Practice Directorate Letter
Russ Newman
(The following is a reprint of the letter Russ Newman sent earlier this year to all members who pay the practice assessment. We believe it deserved to be run again as it reflects some of the most vital issue confronting our practices currently. Comments can be sent to Russ at rnewman@apa.com. Eds)
Dear Colleague,
In my annual letter to practicing psychologists last summer, I spoke of challenges and opportunities that continue to face our profession in a healthcare system badly in need of reform. During the last year I have heard from many of you concerning these issues, particularly about your experiences with those obstacles that make the delivery of psychological services difficult - impediments to access, payers putting profits ahead of patients, reduced reimbursements, and regulatory requirements that complicate practice. I also hear increasingly from early career psychologists who feel ill-equipped to negotiate the maze of business-related issues they are forced to confront in managing a practice.
Without question, these obstacles are the APA Practice Organization’s top priorities. We continue working to remove barriers to accessing psychological services and to increase fecognitioa of the value of what practitioners do. Importantly, as I described in last year’s letter, we are taking steps that better position our profession to take advantage of significant developments in healthcare. As APA Executive Director for Professional Practice, I am writing to update you on our key activities and some important emerging trends.
Perhaps as a sign of the times, the Practice Directorate continues to wage battle against further cuts in healthcare spending and to prevent the elimination of existing protections for mental health services in both the public and private sectors. Fortunately, psychology’s grassroots advocacy network has been quite effective. At the end of 2005, thousands of you contacted your members of Congress in opposition to the 4.4 percent cut in Medicare reimbursement fates scheduled for 2006. The result of this and related advocacy activities was a provision in the Budget Reconciliation Act that eliminated the rate cut. Also, the Practice Organization worked successfully to assure that the Budget Reconciliation Act did not weaken or eliminate Medicaid’s Early and Periodic Screening and Diagnostic Treatment (EPSDT) services for low-income children.
In May, psychology’s membership-based grassroots advocacy network again proved itself to be a powerful force. With teas of thousands of practitioners letting their Senators know what they thought of the Health Insurance Marketplace Modernization Act, or HIMMA, this ill-conceived health insurance deregulation bill was stopped in Congress. Had it been enacted, HIMMA would have eliminated 30 years of state-level protections for mental health and other healthcare services. The Practice Directorate’s online Legislative Action Center generated more than 18,000 e-mail messages from concerned psychologists to their elected officials. In addition, APA Practice Organization Government Relations staff chaired the Stop MMMA Coalition, a collaborative effort involving 224 healthcare and patient advocacy organizations, which generated considerable media coverage and intense public pressure to defeat the legislation.
The Practice Organization’s collaborative work with other organizations remains key to successful advocacy on behalf of practitioners. This spring, we joined forces with 25 non-physician organizations, including nursing, pharmacy, speech-language and hearing, physical therapy and chiropractic, for a unified response to the American Medical Association’s (AMA) “Scope of Practice Partnership” initiative that opposes scope of practice expansion by non-physician health providers. The AMA wrote recently in a membership renewal letter: ‘The AMA strongly believes that the expansion of prescribing rights to psychologists is a serious safety problem. Through the Scope of Practice Partnership, the AMA is involved in legislative advocacy efforts, research and education programs that oppose scope of practice expansions.” Our coalition of non-physician organizations, called the Coalition for Patients’ Rights, launched its effort in June with a press briefing to more than 20 media outlets, publicly calling on the AMA to cease its divisive effort to limit patients’ choice of providers.
This coalition of groups - many of which have successfully pursued prescriptive authority - also has the potential to be a valuable addition to our work to secure prescriptive authority for psychologists. While a third state law to join New Mexico’s and Louisiana’s did not occur in this past legislative cycle, a number of states continued to move forward and closer to their goal of passing a law. Without question, this is a legislative agenda for psychology that requires persistence, patience and solid step-by-step advocacy work. In this regard, Louisiana built on its past success by passing a law to assure that those psychologists certified by their state to prescribe can do so in the state mental health system.
