“IT IS NOT THE CRITIC WHO COUNTS”
This Spring’s APAPO State Leadership Conference (SLC) –Expanding the Practice Spectrum -- was extraordinarily exciting, with Katherine Nordal urging those present to be actively engaged in shaping their own professional destiny. Our nation’s health care environment is undergoing unprecedented change, with increasing numbers of non-physician providers expanding their scopes of practice, reimbursement systems focusing upon outcomes rather than volume of services (i.e., “pay for performance”), and a growing societal appreciation of the social determinants of quality health care. Patient-centered care, provided by interprofessional teams of providers, is the future. The effective integration of behavioral health within primary care is rapidly becoming a major focus. Right after SLC, APA President Susan McDaniel spoke with a group of 12 Senate Democrats including leadership on Mental Health Reform. At the same meeting, political scientist/columnist and long-time Capitol Hill observer, Norm Ornstein spoke of the tragic death of his son with schizophrenia, along with other patient/family rights spokespersons. Susan was the only mental health leader who addressed the importance of integrated primary care.
Katherine: “Welcome to our 33rd annual state leadership conference. Over the years, SLC has become a wonderful melting pot of psychologists representing several generations, various work settings and cultural and ethnic backgrounds. This year 30% of SLC attendees are Early Career Psychologists [ECP]. SLC is a major training ground for leadership and advocacy for students, ECPs, and our diversity delegates. A number of folks in this room got their start at SLC as a diversity delegate, like June Ching, the current vice-chair of CAPP, was a diversity delegate and has since been a state association President, Division 42 President and an APA Council representative. YOU are our future leaders! And we trust that you will lend a hand to those coming behind you to help groom another cohort of psychology’s leaders.”
“Just this Thursday, our physician definition bill was introduced in the U.S. Senate by Susan Collins from Maine and Sherrod Brown from Ohio. This legislation will add psychologists to the Medicare definition of ‘physician,’ thereby allowing us to practice to the full extent of our licensure. Psychologists are the only doctoral trained health care professionals not included in the physician definition, which does include chiropractors, podiatrists, optometrists, and dentists. Increasingly, CMS is developing new mental health measures which can only be reported through a registry. This year, there’s another election that we really need to pay attention to. One of our very own, Ted Strickland, is running for the United States Senate! We have brilliant psychologists doing brilliant things, thinking outside of the box, and trying new and innovative ways to practice. We are building a positive future for professional psychology.”
One of the truly exciting challenges addressed at SLC is the advent of telehealth/ telepsychology. Visionary Steve DeMers, ASPPB CEO, was successful in urging the APA Council of Representatives endorse, in principle, the Psychology Interjurisdictional Compact (PSYPACT) “to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries.” Clinical pharmacy has been in the forefront of this movement. The School of Pharmacy at North Dakota State University: “With more than 80 telepharmacy sites in the state, it is one of the largest (if not the largest) telepharmacy networks in the U.S., if not the world. Thirty-six of North Dakota’s 53 counties are designated by Health and Human Services as ‘frontier counties’ which is defined as less than six people per square mile. So we are very rural and have a very large geographic area that is considered ‘medically underserved’ with many people having problems accessing even basic health care. Telepharmacy has worked very well for us. It has established or restored access to pharmacists and pharmacy services in areas of the state that had no services or had lost their services. The North Dakota Board of Pharmacy established rules for telepharmacy practice which are now the standard of practice in delivering pharmacy services to remote rural communities. Our research has demonstrated that the quality of services being delivered through telepharmacy vs traditional pharmacy services is the same including medication error rates. All telepharmacy sites are receiving standard reimbursement for pharmacy services from third party payers and federal programs and all sites are still up and operational, not one has been lost, so our model has demonstrated that it is economically viable and sustainable. Telepharmacy has increased the profit margins of pharmacists practicing in rural locations thus keeping our rural pharmacy businesses strong. We have developed our telepharmacy services in both community and hospital settings. We have developed a mobile wireless telepharmacy unit (R2D2 robot) for critical access hospitals that can provide 24 hour access to a pharmacist to any location in the hospital (emergency room, nursing station, patient bedside, pharmacy)” (Dean Charles Peterson, November, 2015).
Beth Rom-Rymer and Deborah Baker engaged 25-30 colleagues in a spirited discussion of the maturing RxP legislative agenda. All eyes are currently on Hawaii and the inspirational process in Guam – thanks to the persistence of Judi Steinman and Lyndsey Miller. In her travels, Beth continues to be inspired by her Illinois colleagues who are choosing to pursue prescriptive authority. “I completed a two year fellowship in clinical health psychology in primary care, serving a Federally Qualified Health Center with mostly Hispanic migrant workers and their families. I also served a growing Haitian community in this rural underserved city. Throughout my rotations, I learned that there is a substantial need for psychiatric services and behavioral health services around the country. As consultants, psychologists in primary care have a very important role. With prescriptive authority, psychologists have tremendous potential to improve the quality and reach of behavioral health care services.” During SLC, David Ballard hosted the 11th Annual Psychologically Healthy Workplace Awards ceremony. This particular initiative, showcasing psychology and the business community, is very important; too many of our colleagues remain isolated within their own professional silos.
“Right after SLC, Dr. Janet Heinrich, Senior Advisor at CMS’s Center for Medicaid and Medicare Innovation (CMMI), visited our health policy course at USUHS. The insights she provided about the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons was not only insightful, but confirming. She discussed the various grants and programs that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers. They are pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology. CMMI has been working in close collaboration with a number of the major private health insurers. She emphasized that, without question, all health care is local” (Omni Cassidy, USUHS).
At SLC, HPA’s new Executive Director, Ray Folen, quickly learned that finding the best table location is critical to success. “Who spends himself in a worthy cause; … and who, at the worst, if he fails, at least fails while daring greatly” [Theodore Roosevelt; Spring, 1910]. Aloha,
Pat DeLeon, former APA President – HPA -- March, 2016
