With the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA), APA established its Center for Psychology and Health, with CEO Norman Anderson at the helm. The Center's mission is to aggressively expand psychology's presence within the evolving health care delivery models being adopted across the nation. Former Practice Directorate Deputy Executive Director Randy Phelps heads up the Center's Office for Healthcare Financing with the pressing challenge of ensuring that emerging and current healthcare financing policies treat psychology's practitioners equitably and fairly. He will direct APA's participation in the American Medical Association (AMA) Relative Value Update (RUC) and Current Procedural Terminology (CPT) processes, and will coordinate advocacy with the APA Practice Organization and APA involving the commercial carrier market and the Centers for Medicare and Medicaid Services (CMS). A decade ago, APA had the foresight to establish the Health and Behavior CPT codes. These codes provide an immediately available and critical vehicle for reimbursement ofhealthcare psychology services (beyond mental health services) within fee-for-service integrated care mechanisms in support of team-based care, which is a hallmark of the ACA. There can be no question that physical health and mental health are intimately intertwined. However, perhaps psychology's biggest challenge within the new healthcare environment is that the profession is being defined by marketplace and national health policymakers as primarily (if not exclusively) as a mental health profession, rather than a more generic healthcare profession. For example, as former APA President Suzanne Bennett Johnson passionately emphasized during her Orlando Opening Ceremony, even though psychology has created a number of very effective treatment strategies for addressing the nation's epidemic of obesity -- with two-thirds of adults and almost one-third of children being overweight or obese -- our practitioners cannot be reimbursed in primary care for these services which must be provided by physicians or nurse practitioners.
Randy's challenge is very real on two accounts. The Institute of Medicine (IOM) has observed that health care in America has experienced an explosion in knowledge, innovation, and capacity to manage previously fatal consequences. Yet, paradoxically, it falls short on such fundamentals as quality, outcomes, cost and equity. Each action that could improve quality – developing knowledge, translating new information into medical evidence, applying new evidence to patient care – is marred by significant shortcomings and inefficiencies that result in missed opportunities, waste, and harm to patients. Americans would be better served by a more nimble health care system that is consistently reliable and that constantly, systematically, and seamlessly improves. In short, the country needs health care that learns by avoiding past mistakes and adopting newfound successes. Thus whether psychology's critical expertise will ultimately be embraced is an "open question." Another major barrier is having our members appreciate that unprecedented change is occurring. APA has been successful in having psychologists deemed eligible to bill under three types of CPT codes, mental health (including therapy and diagnosis), testing (including neuropsychology), and health and behavior. The 2011 Medicare data indicate that nationwide our practitioners have submitted less than 400,000 bills under the health and behavior code; in sharp contrast, we have submitted several million under "mental health." Simply stated, psychology is not billing (nor acting) as if we are a healthcareprofession. This must change. Aloha,
Pat DeLeon, former APA President -- West Virginia Psychological Association – February, 2013