In the federal regulatory arena as well, change typically does not happen quickly or easily. After nearly a dozen years of continuous effort, the APA Practice Organization succeeded in persuading Medicare that psychological and neuropsychological testing should include a “”professional work value” when reimbursement rates are calculated. The result is increased 2006 reimbursement rates for testing services that may be as much as 122 percent higher, depending on the specific service and the geographic area. Medicare carriers around the country have been increasingly incorporating the new codes necessary to receive the higher reimbursement, although some implementation problems remain, particularly in the Midwest. The Practice Directorate recently met with officials at the Centers for Medicare and Medicaid Services (CMS) and secured their assurance that CMS will issue clear, written direction to carriers to accomplish full implementation of the new codes.
Other key APA Practice Organization activities since last summer include working on numerous fronts: preserving confidentiality in the wake of expanding electronic health information systems; holding managed care companies accountable for egregious actions that put profits ahead of patient care; achieving fall parity for mental health coverage at both the state and federal levels and in both the private market and public sectors; protecting psychology’s autonomy in hospitals; and defeating recurring challenges to the profession’s doctoral-level licensing standard. As in 2005, the Practice Organization has provided nearly $750,000 this year in direct support to the state, provincial and territorial associations (SPTAs) to deal with these types of issues. We also continue to provide ongoing staff support and consultation to the SPTAs and the APA practice divisions.
In addition to confronting specific obstacles to the delivery of psychological services, it is critical to work to position psychology for a strong future. As I indicated in my letter last summer, we in the Practice Directorate, where the APA Practice Organization is housed, see significant opportunity for our profession as a result of the growing recognition in this country that health and behavior are linked. The public attention to the intersection of psychological and physical health has continued to grow over the past year. The Practice Directorate and the Committee for the Advancement of Professional Practice (CAPP) have been working to expand an agenda that promotes psychology’s expertise in the more comprehensive health arena where behavior plays a pivotal role, well beyond mental health alone. Our work to create and implement the health and behavior Current Procedural Terminology (CPT) codes - which enable psychologists to claim reimbursement for services to individuals with physical health diagnoses - was a step toward that expansion. Similarly, we have developed demonstration projects that integrate psychological services into primary care to underscore psychology’s value where health and behavior are concerned. And we are beginning discussions with at least one major insurance company about how to maximize the use and value of psychologists in a healthcare delivery system that better integrates behavioral healthcare with primary care. The latest iteration of the APA public education campaign intended to help position psychologists effectively in a healthcare system that recognizes the link between behavior and health is now well under way.
The campaign, entitled, “Mind-Body Health: For a Healthy Mind and Body, Talk to a Psychologist,” provides an umbrella for a broad educational effort - including psychology’s science base for our work in physical and mental health, wellness, resilience, prevention, disease management, and even the psychologically healthy workplace- The specific focus of the campaign is on psychology’s unique and central role at the intersection of psychological and physical health. Earlier this year, as part of the campaign, we released the results of a survey looking at the effects of stress an mind-body health, done in partnership with the National Women’s Health Resource Center and iVillage.com, The survey results, along with the campaign’s mind-body health message, became the focus of a segment on Good Morning America, a USA Today article, and local radio sad print coverage around the country.
Also in our efforts to educate the public about psychology, the Practice Directorate debuted its first annual national Psychologically Healthy Workplace Awards (PHWA) in addition to continuing to provide company “Best Practices” Honors. The PHWA program recognizes organizations that make a commitment to programs and policies that foster employee health and well-being while simultaneously enhancing organizational performance. Central to many of these programs and practices are the very connections between lifestyle, behavior and health described in our Mind-Body Health campaign, When incorporated into the workplace, programs relying on these connections produce organizational as well as individual benefits.
The PHWA program is enabling employers to better understand and appreciate the connection between behavior, health and productivity, the value of psychology, and the benefits of providing their employees with access to adequate mental health services.
