APA State Leadership Conference: At this year's exciting event, Bringing Psychology to the Table: State Leadership in Health Care Reform, Katherine Nordalhighlighted the critical role of President Obama's Accountable Care Act (ACA) in furthering health care reform and the importance of action by psychology at the state level. "We're facing unchartered territory with proposed new models of care delivery. Again, different kinds of care delivery models than we've been used to working in before. We're facing new financing mechanisms that we're going to have to understand and appreciate, and the ways that they are going to impact practice, whether it's private practice or institutional practice…. (W)e know that the states are in the drivers' seat and most of what happens about health care reform is going to happen back home…. There is also marketplace uncertainty for us…. (I)f you think you won't be affected by Medicare and Medicaid because you've opted out of those systems or you don't want to participate in those systems, you really need to think again. Medicare and Medicaid contribute over 50% of all the funding for hospitals in this country. I'm not talking about just mental health care; I'm talking about health care in this country. Medicare and Medicaid and other public funds pay for about 58% of all mental health and substance abuse care in this country. And we know that commercial carriers often times peg their rates to the Medicare rates. So Medicare rates not only affect the income of private practitioners; they affect the income of agencies, they affect the income of hospitals, they affect incomes in federally qualified health centers [FQCHCs], community mental health centers and community health centers…. (D)espite all of this uncertainty, change is here. And change is fairly inevitable…. So we have to be ready to claim our place at the table. We need to be involved at the ground level…. If we don't participate, then we abdicate our responsibility there and we let other people… define what our future is going to be as a profession. And that's just not an option for us."
Health Care Reform: The newly established Accountable Care Organization (ACO) provision of ACA reflects the Administration's commitment to ensuring that all Americans will have ready access to necessary high quality primary care services. For many health policy experts, ACOs are functionally equivalent to the HMOs of President Nixon and the Managed Care efforts of President Clinton. Sandra Wilkniss, former APA Congressional Fellow and currently on the staff of U.S. Senator Jeff Bingaman, reviewed the statutory language and implementing regulations for ACOs. In neither were psychologists expressly enumerated. Clinical management and oversight must be managed by a senior-level medical director who is a physician and is one of the ACO providers/suppliers; is physically present on a regular basis in any clinic, office, or other location participating in the ACO; and is board-certified and licensed in the State in which the ACO operates. Public response: "A number of commenters recommended CMS include measures that are more inclusive of specialty care, pediatric care, and non-physician professionals, such as nurse practitioners and registered nurses. Many of these commentaters noted that the proposed measures were heavily focused on primary care…. Response: We believe that the final set of measures is appropriately focused and measures care furnished by a variety of providers including specialists, nurses, and nurse practitioners." As Kathleen so eloquently urged, our practitioners mustbecome actively involved, especially at the local level, for the future of the profession.
Addressing Society's Needs: Over the years, we have been impressed by the extent to which our nation's elected officials actively support those who serve society. Sallie Hildebrandt reports that more than 110,000 active-duty Army troops last year took antidepressants, sedatives and other prescription medications. In 2008 the Rand Corporation's comprehensive study of the mental health and cognitive needs of returning service members and veterans found that nearly one-third of returning service members reported symptoms of a mental health or cognitive condition. Approximately 18.5% of those who have returned from Afghanistan andIraq have PSTD or depression, with 19.5% experiencing a traumatic brain injury during deployment. Half of those needing treatment seek it, but only slightly more than half who receive treatment receive minimally adequate (i.e., scientifically based) care.
Without question, as the U.S. Army Surgeon General Patricia Horoho testified: "For those who do suffer from PTSD, Army Medicine has made significant gains in the treatment and management of PTSD…. The DoD and VA jointly developed the three Evidenced based Clinical Practice Guidelines… on which nearly 2,000 behavioral health providers have received training. (Our) researchers develop strategies and advise policy makers to enhance and sustain mental fitness throughout a service member's career. Psychological health problems are the second leading cause of evacuation during prolonged or repeated deployments…. (Our) psychological health and resilience research focuses on prevention, treatment, and recovery of Soldiers and Families behavioral health problems, which are critical to force health and readiness." General Horoho is the first female (and nurse) Surgeon General in the Army's history. We would rhetorically ask: How is Hawaii Psychological Association reaching out to our military and veteran community, many of whom are being served by Hawaii's FQCHCs, in order to provide pro bono care and expertise? From personal discussions, we know that our State's health centers are very interested in collaborating.
An Interesting Evolution: Elaine Rodino, while in full-time private practice, is exploring new frontiers. "You asked that I send you some information about my new business venture. This isSeniorPremierDating.com. Our senior dating website is for people 50+ to connect with others for dating, companionship and house sharing. As you know, the senior population is growing rapidly with the aging of baby boomers and the increasing longevity of existing seniors – all of whom are increasingly computer savvy. Our site is different from existing sites in two specific ways, Humor and Psychology. We will have short videos depicting senior dating scenarios that will be created and performed by Renee Taylor and Joseph Bologna. Taylor and Bologna are Emmy Award winning writers and performers in theatre, film and TV. Their work has always been about the foibles of relationships. The psychological aspects of issues facing seniors dating will be presented by myself and by contributing psychologists. Each contributor will write short articles on topics in their specialty areas such as aging issues, weight and sex, and also include a short statement about their practice and a link to their website.
"At this point the site has a simple questionnaire for subscribers to complete. Profiles of potential subscribers will be gathered beginning in June through email blasts to those potentially interested. In August we will activate the site to accept subscribers and do matching. We've done a lot of research and consultation for this project. We have an extensive business plan and a hopeful financial projection for the next five years. Colleagues interested in contributing articles or in learning more about our venture should contact us atERodino@aol.com." Fundamental change is upon us. Aloha,
Pat DeLeon, former APA President – HPA – June, 2012
