WITH THE WHITE HOUSE EMBRACING HEALTHCARE TECHNOLOGY
At the end of last year, the White House released a report entitled Reforming America’s Healthcare System Through Choice and Competition, authored by the Secretaries of the Departments of Health and Human Services, Treasury, and Labor. “As health care spending continues to rise, Americans are not receiving the commensurate benefit of living longer, healthier lives. Health care bills are too complex, choices are too restrained, and the insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue. Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition…. Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer. This report recommends policies that will broaden providers’ scope of practice [SOP] while improving workforce mobility, including telehealth, to encourage innovation and to allow providers more easily to meet patients’ needs.”
Several salient conclusions include that government rules restrict competition if they keep healthcare providers from practicing to the “top of their license” – i.e., to the full extent of their abilities; given their education, training, skills, and experience -- consistent with the relevant standards of care. This includes restrictions on the appropriate use of telehealth technologies and the range of services providers can provide. Oftentimes, SOP restrictions limit provider entry and ability to practice in ways that do not address demonstrable or substantial risks to consumer health and safety. Further, there is a risk that healthcare professionals with overlapping skill sets will seek these restrictions as they view SOP restrictions as an easy, state-sanctioned opportunity to insulate themselves from competition. For example, the report found that Advanced Practice Registered Nurses, Physician Assistants, Pharmacists, Optometrists, and Dental Hygienists can safely and effectively provide some of the same services as physicians, in addition to providing complementary services, citing the Institute of Medicine (IOM) and the Federal Trade Commission (FTC). Interestingly, this extends to physician supervision and collaborative practice regulations, which can be unreasonably restrictive. One specific recommendation: “States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.”
The report further addressed the related issues of licensure mobility and telehealth; both of which are highly relevant to psychology’s practitioners and their vision for the future. State-based licensing requirements, by definition, inhibit provider mobility and often inhibit delivery of services across state lines by making it more difficult for qualified practitioners, who are licensed in one state to work in another state, even though most complete nationally certified education and training programs and sit for national qualifying exams. Appropriate standards of care do not differ from state to state; yet, the process of obtaining a license in another state is often slow, burdensome, and costly. There is little economic justification for this and it can inhibit the efficient development and use of telehealth, as well as in-person services. The report further noted that Interstate Compacts and model laws can mitigate the effects of state-licensing requirements. The compact approach has only recently been proposed, with nursing enacting the first in 1999.
Telehealth is described as a significant innovation in healthcare services with mental health highlighted as an example of its usefulness. It increases the virtual supply of providers and extends their reach to new locations, promoting beneficial competition, reducing transportation expenses, and improving access to quality care and long-term quality outcomes. Nevertheless, a variety of regulatory barriers keep telehealth from reaching its full potential. Two specific recommendations: States should consider adopting licensure compacts or model laws that improve licensure mobility by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice. And, States generally should consider allowing individual providers and payers to mutually determine whether and when it is safe and appropriate to provide telehealth services, including where there has not been a prior person-to-person visit.
For psychology, the key to the future is the vision of Steve DeMers, retired CEO, Mariann Burnetti-Atwell, current CEO, and the Board of the Association of State and Provincial Psychology Boards (ASPPB). In 2015, ASPPB developed, with input from all major psychology stakeholders and some consumer organizations, and then approved PSYPACT (Psychology Interjurisdictional Compact) to provide for the legal and ethical practice of psychology across jurisdictions. PSYPACT will allow psychologists with an E.Passport certificate from a compact state to electronically provide psychological services into another compact state without having to get licensed in the remote state. It will also allow psychologists in a compact state with an IPC (interjurisdiction practice certificate) to physically go into another state to provide temporary in person, face-to-face psychological services without having to get licensed in that state. Individual psychologists in any compact state would apply for an E.Passport and/or IPC as a prerequisite to being able to practice under the authority of this compact. PSYPACT will vet all psychologists who apply for the E.Passport and/or IPC to make sure they have the requisite education, training, experience and do not have prior discipline, child abuse or criminal history.
PSYPACT will have the effect of increasing access to care for patients, increasing continuity of treatment if a patient moves out of state, decreasing licensure barriers for psychologists to practice, while ensuring the public is protected. Where there are conflicts of law between states (i.e., duty to warn laws), PSYPACT will help ensure both the psychologist and the patient will understand which laws govern the psychological interaction. To date, seven states (Arizona, Utah, Nevada, Colorado, Nebraska, Missouri, and Illinois) have adopted PSYPACT. So far in the 2019 legislative session, North Dakota (NDHB 1343), New Mexico (NMSB 141), New Hampshire (NHHB 484) and Georgia (GAHB 26) have all introduced PSYPACT legislation. We are anticipating that the District of Columbia and Pennsylvania will introduce legislation soon. In Texas, PSYPACT is part of the Texas sunset legislation which will hopefully be introduced in the near future. Psychologists in the above states are encouraged to contact their legislators to support PSYPACT legislation. ASPPB has heard from several other states which have expressed an interest in pursuing PSYPACT legislation. For more information, please contact Alex Siegel at asiegel@asppb.org). The words of Steve Ragusea should be taken to heart by those who wish to ignore the changing healthcare environment: “Based on inflation, the amount I get paid through most third party payers today is one third less than I was getting in 1980.”
APA’s Vision for the Future: “I recently attended the first meeting of APA’s inaugural Advocacy Coordinating Committee as the sole student among fourteen members led by exceptional co-chairs former APA President Tony Puente and former APA Recording Secretary Jennifer Kelly. We received in-person support from another former President Jessica Daniel, President Rosie Bingham, and President-elect Sandy Shullman. Having the recent, current, and future APA Presidential trio in the room was inspiring. CEO Arthur Evans and Deputy CEO Jim Diaz-Granados spoke at the meeting, several key staff sat alongside us for the entire two days, and the Board of Directors joined us for dinner following the first day of the meeting. I was particularly pleased to learn the recommendations of Bob Frank who has served as a Robert Wood Johnson Fellow and President of the University of New Mexico.
“Joining this committee is my next step following what seems like years of involvement with APA Divisions, including serving as an APAGS Board representative and convention programming co-chair for Division 55. By sharing my experiences and perspective, I hope to help others see the value of student involvement in advocacy and for students to see a path to leadership roles. Visionary leader Ron Fox once said that as beneficiaries of the shared resources of higher education, we have an ethical obligation to engage in advocacy. The goal of this advocacy, as outlined in the mission statement in APA’s newly drafted strategic plan, is ‘to benefit society and improve lives.’ The Committee is key to advancing APA towards fulfilling this mission (Joanna Sells, graduate student Uniformed Services University).” Aloha,
Pat DeLeon, former APA President – Division 42 – February, 2019
