Hi colleagues,
I received the Summit Task Force’s Final Report today, courtesy of Dr. Bray, who tell me this was approved by APA Council yesterday.
The report is in pdf format here.
I would be interested in any comments and ongoing discussion about the report and, more importantly, action. What’s next?
Reimbursement For Psychologists’ Services:
Trends, Impact on Access to Psychologists, and Solutions
Gordon I. Herz, PhD
Madison, WI
May 2009
Efforts to fully integrate psychological services into the broader health care system will fail unless the problem of fair compensation for such services is solved. Reimbursement for psychologists’ services under managed care has been declining in real dollars for at least the past 20 years. The financial viability of the independent practice of psychology has been devastated by this trend. Consumer access to psychologists in managed reimbursement environments continues to worsen, with declining numbers of contracted psychologists, and false claims by managed care about the numbers who remain. A for-profit, managed reimbursement financing system is fundamentally incompatible with the independent practice of psychology and unfettered access by the public to doctoral level psychological services. Organized psychology must acknowledge the damage caused to the provision of psychological health services by for-profit reimbursement schemes, utterly reject such an approach in any reformed system, and develop and implement a comprehensive set of actions to usher in a new health care delivery, financing and reimbursement system. Reimbursement trends and resulting limitations in the public’s access to psychologists are documented, and recommendations for roles, strategies and actions for our professional organizations are provided.
Read the complete paper here.
The paper is available here in pdf format.
When redistributing this paper please reproduce it in its entirety and provide citation.
I welcome all comments, input, and suggestions about the paper. Please add your comments below.
I spoke on a panel this weekend with Drs. Frank Goldberg and Barbara Fontana, members of the “Crisis in Psychotherapy Practice” group, at the New York State Psychological Association Annual Convention. The topic of my talk was “Reimbursement for Psychologists’ Services: Trends, Impact on Access, and Solutions.”
“What is a Practicing Psychologist” is being provided to the Summit’s invited guests.
WHAT IS A PRACTICING PSYCHOLOGIST?
Summary
A practicing psychologist is a doctorally-trained professional with the knowledge and skills to foster and sustain change in individuals, couples, families, organizations, and communities. A psychologist has expertise in human health, development, performance, problems, and most importantly, human behavior. This expertise is based on a large body of scientific evidence about individual behavior and systems change in the context of gender, age, race/ethnicity and culture.
Today, practicing psychologists work with other health care providers to design and deliver integrated care to provide comprehensive care for children, teens and adults across the life span. Psychologists are committed to improving access, quality, and value in healthcare; and promoting healthy lifestyles in the context of healthy relationships, workplaces, and communities.
We are committed to extending psychological science and service to improve the health and well being of the nation – we look forward to your ideas on how to move toward a future where psychological services better serve your needs.
WHAT IS A PRACTICING PSYCHOLOGIST?
A practicing psychologist is a doctorally-trained professional with the knowledge and skills to foster and sustain change in individuals, couples, families, organizations, and communities A psychologist has expertise in health, development, performance, problems, and most importantly, human behavior. This expertise is based on an extensive body of scientific evidence about individual behavior and systems change in the context of gender, age, race/ethnicity and culture.
Practicing psychologists have been associated with science and service since the beginnings of the profession. Lightner Witmer, who formed the first psychological clinic in 1896, highlighted the importance of evidence-based practice:
“The pure and the applied sciences advance in a single front. What retards the progress of one retards the progress of the other; what fosters one fosters the other.”
The expectation that professional psychologists be trained as both scientists and practitioners was adopted as policy by the American Psychological Association (APA) in 1947. Successive decades brought advances in services. Psychologists dramatically expanded their professional roles in response to the tremendous unmet mental health needs among WWII veterans. The 1960s saw many psychologists working in leadership roles to further the community mental health center movement, which ended the era of isolated mental hospitals and offered localized multidimensional care.
Today, community health centers offer similar opportunities for psychologists to work with other health care providers to design and deliver population-based, integrated care. The Freedom of Choice Act in the 1980s offered the public equal access to psychologsts and physicians for private sector mental health care. In this first decade of the 21st century, the parity of mental health and physical health has finally been recognized by Congress, thus paving the way for true integrated health care and improved access to services. During this same period, psychologists took on key internal and external consulting roles in leadership and talent management and in addressing the challenges of rapid organization change in the new global marketplace.
