THE INEVITABLE WINDS OF CHANGE
From a public policy/political perspective, one can sense that the U.S. Congress is steadily returning to the days of bipartisanship, collaboration, and focusing upon meaningful accomplishments. Recently, a number of congressional committees have recommended bipartisan bills; the most directly relevant to psychology is the Medicare “Doc Fix” legislation which has been a high priority for APA over the past several years, notwithstanding that it will add $141 billion to the projected federal deficit over the next decade. The potentially highly emotionally charged “No Child Left Behind” reauthorization was unanimously endorsed by the Senate HELP Committee, while efforts to reform civil-asset forfeiture laws have gained strong bipartisan support within the Senate Judiciary Committee. Although initially tied to the Attorney General’s confirmation deliberations, the far reaching Sex-Trafficking legislation was ultimately sent to the President after a 99-0 Senate vote. Similarly, this spring the Senate Commerce Committee has been exploring telehealth issues, again on a bipartisan basis. These efforts would simply not happen without the strong encouragement of the leadership of both political parties.
The APA State Leadership Conference (SLC): The theme for this year’s exciting APA State Leadership Conference (SLC) was Practice Innovation and it was the 10th anniversary of David Ballard’s visionary Psychologically Healthy Workplace and Organizational Excellence awards presentations. Katherine Nordal stressed that: “Innovation involves new ideas and processes, change, upheaval and transformation. To be innovators we need to shake off some old ways of thinking about traditional practice models. We also need to shake off the negative attitudes some of our colleagues have about what’s happening in health care. This world is changing. Everyone in this room knows it. And health care is moving ahead – with or without psychology. Whether we move forward will be up to us! We need to think differently about our professional roles and the way we provide services. Too many psychologists are stuck in the traditional 50-minute therapy box. And that box is way too confining. We need to think creatively about where psychology can best influence our evolving health care system… how we practice… where we practice… and what we practice.”
Katherine recently addressed our interdisciplinary health policy class at USUHS and, as she did at SLC, urged our next generation to see and understand the bigger picture – the health care environment in which psychology (and nursing) lives. “We’ve developed a new registry to help fix the problem of low success rates with claims-based reporting, and to protect psychologists’ Medicare payments. Our Practice Organization was the first and only mental health organization to develop a registry. Unlike other registries, our APAPO RQRSPRO focuses on mental and behavioral health measures. We rolled out the registry in December and already have almost 1,200 registrants. We have long-term aspirations. We’re laying the groundwork for a qualified clinical data registry. Such a registry would give psychologists more choices of quality measures that better reflect the work that we do. Psychology should be the discipline that defines and expands the mental health quality measures available for Medicare and other public and private payers as these measures become more widely required.”
I was particularly pleased to see her continuing emphasis upon engaging psychology with Medicaid, which is one of the foundations of President Obama’s Patient Protection and Affordable Care Act (ACA). The Congressional Budget Office (CBO) estimates that the ACA will reduce the number of uninsured Americans by 32 million. Medicaid, which is a state administered program, is the largest single payer for mental health services in the nation, and as Katherine pointed out with Arkansas’s recent success, has the potential for reimbursing the services of psychology’s interns. Getting psychologists to seek recognition under Medicaid has been a struggle given its traditional lower reimbursement rates; however, those with vision could appreciate its long term significance even prior to the enactment of the ACA.
Most fittingly, Katherine also expressed all of psychology’s appreciation for the successful efforts of the Illinois Psychological Association and Beth Rom-Rymer in particular. “I want to share an example of a state that did a great job with collaborating and building partnerships. That state is Illinois, gaining prescriptive authority for qualified psychologists. And yes, it happened in the state that’s home to the American Medical Association! Hats off to Dr. Beth Rom-Rymer, who led the charge with her colleagues in Illinois. It was a big win – the culmination of several years of tireless advocacy and a hard-fought legislative battle. Our Illinois leaders demonstrated amazing skill in laying the groundwork for bringing medicine to the negotiating table and gaining support from a variety of organizations and groups – stakeholders like federally qualified health centers, prisons and the sheriff’s association. This win in Illinois has reinvigorated our profession’s quest for prescriptive authority. Idaho, Hawaii, New Jersey, North Dakota and Nebraska are engaged in legislative activity this year, and they’re getting results.”
Integrating Behavioral Health Into Primary Care: The California Technology Assessment Forum (CTAF) recently addressed the comparative clinical effectiveness and value of integrated behavioral health care. “Despite a long history of treating physical health conditions separately from behavioral health, the two are inextricably linked. Up to 70% of physician visits are for issues with a behavioral health component. A similar proportion of adults with behavioral health conditions have one or more physical health issues…. Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions.”
As Katherine consistently emphasizes, CTAF also noted that no single approach to integration will work for all communities; rather, integration should be designed for a particular set of local or statewide circumstances. “In sum, there is a very large body of literature on the integration of mental health into primary care. Studies of different models of integration across wildly varying delivery systems demonstrate with great consistency that integrated care improves depression and anxiety outcomes, although the absolute benefits are only small to modest. Furthermore, integrated care improves patient quality of life and satisfaction with care.”
A Personal Reflection: A number of years ago, former APA President Stan Graham shared his thoughts about the prospect of having to decide what to do with all of the awards and plaques he had received over the decades. Perhaps send some of them to David Baker at the University of Akron’s Psychology Achieves for posterity? When they visit, our two grandchildren love to play in our closed-off roof dormer room. The competition for that limited space is exactly what Stan described. What to do with the Honorary Degree that former APA President Ron Levant bestowed upon me at Nova Southeastern University, or the impressive APA plaques and those from the State Associations which I visited during the past four decades? How about the autographed photographs with our psychology colleagues who have been elected to the U.S. House of Representatives or the meeting we arranged with then First Lady Hillary Clinton to provide APA with the opportunity to talk about her National Health Insurance proposal? Fond memories. However.... The Inevitable Winds Of Change. Aloha,
Pat DeLeon, former APA President – Division 42 – May, 2015
