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Archive for the ‘Action’ Category

NYSPA Crisis in Psychotherapy Task Force Statement

Wednesday, May 13th, 2009

May 13, 2009

To: APA Practice Summit Delegates

From: the Crisis in Psychotherapy Practice Task Force of the NYS Psychological Association

The Crisis in Psychotherapy Practice Task Force (CPP) was formed in 2007 by Dr. Dianne Polowczyk while she was NYSPA President.   Members of the Task Force are: Drs. George Northrup, Beverly Lawson, Jerry Grodin, Jamie Shiffner, Sharon Brennan and Dianne Polowczyk; Drs. Frank Goldberg and Barbara Fontana are co-chairs.

Many psychologists both in New York and across the country are in independent private practice providing psychotherapy services and want to continue to do so.  Yet many of our colleagues are struggling to earn enough money to support their families and early career psychologists have the additional burden of student loan debt. We are all aware of the stagnant reimbursement rates over the last twenty-plus years and the increase in master degree level practitioners who also provide psychotherapy services. We believe psychologists are the best trained mental health professionals; consumers want and need our services but it becoming increasingly difficult for them to access care by a psychologist.

We support the vision of Dr. James Bray and others to expand the practice of psychology into other areas such as integrated care and prescription privileges.  But we also think APA must make a heroic effort on behalf of the vast majority of psychologists, young and old, who pay the Practice Assessment and provide psychotherapy.

We have summarized below some of our concerns and recommendations.

  • We value the Practice Organization’s efforts to fight cuts in Medicare rates and have psychologists designated with equivalent status to physicians within Medicare. But, in our opinion, the compelling issues of psychologists in private psychotherapy practices are not being addressed at the level necessary to preserve our profession.
  • While we know that psychotherapy often helps people live happier and more functional lives, medication rather than psychotherapy is being used more frequently to alleviate mental health problems.
  • Many students enter doctoral programs in psychology because they want to provide psychotherapy. If graduates can’t earn a living in psychotherapy practice, admissions to these programs will eventually drop because of supply and demand.  This will affect our academic colleagues.
  • Data we have collected indicate that both NYSPA and Division 42 members overwhelmingly chose fair reimbursement as the number one priority for APAPO in health care reform. In a NYSPA survey this year, 75.9% of the 673 respondents chose “reasonable compensation for psychotherapy in private practice” as the top priority for APA to address during health care reform discussions.  In a Division 42 survey 71% chose compensation as the top priority and in a Tennessee Psychological Association survey 47% of 58 respondents also chose compensation as the top priority. (NYSPA survey results are attached)
  • In the same NYSPA survey psychologists were divided on the statement: “APA is making good use of the practice assessment that private practitioners pay in addition to regular dues.” Of 684 respondents, 30.2% disagreed or strongly disagree; 21.7% agreed or strongly agreed; 24.7% neutral; 23.7% no opinion.
  • A number of psychologists in private psychotherapy practice resigned from APA because they felt abandoned by APA and the PO; many others withheld the practice assessment for the same reason.
  • Our data indicate that psychologists resign from insurance panels primarily due to low reimbursement rates.  These resignations negatively impact consumer access to treatment by psychologists (see attached Phantom Panel Survey Results).
  • Our data indicate that NY psychologists received many calls from consumers who have contacted several psychologists in their plan’s network and cannot find a psychologist who is in the plan and accepting new patients.  Again, consumer access to care by psychologists is negatively impacted. (see Phantom Panel Survey Results)

Recommendations to APA and/or the Practice Organization are as follows:

  1. Launch a historic marketing campaign with the message that psychologists are the best trained mental health doctors, we provide psychotherapy based on science and research, our treatment is highly effective and in some cases more effective than medication.
  2. Aggressively pursue reasonable compensation for psychologists as a top priority in health care reform discussions since it affects consumer access to treatment by the best trained mental health professionals.
  3. Be a major player in health care reform and form strong alliances with other professional organizations to influence health care reform and fair compensation in all plans.
  4. Allocate much more of the practice assessment to save psychotherapy practice from extinction.

We are most interested in the survival of psychotherapy practice and appreciate your assistance in this crisis.  You can reach the co-chairs of the CPP Task Force or the President of NYSPA if you have any questions or would like to start a similar task force in your region or division.

Dr. Frank Goldberg, co-chair, fhgphd@optonline.net

Dr. Barbara Fontana, co-chair, drfontana@aol.com

Dr. George Northrup, NYSPA President, ghnorthrup@earthlink.com

Attachments: NYSPA Survey of APA Health Care Reform Issues

CPP Phantom Panel Survey

Reimbursement For Psychologists’ Services: Trends, Impact on Access to Psychologists, and Solutions

Saturday, May 9th, 2009

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.

Draft letter HR1 funding and indep practice psytx research

Friday, February 20th, 2009

This is a draft letter regarding HR 1 funding and independent psychologist access to funding and involvement in treatment effectiveness research. Please be specific in your recommendations for language additions and/or changes.  Also, indicate if you would like to add your name as a cosigner when the letter is sent, with your credentials and affiliation as you would like those listed on the letter.

————-

Dear Drs. Bray and Nordal,

We recently read with interest that HR1 (the “stimulus package legislation”) includes $1.1 billion in funding to conduct comparative treatment research,  that such research could investigate psychotherapy effectiveness, and that a 15-member council will be established to determine how those funds are to be allocated.

We want to let you know we consider it essential that practicing psychologists have a voice at the table in determining the allocation of those funds, and that funds specifically are allocated to flow to independent psychology practices to investigate psychotherapy effectiveness as it is provided in the real world.

We request that APA, APAPO and whatever appropriate  offices and resources within APA be brought to bear to ensure that one or more practicing psychologists with expertise in outcomes research be appointed to the 15-member council.  There are many to recommend as the council is established.

We are concerned there could be a tendency to investigate psychotherapy in large practice settings based on manualized treatment protocols, ultimately leading to a “finding” that such treatments and settings are the only ones to be funded in a reformed health care system.  We know that such models entirely miss the true active ingredients of psychotherapy.  Given that this is not the way the bulk of psychotherapy is conducted in the real world by practicing psychologists, we consider it essential to have independent, solo and small group practicing psychologists represented at the table when funds are allocated to investigate psychotherapy effectiveness.

We also ask that APA, the Practice Directorate and whatever offices and resources are appropriate ensure that available funding flows from the HR1 allocation to independent psychologists’ practices to investigate psychotherapy effectiveness.  Without such advocacy, it seems highly likely the small, independent practice setting would be overlooked and unrepresented in funding allocations and research settings.  Perhaps you are already working on this.  If so,  we would very much like to know what is already being done or planned, so that we can actively support those initiatives.

We are quite confident about what psychotherapy therapy effectiveness studies would show in the solo- or small group independent psychology practice setting.  Therefore, we would also like to let you know that many of us stand ready to provide access to our practice settings for such research when funding is made available through the HR1 allocations.

We are encouraged by the renewed energy and efforts directed toward collaboration between independently practicing psychologists and the Practice Directorate.   We believe the potential to affect allocation of funding to conduct effectiveness research in the independent practice setting, and to conduct such research, could be an outstanding collaborative project.

In addition, we see the potential here to build collaborations between practice and science, and look to you to help us understand available mechanisms, offices, resources and initiatives possibly already in progress within APA to help us with these efforts.

Finally, given that one of the goals of the upcoming Summit on the Future of Psychology Practice is to identify available resources, we request that there is discussion at the Summit about how ensure psychologists in  independent practice may access HR1 funding for psychotherapy effectiveness research.

Thank you for your attention,