Shirah Vollmer MD

The Musings of Dr. Vollmer

Measuring Depression

Posted by Dr. Vollmer on June 6, 2016


Valued based care: more language to describe the changing health care delivery system. Doctors are not going to be paid per visit, but rather per clinical improvement obtained. In the primary care world that means the more patients who have controlled Diabetes, the more money the doctor will see. In the mental health world, that means that the lower the patient’s score of the PHQ-9, the more money the doctor makes. The doctor now has a huge incentive to encourage the patient to tilt the score positive, thereby diminishing the trust of a deep relationship which allows for patients to be honest about how they are feeling, whatever that may be. Once again, I am taken back to my training, where the value was in acceptance and tolerance of deep and difficult feelings, as opposed to the antithetical notion in which we encourage a more shallow approach to patient care. The need for measurement in primary care makes sense; numbers tell the story. Yet, in mental health, there should be no numbers, no quantifiable approach to disease or disease management. Mental health is the acceptance of many layers of feelings which float around in a stew in which the dominant flavor keeps changing, as we are sentient beings. This is obvious on one level, but in the health care world, this obvious point is lost. Sad, sad, sad.

2 Responses to “Measuring Depression”

  1. Shelly said

    Shirah, is it the insurance companies who will be paying based on the clinical improvement scores? Does it start with the baseline score set by the psychiatrist and then they measure the improvement by how the patient scores himself on the PHQ-9? Is the PHQ-9 completed with patients on or off medication? After how many sessions with the psychiatrist? Do you get to see the PHQ-9s or are they confidential?

    • As usual, Shelly, those are all very good questions. Yes, the insurance companies, including Medicare will pay based on “value” which means improvement of scores. The patient fills out the PHQ-9 and the medical assistant does the scoring. Yes, it is done on and off medication. I believe they will do the PHQ-9 at every visit. They are confidential health information, and as such, people on the treatment team have access to the records. A new world. Thanks, as always.

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