The Affordable Care Act (ACA): With the steady implementation of President Obama's Patient Protection and Affordable Care Act (ACA), psychology's practitioners and nursing's Doctors of Mental Health Nursing Practice (DNP) are increasingly being held to the requirements of the more generic healthcare system. This evolution is especially relevant to integrated care models; for example, the Accountable Care Organizations and Patient-Centered Medical Homes fostered by the Act. Central to this evolution is the necessity of appreciating the common procedural terminology (CPT) system which has become the most widely accepted nomenclature used in the reporting and reimbursement of health services under public and private health reimbursement programs. From a policy perspective, it is evident that the CPT system is just beginning to address the complexity involved in recognizing that mental health and physical health are intimately intertwined, as well as the critical contributions of the psychosocial-economic-cultural gradient to "quality" health care.
Tony Puente has been working at the interface of practice and policy with the CPT system since the late 1980s. He served as APA's first representative to AMA and for 15 years has been working with them. He is presently a voting member of their CPT Editorial Panel. Tony's report: "The CPT was developed almost 50 years ago by surgeons and physicians and today is copyrighted by the AMA and owned by the Centers for Medicare and Medicaid Services (CMS). A new code for psychological services would be developed by a Health Care Professional Advisory Committee, all non-physicians, then is edited and researched by a selected work group and referred to the CPT panel on which I serve for review and possible approval. If successful, this process can take anywhere from two years to twelve years.
"Out of the approximately 8,000 codes, around 60 are possible codes for psychologists to utilize. These fall within a few major categories including Psychiatric/Mental Health, Central Nervous System Assessment, and Health and Behavior. Miscellaneous codes also cover preventive measures, evaluation and management (E&M), and telehealth. Psychiatric/Mental Health codes were added in the 1970s, testing codes 20 years later, and Health and Behavior codes soon thereafter. Biofeedback codes have also been included. Due to changes in practice patterns and increasing recognition of co-morbidities, codes established for psychotherapy underwent major changes last year. Most current procedure codes reimburse for 'silo' or non-interactive procedures, such as psychotherapy. There is an expanding vision to create codes that financially incentivize professionals to integrate health services. APA is well represented by Neil Pliskin and James Georgoulakis in the AMA process and Randy Phelps as Director of APA's new Office of Healthcare Financing." Tony ran for APA President in 2014 and we fully expect he will be on the ballot for 2015.
Being at the Table: At the annual APA State Leadership Conferences (SLC), Katherine Nordal has consistently stressed the importance of psychology becoming actively involved in policy discussions at the local and national level -- "If we're not at the table, it's because we're on the menu." A Longtime Friend to Hawaii, now in our Nation's Capital: Diane Elmore: "After spending summers in Hawaii as a child and completing my doctoral internship at the Honolulu VA Medical Center/National Center for PTSD, Pacific Islands Division, I moved to Washington, DC in 2002 to pursue a career in health policy. I spent nearly a decade at the APA where I served as Associate Executive Director of the Public Interest Government Relations Office, Director of the APA Congressional Fellowship Program, and Coordinator of APA's military and Veterans activities. During my tenure at APA, I worked on key federal legislation focused on the needs of underserved/priority populations, including indigenous populations, older adults, survivors of trauma across the lifespan, and military service members and Veterans. As a member of the APA health care reform policy team, I helped to successfully secure key provisions in the ACA related to issues including integrated health care, prevention and wellness, and workforce development.
"As the former Director of the APA Congressional Fellowship Program, I served as a mentor to dozens of psychologists who came to Washington, DC to experience the policymaking process up close and personal. My own experience as an APA Congressional Fellow inspired me to help other Fellows navigate and adjust to the fast-paced and exhilarating landscape on Capitol Hill. I served in the Office of then-U.S. Senator Hillary Rodham Clinton, where I was a member of the health team working on a range of health policy issues. Among the federal policies the Senator helped to advance were new mental health initiatives for older adults (as part of the reauthorization of the Older Americans Act) and federal legislation to address the needs of family caregivers across the lifespan (Lifespan Respite Care Act), which both became law in 2006. I helped to share scientific/clinical expertise on timely initiatives related to the mental health of military service members and Veterans and the psychological consequences of terrorism, in the aftermath of 9/11.
"My passion for engaging scientists and practitioners in policy and advocacy efforts led to a multi-year collaboration with colleagues in the APA Education Government Relations Office to develop the APA PsycAdvocate® Series, which is available on the APA Continuing Education website. This series of training modules provides psychologists, psychology students/trainees, and others with the skills to become effective public policy advocates at the federal, state, and local levels.
"Last year, I joined the UCLA/Duke University National Center for Child Traumatic Stress as its Washington, DC-based Policy Program Director. In this role, I help to lead the National Child Traumatic Stress Network (NCTSN) efforts to educate and inform federal, state, and local policymakers about the critical issue of child trauma. Today, nearly two-thirds of children in the U.S. are exposed to a traumatic event before age 16. The cost of child trauma is not only felt in human terms (e.g., physical and mental health effects), but also in billions of dollars in estimated associated costs.
"The NCTSN was created by Congress in 2000 to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. Our policy team works closely with current NCTSN grantees and affiliates (formally funded centers) working in hospitals, universities, and community based programs in 43 states across the U.S. Included among the NCTSN affiliate programs is Catholic Charities Hawaii, Youth Enrichment Services Division. NCTSN grantees and affiliates provide clinical services, develop and disseminate new interventions and resource materials, offer education and training programs, collaborate with established systems of care, engage in data collection and evaluation, and inform public policy and awareness efforts. Please visit http://www.nctsn.org/."
With the future stressing integrated and interprofessional care, it is exciting that nursing's leadership is strategically implementing a vision similar to that proposed by Katherine and Diane. The American Academy of Nursing has announced their participation in the Nurses on Boards Coalition, which is a group of national nursing organizations dedicated to increasing nurses' presence on corporate and non-profit health-related boards of directors throughout the nation. The coalition is working on implementing a national strategy to bring nurses' valuable perspective to governing boards, as well as to state-level and national commissions with an interest in health. Their goal is to put 10,000 nurses on boards by the year 2020, pursuant to the recommendations of the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health (2011). This effort is being supported by the Robert Wood Johnson Foundation and AARP. Pursuant to this challenge the Nursing Campaign for Action, which has coalitions in all 50 states and the District of Columbia, is actively seeking to promote healthier lives, supported by a system in which nurses are essential partners in providing care and promoting health.
True Quality Care: Mike Sullivan, who was instrumental in passing psychology's earlier RxP bills in his APA Practice Directorate State Leadership role: "The September Monitor's article 'On the Reservation' about the Crow/Northern Cheyenne Indian Health System hospital in Montana with RxP is outstanding! Marie Greenspan's quote 'We maintain a policy of no pills without skills. If we're giving medication, people also need to come in and talk with us and learn non-pharmacological ways of managing their issues as well.' That's psychology's contribution to prescribing in a nutshell. Especially when these services would otherwise be unavailable." Aloha,
Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2014