While no organized comprehensive healthcare reform plan has yet to appear on the horizon, policy makers and third-party payers are increasingly seeing the potential to use the strong connections between lifestyle, behavior and health to improve, if not fix, the country’s broken healthcare system. To state the obvious, good health is all about behavior - everyday behaviors that can be learned. If improving health has the potential to solve many of the problems in our current healthcare system, and behaviors can improve health, it is not such a stretch to say that healthcare reform, then, is really all about behavior reform. While we, as psychologists, may see the logic of this, we must continue our work to assure that the public, policy makers and third-party payers see this as well.
One trend that is gaining strength in the healthcare marketplace is the movement toward consumer driven healthcare. Proponents of consumer-driven healthcare see developments in this area as a way to bring the power of informed consumer decision-snaking to healthcare in order to remedy the distorted purchasing decisions and uncontrollable inflation occurring in a healthcare system where someone other than the patient is paying the bill. Consumer-driven healthcare is thought to be a way of replacing managed care’s efforts to limit the “supply side” of healthcare with a set of incentives that influence demand for services. The health savings accounts to which employers and employees contribute, combined with a high-deductible insurance plan, are but one incentive-based tool to affect consumer demand, choice and decision-making, although it is the version of consumer-driven healthcare most frequently seen today.
Whether consumer-driven healthcare can have a positive impact on the healthcare system, and whether it can ‘’mature’’ beyond the limited health savings account version being utilized today, is yet to be determined. But what is clear already is that strong forces are converging that will likely propel the continuing adoption of consumer-driven healthcare efforts for some time to come. A clear realization of a broken healthcare system, the baby boomers demand for consumer empowerment, and employers desperately wanting a shift in their responsibility for employee healthcare are all contributing to the growth of consumer-driven healthcare. Add to this the fact that those who oppose increased government control as a way to solve the healthcare system’s woes view consumer-driven healthcare as their last opportunity to stave off such a solution, and the stage is set for a development in healthcare with which our profession will definitely have to contend. Of particular note, though, are the potential important roles that lifestyle, behavior, health promotion, prevention and disease management will play in a system that incorporates consumer-driven healthcare and which attempts to incent those behaviors contributing to good health.
Whether consumer-driven healthcare materializes or not, the healthcare system is likely to remain in flux for the foreseeable future, That future will require both persistence and resilience in the face of obstacles that make practicing psychology a challenge. It will also require specific skills to help navigate the maze of business, practice management and regulatory requirements that can all too often make it difficult to practice.
To that end, the Practice Organization is pleased to announce ongoing development of the Center for Professional Development, a defined space on our Web portal, APApractice.org, dedicated to providing practical tools and information to help practitioners start, manage, market and grow their practices. We anticipate that the Center will provide high quality, reliable resources for psychologists seeking continuing education in practice management and development, and in the many aspects of financial management and business that are required for successful practice in today’s healthcare marketplace. The Center will also include online continuing education offerings related to evidence-based practice. This will enable practitioners to effectively deal with the concept of evidence-based practice as it is increasingly used by third-party payers and to keep abreast of the latest clinical developments in such areas as depression, anxiety, obesity and disease management, Importantly, I want to say how very grateful we are to you and the other members who support the MA Practice Organization’s work by paying the Practice Assessment. We particularly appreciate your continuing support this past year as we implemented changes to the Practice Assessment to assure that our resources are able to keep pace with inflation. We also appreciate the many other ways that members like you support the profession, such as participating in grassroots legislative and public education campaign activities.
CAPP and the Practice Directorate are committed to working to eliminate those obstacles that make practicing psychology less gratifying than it used to be, and to eliminating those barriers that prevent people in need of psychological services from getting the services they need. We are equally committed to working to diversify the practice of psychology well beyond mental health, and even beyond health, to more clearly establish us as experts in behavior who offer unique and effective problem-solving skills wherever behavioral problems are found. We know that it will not be easy, but we continue to be optimistic that by working strategically and by working together as a united community, we can maximize the power of the practice community to assure a vibrant future built on our profession’s rich past.
For additional information about our activities, practitioner tools and services, log on to APApracrice.org, the portal for licensed psychologists who pay the Practice Assessment.