Psychology practice evolved in innovative ways that continue today in a range of public and private settings such as health centers and hospitals, schools, corporations, governmental agencies, the military, universities, and community organizations. Depending on their context, psychologists may:
Now, amidst harsh economic realities and urgent social need, we join together with other professionals to support healthcare reform that provides comprehensive care for all children, teens and adults across the life span. Psychologists are committed to improving access, quality, and value in healthcare; and to promoting healthy lifestyles and advantageous social conditions in the context of healthy relationships, workplaces, and communities.
Consistent with recommendations from the Institute of Medicine (2001, 2004), we wish to collaborate with other disciplines in the interdisciplinary training of health professionals across specialties to ensure a work-force with the competencies to deliver high quality, comprehensive, integrated care. We wish to build partnerships to apply effective public health models that will reduce the burden of health, mental health and social concerns that negatively affect well being, healthcare utilization, and costs. We wish to work with businesses and corporations to enhance the health, well-being, and productivity of their employees.
Finally, we wish to lead and collaborate in the ongoing research and evaluation of outcomes in health care reform to ensure quality; effectiveness; safety; adherence; gender, cultural and geographic relevance; as well as improved patient health and satisfaction at reduced costs. We are committed to extending psychological science and service to improve the health and well being of the nation.
The Task Force sees necessary activities reaching in two directions: INTO APA/PO and TOWARD members to build cohesion and ability to act with a more unified and effective voice, and OUTWARD toward the public.
In the INTERNAL direction we heard last night, for example, about the “peer review” law for psychologists in New Jersey which limits the amount of information they are required to give to managed care and insurance companies, and about a law in Maryland which requires insurers to pay for out-of-network (mental health and other) care when a subscriber cannot obtain services without unreasonable delay or travel. While these are specific legislative successes, the larger point is that the individual psychologist-in-the-field, even though very linked in, may not know about what is happening in different states. APA/PO must develop effective methods to collect such events and disseminate the information systematically, and support replication in other states.
In terms of the outward perspective, we want the APA/PO to be allying with key other groups including other mental health and health professionals, and with consumer groups. Linking with other professionals will help work toward mutual agendas of increasing reimbursement and health care dollars. Linking with consumer groups will help give grass roots voice to lack of access to psychologists and mental health care.
The following references have been provided to delegates as reading materials to prepare for the Summit.
New health care system could use psychology to provide better health care. Orszag stated “human behavior has been left out of models for years” in “health care, economics, medical science”. Says he was mis-trained as pure economist and wished he knew more about human behavior. Orszag said “psychology matters”.
http://www.npr.org/templates/story/story.php?storyId=102723682
Read about Integrated Health Care
Two-Thirds Of Primary Care Physicians Can’t Get Mental Health Services For Patients
Shortages Of Mental Health Providers, Health Plan Barriers, And Lack Of Or Inadequate Coverage Cited As Roadblocks To Mental Health Care Bethesda, MD — About two-thirds of U.S. primary care physicians reported in 2004-05 that they couldn’t get outpatient mental health services for their patients — a rate that was at least twice as high as for other services, according to a national study funded by the Commonwealth Fund published today as a Web Exclusive in the journal Health Affairs.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.3.w490
Lowman, R.L. (1998). Consulting to organizations as if the individual mattered. Consulting Psychology Journal: Practice and Research, 50, 17-24.
David Peterson’s chapter called “Management development: Coaching and mentoring programs” p. 160-191 In Kraiger, K. (Ed.). (2002). Creating, implementing and managing effective training and development. San Francisco: Jossey-Bass.
The Practice Summit Agenda is available now. You may view it here: Summit Agenda.
Since this blog began 1/21/09, we have had 4 new members, including one of your Division 42 Summit Delegates (Dr. Ed Wise of Memphis, TN).
New members recognized by your host will be given “Author” level access, which means you are able to create, manage and publish your own posts, i.e., start new topics and lines of conversation in addition to commenting on other topics already begun.
If you do not appear to have that level of access, send an email to Gordon@DrHerz.us and let me know. We have to do a bit of monitoring to prevent spam.
In the mean time, please see Dr. Wise’s question entitled “Top Problems?”.