Evolving Reimbursement Priorities: With the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA), our nation's health care environment and its underlying reimbursement mechanisms are undergoing unprecedented change. The ACA places a high priority on developing patient-centeredsystems of care which will emphasize utilizing interdisciplinary teams of providers and capitalize upon the clinical potential of the advances occurring within the communications and technology fields. Cross-patient and cross-population comparisons in real time, will allow for the development of data-based "gold standards" of care. Providers will be held accountable for their clinical decisions and be expected to be knowledgeable about state-of-the-art protocols, resulting from clinical effectiveness research. Educated consumers will be urged to take responsibility for their own health care. Prevention, wellness, healthy lifestyles, holistic care (including diet, exercise, and relaxation) will be given increasing priority. Reimbursement strategies will gradually move from encouraging procedures to rewarding wellness.
The Centers for Medicare and Medicaid Services (CMS) recently approved the State of Maryland's proposal to continue setting hospital prices while adding an overall cap for all hospital spending, thereby limiting hospital spending growth to 3.58% per annum for the next five years. This will occur largely by giving each of the state's 46 hospitals a firm budget to work within. Since the mid-1970s, Maryland has been the only state in the nation to set the prices that hospitals charge patients – and not insurance companies. The Governor: "We need to shift away from our near exclusive focus on treating illness, and move to a balanced approach that encourages prevention and wellness. Such a shift will reduce costs for families and small businesses and will simultaneously keep many Americans from dying of preventable causes." If successful, Maryland state officials plan on exploring ways to extend a similar approach to other parts of the health care system, such as doctors' offices and nursing homes. This approach should be understood within the context of the Institute of Medicine (IOM) having consistently found that health care in our nation is more expensive than in other developed countries, costing $2.7 trillion in 2011. And, at the same time, despite advances in biomedical science, medicine, and public health, health care quality remains inconsistent with underuse, misuse, and overuse of various services often putting patients in danger. Most significantly, regions of the country that deliver more services do not appear to achieve better health outcomes than those that deliver less.
Individual Involvement Makes A Difference: For over two decades, working behind the scene, Tony Puente has been in the forefront of psychology's efforts to obtain administrative parity within Medicare. About 16% of the Gross Domestic Product of the nation is health care. And most, if not all, is associated with a nomenclature system called the Current Procedural Terminology (CPT). This system has been developed by the American Medical Association (AMA) under license by the CMS. It is a numerical system of 8,000 procedures that the federal government and most private insurance companies consider scientific and clinically useful. The CPT essentially determines what health procedures can be done, how they should be documented, and how much they should be reimbursed. The system is comprised of over 120 advisors from the health specialties in the U.S. (e.g., psychology and family practice physicians) who advise a voting Panel of 17 members which include CMS, Blue Cross/Blue Shield, and others. Around 1990, psychologists had access to about 3-5 codes and over time, as psychology's scope of practice and scientific breakthroughs evolved, that number has increased today to over 50. Though the majority of the codes are in the psychiatry (mental health) section, they are also now found in other sections that reflect more medical types of problems (e.g., brain injury, diabetes, etc.). Tony has represented APA since the AMA opened the system to non-physicians in 1992. In 2008, he was voted on to the Panel itself and now no longer represents APA. Instead he is responsible for addressing all health proposals and has the same voting capacity as Medicare and Blue Cross/Blue Shield. At the Panel's next meeting they will address 110 different proposals, with APA being represented by Norman Anderson, Randy Phelps, and Neil Pliskin (Tony's replacement).
