active psychiatrists in 2014 and 56,492 in 2022.

Traditional Medicare Part B enrollment declined by 10.6% over the study period. Enrollment changes varied by region, decreasing by 15.2% in the Midwest (loss of 1,153,529 enrollee-years), 13.3% in the South (loss of 1,751,908 enrollee-years), and 12.0% in the Northeast (loss of 731,943 enrollee-years). Conversely, it increased by 2.2% in the West (gain of 138,628 enrollee-years).

Despite the 12.1% increase in the absolute number of active psychiatrists nationwide, those submitting over 10 claims to Medicare Part B decreased by 16.8% (n = 3772). Similarly, the nationwide proportion of professionally active psychiatrists submitting claims to Medicare Part B for professional services declined from 44.4% in 2014 to 33.0% in 2022. By region, the absolute number of psychiatrists submitting professional services claims to Medicare Part B during this period decreased by 19.1% in the Northeast, 18.8% in the Midwest, 15.7% in the South, and 12.7% in the West.

The highest numbers of traditional Medicare Part B–serving psychiatrists per 100,000 Medicare enrollees during 2022 were in Rhode Island, the District of Columbia, and Connecticut at 174.7, 163.7, and 126.9 psychiatrists per 100,000 enrollees, respectively. Conversely, the lowest numbers were in Wyoming, Mississippi, and Montana at 13.8, 22.1, and 27.4 Medicare Part B–serving psychiatrists per 100,000 Medicare enrollees, respectively.

The state with the greatest decrease in per-enrollee psychiatrists was Wyoming, with a reduction of 67.8% (from 42.9 to 13.8 active psychiatrists per 100,000 enrollees; CAGR, –13.2%). Conversely, the state with the largest increase was Alabama, with a 31.7% growth in per-enrollee psychiatrists (from 36.5 to 48.1 active psychiatrists per 100,000 enrollees; CAGR, 3.5%). Despite state-specific increases in the absolute number of psychiatrists, every state and federal district saw a decline in the percentage of active psychiatrists billing Medicare Part B for professional services.

The researchers acknowledged their study’s limitations, including the limit to traditional fee-for-service Medicare data since it was freely and publicly available. Also, the study did not address the rise of telepsychiatry during the COVID-19 pandemic lockdown, which may have distorted the data during this time. However, the researchers expressed confidence in their findings and suggested areas for further research.

“…the results of this study suggest a potential decline in access to psychiatrist-led care among many individuals with mental and physical disabilities and older adults nationwide,” the authors concluded. “The causes of these findings and their implications on mental health care access and equity merit further research.”

References

1. Havlik JL, Wahid S, Priest KC, Ososanya L, Igunbor M, Humphreys K. Trends in psychiatrist-led care for Medicare Part B enrollees. JAMA Netw Open. 2025;8(2):e2458160. doi:10.1001/jamanetworkopen.2024.58160
2. Medicare physician & other practitioners - by provider and service. CMS. Updated 2022. Accessed February 10, 2025. https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service