Psychology, along with the other health professions, is beginning to appreciate the extent to which the unprecedented advances occurring within the communications and technology fields are having an extraordinarily impact upon our nation's health care environment. It was not that long ago when President G.W. Bush noted: "The health care industry is missing an opportunity…. IT, information technology, hasn't shown up in health care yet. But it has in one place, in one department… that's the Veterans Department. Tommy Thompson is the Secretary of the Department of Health and Human Services – a strong advocate about the spread of IT throughout the health care industry…. By introducing information technology, health care will be better, the cost will go down, the quality will go up, and there's no telling whether other benefits will inure to our society…. When we get this implemented, America will remain on the leading edge of technological change. This is the kind of innovation that's practical and makes sense, that will keep us the leader in the world." The VA reports that in Fiscal Year 2013, more than 600,000 Veterans received health care utilizing telehealth – accounting for more than 1.7 million episodes of care. The issue of licensure mobility/portability is critical to this evolution – and it is an area in which theNational Register has demonstrated proactive leadership.
State Leadership Conference (SLC): For practitioners, the annual APA Practice Directorate State Leadership Conference (SLC) is one of, if not the, highlights of the year. At last year's conference, Katherine Nordal described the beginning stages of the implementation of President Obama's Patient Protection and Affordable Care Act (ACA) as: "Really just a mile marker in this marathon we call health reform. We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us." This year, Katherine noted: "Our country still doesn't pay nearly enough attention to mental health and substance use treatment. Health care reform implementation is a work in progress. And there are hopeful signs, especially related to the goal of increasing the ranks of Americans with health insurance coverage. As we confront serious problems and the uncertainty of a health care system in flux, psychology continues to demonstrate that we're poised to face those challenges. The 2014 Medicare fee schedule marked the first time since 2007 that the payment pool allocated for Medicare psychological services increased – psychologists gained the second highest increase in payment allocation among all Medicare provider groups. The demand for evidence-based practices and use of quality measures related to process and outcome, including behavioral health measures, will grow. And the increasing use of technology for electronic health record keeping and telepsychology service delivery will continue to evolve. In a survey last fall, we asked what specific changes members were likely to make in their practice over the next three to five years. Nearly half indicated they will increase their use of technology…. We achieve good results when psychologists get energized and commit themselves to making positive things happen."
One of the most intriguing workshops at SLC, chaired by Deborah Baker, was "Developing a Roadmap for Telepsychological Practice." Already 21 states have affirmatively addressed the issue of insurance reimbursement for telehealth services, with an additional 19 state legislatures currently considering legislation. The underlying issue of licensure mobility/portability is complex. For example, does the locus of the patient or provider or both provide the legal authority for licensure board jurisdiction? Thoughtful views from the APA Insurance Trust (Jana Martin) and the Association of State and Provincial Psychology Licensing Boards (ASPPB) (Fred Millan) were shared – all clearly seeking ways to ensure that psychology will be responsive to the dramatically evolving health care environment. Will, for example, a special licensure category be established for providing Telepsychology care? It was refreshing to hear how proactive the joint APA-ASPPB-Insurance Trust taskforce, co-chaired by presenter Linda Campbell, is during its deliberations. Steve DeMers pointed out that ABPPB has received a special grant from the Health Resources and Services Administration (HRSA) to address the underlying issues. The National RegisterMobility Program is becoming increasingly timely – now approved or in the process of being approved in 46 jurisdictions in the U.S. and Canada.
FY 2015 HRSA Budget Request: The Administration has requested $124.5 million this coming year for the Office of Rural Health Policy. Established in 1987, this is the focal point for rural health activities within HHS. Historically, rural communities have struggled with issues related to access to care, recruitment and retention of health care providers, not to mention maintaining the economic viability of hospitals and health care providers in isolated communities. Today there are nearly 50 million people living in rural America who face challenges in accessing health care. Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts. The potential for telehealth providing quality specialty care, professional continuing education activities (addressing provider isolation); and innovative, evidence-based behavioral programmatic activities should be evident. Interestingly, the Office has historically worked collaboratively with the VA and the Departments of Agriculture, Education, Labor, and Transportation given its holistic approach to ensuring comprehensive care.