Serving The Community: As highly educated members of society, we have a unique obligation to provide visionary leadership and personal involvement in effectively addressing our nation's most pressing needs. Two impressive examples of such dedication, who were highlighted by President Don Bersoff at our Honolulu convention, are Barbara Van Dahlen for "Give an Hour" and Jon Nachison for "Stand Down." The President of the American Psychiatric Nurses Association (APNA), Patricia Cunningham, noted for her membership that in the next five years, over one million Service Members are projected to leave the military. Accordingly, she has initiated a Presidential Task Force on Military Mental Health. "Helping to meet the mental health needs of Service Members and Veterans is a top priority for the mental health community." She has charged her Task Force with developing a White Paper to inform the membership and the mental health community at large on actions they believe are appropriate for an evidence-based approach to military mental health. A former USUHS colleague of mine, Commander (Ret.) Sean Convoy, will chair the Task Force. "I believe that there are many across APNA's ranks that want to actively support military mental health. The problem is, they don't necessarily know how or what to do. The APNA White Paper can provide that necessary structure." Psychiatric-mental health nurses representing all branches of the military will be working with the Task Force. Their deliberations will build off First Lady Michelle Obama's Joining Forces Initiative and have an evidence-based orientation.
The IOM recently released a very thoughtful report "Educating the Student Body: Taking Physical Activity and Physical Education to School." Like most of us, children and adolescents in our nation have grown accustomed to a sedentary lifestyle. The predictable result has perhaps been best crystalized by the proclaimed "Epidemic of Obesity." Extensive scientific evidence clearly demonstrates that regular physical activity promotes growth and development in youth and has multiple benefits for physical, mental, and cognitive health. Physical activity is related to lower body fat, greater muscular strength, stronger bones, and improvements in cardio-vascular and metabolic health; as well as improvements in mental health, by reducing and preventing conditions such as anxiety and depression and enhancing self-esteem. There is also a growing body of evidence which suggests a relationship between vigorous and moderate-intensity physical activity and the structure and functioning of the brain. Children who are more active show greater attention, have faster cognitive processing speed, and perform better on standardized academic tests than children who are less active. A longtime colleague to whom I had the pleasure of presenting a special APA Presidential Citation, Colleen Hacker, has worked with several women's Olympic teams over the years. Her American Psychological Foundation (APF) William Bevan Lecture enumerated in great detail the long term health, education, and employment benefits of active participation, especially for girls, in team sports.
Due to a number of issues, including constricting budgets and the federal pressure to raise standardized test scores through increased classroom contact time, schools today are increasingly challenged to provide sufficient time, resources, and supervision for adequate physical activity. As a result, our nation's school systems present an unprecedented opportunity for psychologists and other mental health specialists to provide pro bono consultation on how to increase the likelihood of student and faculty engagement in meaningful physical activities. This is, after all, a "people" problem – and one too important to ignore. Similarly, another colleague at USUHS recently inquired that since there are 9,000 rural and urban communities served by Federally Qualified Community Health Centers, which under ACA must provide mental and behavioral health services, "Are your behavioral health colleagues providing pro bono anti-violence services for the families and youth these centers serve?" Visionaries such as Rodney Hammond (retired from CDC) have developed effective teenage-oriented anti-violence programs. Her fundamental question remains, however. As a profession, is psychology and nursing aggressively bringing this evidenced-based expertise to fruition, where it is so clearly needed?
Sincere Appreciation: As I reflect upon my rather lengthy career within APA, several individuals from New Jersey immediately stand out. Without the guidance and mentoring of Stan Moldawsky, Marv Metsky, Bob Weitz, and Gene Shapiro, I seriously doubt that I would have been so intimately involved within our association's governance and for such a long period of time. During my Presidential convention, Stan's band was a highlight at our Union Station "blast." I have also had the pleasure of serving on the APA Board during Dorothy Cantor's exciting year and subsequently with her on the extremely visionary APF Board. One of my fondest policy memories was hearing the staff director for New Jersey Senator Pete Williams say that the Chairman had directed him to include psychology in the Federal Workers' Compensation statute after listening to Gene's testimony. Involved individuals do make a very real and lasting difference. Aloha,
Pat DeLeon, former APA President – New Jersey Psychological Association – February, 2014
