The enactment of President Obama's landmark health care reform legislation, thePatient Protection and Affordable Care Act (ACA) [P.L. 111-148], provides visionary psychologists and advanced practice nurses (DNP) with an unprecedented opportunity to serve the nation, and in so doing determine their profession's future. With many of ACA's provisions taking effect by 2014, we are currently in the implementation stage -- the states having been granted considerable flexibility to craft innovative approaches to broad, overarching federal requirements. The health care system of tomorrow will provide patient-centered, interdisciplinary-oriented integrated care, with priority being given to holistic, wellness, and preventive services; rather than the traditional emphasis upon procedure-reimbursed acute care. Chronic disease management, encouraging healthy behaviors and lifestyles, integration of mental health into primary care, and the unprecedented utilization of developments occurring within the communications arena (i.e., telehealth and electronic health records (EHRs)) are the future.
Ever since November, 1984 when U.S. Senator Daniel K. Inouye urged the Hawaii Psychological Association to seek prescriptive authority in order to provide comprehensive care, the RxP legislative agenda has steadily matured. In 2002 New Mexico became the first state in the nation to enact legislation, soon followed by Louisiana. Guam andIndiana had previously succeeded; however, their bills have yet to be implemented. Throughout the federal system psychologists have formally prescribed with Floyd Jenningsobtaining this authority in the Indian Health Service in June, 1988. Consistently, the quality of their care is outstanding. Bob McGrath, Director of the Fairleigh Dickinson Clinical Psychopharmacology training program and a participant in your November meeting devoted to health care reform, estimates that there are over 1,700 colleagues who have completed their advanced RxP training. His program has been expanding in recent years, continuing to attract students from almost every state and from the military. Details are available atwww.rxpsychology.com and/or chat with your President Rick Barnett, a FDU graduate.
The Alliance for Health Reform recently conducted a Congressional briefing on the Virtual World of Health Information Technology. Whereas at the time of enactment of ACA the Administration estimated that only 5% of physicians possessed fully functional EHRs, a 2011 survey found that 55% of physicians had adopted EHRs with a slightly greater proportion of primary care providers vs. specialists. The vast majority of providers using EHR systems (85%) report being "somewhat" or "very" satisfied. Rural providers have been particularly engaged in this transformation process and private vendors are proactively responding to the advent of health care technology.
A fundamental element of ACA is encouraging systems of care, as reflected in its Accountable Care Organization (ACO) andPatient-Centered Medical Home provisions (neither formally recognizes psychology). This is not a new approach, reflecting the strategic thinking of the Nixon Administration HMOs and President Clinton's Managed Care models. Almost all of the panelists described their systems as having been functioning as an ACO for a number of years. They stressed the effectiveness of technology in improving quality of care, holding down costs, and allowing cross-patient and cross-diagnostic comparisons. Engaged consumers (i.e., patients) were a reality. During the audience discussion, the importance of integrating mental health, substance abuse, domestic issues, etc. into primary care was highlighted. This is a (r)evolution that the Institute ofMedicine has increasingly emphasized -- "Primary care providers address a broad range of health issues to which mental health concerns are integral."
For the profession of psychology to thrive within our nation's evolving health care environment it is absolutely essential that we become personally engaged, proactive, and responsive to society's pressing needs. Psychology is one of the health care professions and our services are increasingly being deemed those of "primary care." The knowledge and clinical expertise surrounding the appropriate utilization (or lack thereof) of psychotropic medication is definitely needed throughout primary care and in rural America. Whether the Vermont Psychological Association will rise to this exciting challenge is yours to decide. As Katherine Nordal so eloquently stated during this year's State Leadership Conference: "If we're not at the table, it's because we're on the menu." Aloha,
Pat DeLeon, former APA President – Vermont Psychological Association – October, 2012