The Office of Rural Health's Telehealth Grants initiative proposes to expand the effective use of telecommunications technologies within rural areas that can link rural health providers with specialists in urban areas, thereby increasing access and the quality of healthcare provided to rural populations. Telehealth technology also offers important opportunities to improve the coordination of care in rural communities (a priority of the President's AAC) by linking rural health care providers with experts not available locally. These grants are expected to strengthen the rural health care infrastructure. This year's budget proposes specific evaluations of the program's impact on the health status of rural residents with chronic conditions, including obesity, and the return on investment for rural grantees and communities. $13.9 million has been proposed in the coming fiscal year for telehealth activities supporting: 1.) Telehealth network Grant Program grantees (up to 26 grants); 2.) Telehealth Resource Center Grant Program grantees (up to 14 grants); and, 3.) The Licensure Portability Grant Program (2 grants).
The Federal Trade Commission (FTC): In March of this year, the FTC issued a policy paper suggesting that state legislators should be "cautious when evaluating proposals to limit the scope of practice of Advanced Practice Registered Nurses (APRNs). By limiting the range of services APRNs may provide and the extent to which they can practice independently, such proposals may reduce competition that benefits consumers. Even well-intentioned laws and regulations may impose unnecessary, unintended, or overbroad restrictions on competition, thereby depriving health care consumers of the benefits of vigorous competition." In the view of the FTC, consumer health and safety are paramount concerns in the regulation of the health professions, and competition is an important mechanism to promote high quality health care. It is also a means of controlling costs and allocating resources. When restrictions restrain competition and are not closely tied to legitimate policy goals, they may do more harm than good. As psychology seeks to expand its clinical influence under the provisions of the ACA, both in its scope of practice (e.g., obtaining prescriptive authority) and actively engaging in the treatment of those with chronic conditions, for example, the recommendations proffered by the FTC become highly relevant.
Recognizing Two Colleagues Whose Leadership Has Made a Real Difference: On June 13, 2013 Colonel Rebecca Porter became the first clinical psychologist in the U.S. Army to command a Medical Treatment Facility (MTF). She assumed command of Dunham U.S. Army Health Clinic at Carlisle Barracks, Pennsylvania. Durham provides primary care to students, faculty, and families at the U.S. Army War College through its Patient Centered Medical Home. Dunham and its outlying clinics, including the Army Wellness Center, serve a beneficiary population of more than 9,000 active duty military members, retirees, and their families. Commanding a MFT is not the only "first" for Becky. She was also the first clinical psychologist to serve as the Army's Director of Psychological Health and Chief of Behavioral Health for the Army Surgeon General (2010-2013), and the first clinical psychologist to serve as a Special Assistant to the Chief of Staff of the Army (2001-2003). She is a member of the APA and Past-President of Division 19, the Society of Military Psychology.
"Each and every day of an extraordinary 23 accomplished years, Judy Hall lived and breathed the NationalRegister. We could not have asked for a more dedicated, intelligent, and caring leader. Judy kept the Register healthy and on a steady track through two+ decades of profound changes in the health care landscape. A passionate and tireless advocate for us and professional psychology, she represented the organization in over 300 invited program presentations and 60 interviews on radio, TV, and in print. For years, Judy has had a central role in formulating national standards for education and training in professional psychology and I sincerely doubt that anyone else in the nation has anywhere near the intimate knowledge that she has of every training program in psychology. While she has retired from the role of Executive Officer, we have asked Judy to continue with us in a consulting role and are extremely pleased that she has agreed to do so. Speaking for the Board of Directors – and I believe the 11,000 members of the National Register as well – Judy has our profound thanks for a job well done" [Ray Folen, President/Chair]. Aloha,
Pat DeLeon, former APA President – National Register – March, 2014
