The Practice Directorate engages in a broad range of activities on behalf of practicing psychologists in diverse settings and consumers of psychological services. The directorate’s primary activities involve advancing and protecting professional psychology and health care consumers’ access to psychological services.
APA Executive Director for Professional Practice Katherine C. Nordal, PhD, provides staff leadership for the work of the APA Practice Directorate as well as the APA Practice Organization (APAPO), a companion organization to APA. The APAPO is a 501(c)6 organization under IRS rules that enables additional advocacy for the professional practice community beyond what APA, as a 501(c)3 organization, is legally permitted to do.
Following are brief highlights of selected Practice Directorate activities and significant developments from February through July 2014, including key activities of both the APA Practice Directorate and the APA Practice Organization.
The changing landscape of health care reform set the stage for the 31st annual State Leadership Conference sponsored by the American Psychological Association (APA) and the APA Practice Organization (APAPO). The conference focused on creating roadmaps for psychologists navigating an evolving health care system. Around 450 psychology leaders from the U.S., its territories and Canada gathered in Washington, D.C., March 8-11, 2014, to learn, network and advocate for professional psychology and consumers of psychological services. On the final day of the conference. SLC attendees took three key advocacy messages to approximately 300 meetings on Capitol Hill with members of Congress and staff:
- Congress should halt plummeting psychologist Medicare payments.
- Psychologists should be added to Medicare’s “physician” definition, and thereby be allowed to practice without unnecessary physician supervision.
- Psychologists should be made eligible for incentive payments for adopting electronic health record keeping systems.
APA Practice is also working to address regulatory issues that could affect psychologists. On April 28, the American Psychological Association (APA) Practice Directorate, with assistance from Div. 38 (Health Psychology) and Div. 40 (Clinical Neuropsychology) submitted comments to the Social Security Administration (SSA) on proposed revisions to the medical criteria used for evaluating neurological disorders. APA Practice submitted additional information from Div. 40 addressing a disability determination question, and will continue to monitor the Federal Register for future notices regarding SSA’s next steps.
On June 9, APAPO called on the Departments of Labor, Health and Human Services, and the Treasury to revoke and revise a Frequently Asked Question (FAQ) released by the departments in April 2013 on the provider nondiscrimination section (2706(a)) of the Public Health Service Act. As written, the FAQ could be used to restrict provider participation in group health insurance plans and limit beneficiary access to services.
An updated analysis conducted in early 2014 by Healthcare Visions Inc. on behalf of the APA Practice Organization (APAPO) found that Medicare’s reimbursement rates for psychologists are 17 percent lower, on average, than private sector indemnity insurance reimbursement rates. A separate 2013 survey conducted by the APA Practice Directorate’s Practice Research and Policy office found that 26 percent of psychologists had stopped participating in Medicare — primarily due to low reimbursement rates — and that roughly half of those psychologists had left the program within the last five years.
The gap between Medicare’s rates and private sector payments discourages participation in Medicare and places beneficiaries’ access to mental health treatment at risk. APAPO is addressing Medicare reimbursement on several fronts, including working to repeal and replace the flawed Sustainable Growth Rate (SGR) formula which would slash Medicare provider payments considerably.
On April 1, President Obama signed the Protecting Access to Medicare Act of 2014 (H.R. 4302), which averted the 24-percent Sustainable Growth Rate (SGR) cut in Medicare provider payments through March 31, 2015. The new law extended a 0.5 percent Medicare reimbursement rate increase through Dec. 31, 2014, and delayed adoption of the International Classification of Diseases-10 (ICD-10) code set from Oct. 1, 2014, until Oct. 1, 2015. The APA Practice Organization coordinated grassroots advocacy efforts, which resulted in nearly 16,000 psychologist messages being sent to congressional offices. Lobbyists for APAPO continue to work diligently with legislators to gain permanent repeal of the SGR.
APAPO responded to a request for information (RFI) in March from the Centers for Medicare and Medicaid Services (CMS) about large-scale transformation of clinical practices. APAPO) responded to 15 of the 35 questions that related to key issues for psychologists about reimbursement, integrated health care, guidelines and electronic health records.
As Medicare’s Physician Quality Reporting System (PQRS) continues to evolve, APAPO is working to ensure psychologists who participate in Medicare are aware of the program’s changing requirements and new processes in order to avoid financial penalties in future years. Starting in 2015, the Centers for Medicare and Medicaid Services (CMS) will begin imposing penalties for eligible providers who did not successfully participate in 2013.
APA Practice provided information for practitioners in Medicare who were required to begin using the new CMS-1500 claim form by April 1, 2014. Providers could use either version of the form until March 31, but payers will no longer accept the old form, version 08/05, after April 1.
APAPO is considering collaborating with state psychological associations on class action litigation that would include patients (and/or psychologists representing the interests of their patients) as plaintiffs who have faced violations of the federal mental health parity law. The APA Practice Organization (APAPO) is looking to identify potential plaintiffs for class action litigation who have experienced denials of mental health care coverage in violation of that law.
The Clinical Practice Guidelines initiative is jointly overseen through the Science and Practice directorates. The Practice and Science directorates managed the nomination process to fill vacancies on the Advisory Steering Committee and the obesity guideline development panel in February. Barbara L. Andersen, PhD, was nominated to serve on the Advisory Steering Committee for Development of Clinical Practice Guidelines of the American Psychological Association (APA) and Caroline Jhingory was appointed to the obesity guideline development panel in February.
The PTSD guideline development panel met in May, and had an in-person meeting July 13-14 to begin drafting recommendations, the first of the three guideline development panels to do so.
A workshop at the March 2014 State Leadership Conference focused on the growing impact of clinical practice guidelines. Andrew Bertagnolli, PhD, senior manager for the Integrated Behavioral Health Care Management Institute at Kaiser Permanente, Rhonda Robinson Beale, MD, former chief medical officer for external affairs at OptumHealth Behavioral Solutions, and Arthur C. Evans, PhD, commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services presented on their experiences using clinical practice guidelines.
APAPO-PAC, the political action committee for the APA Practice Organization, launched a new blog in June to keep psychologists up-to-date on the PAC’s political advocacy efforts. The PAC released a midterm election update and preliminary analysis of key races in the House and Senate that could affect psychology’s legislative advocacy agenda.
APAPO-PAC’s redesigned website was launched in time for the 2014 annual APA convention, Aug. 7-10. The redesigned site includes information on key issues and a voter guide for those interested in legislative advocacy efforts on behalf of the practice of psychology and education in psychology.
On Jan. 28, 2014, the American Psychological Association provided testimony in a virtual hearing sponsored by the Health Information Technology Policy Committee (HITPC) of the Office of the National Coordinator for Health IT (ONC). The hearing addressed a potential new ONC-sponsored program that would allow for the certification of electronic health records (EHR) products for behavioral health settings, with a goal of improving coordination of care across the health care continuum. APA noted that a voluntary certification process could benefit psychologists by providing additional tools and resources to help providers choose EHR systems, and could further collaboration with primary care providers by helping psychologists select a system that is truly interoperable.
APAPO created a new section on the Practice Central website called Practitioner Pointers that provides answers from APA Practice staff to common inquiries from members about issues that affect practice. The first two Practitioner Pointers developed are:
To augment guidance provided in the Spring/Summer 2014 issue of APAPO’s Good Practice magazine, APAPO has created additional resources for psychologists getting started with creating a professional will. Resources include a sample professional will, further instructions and considerations, and a sample list of information for professional executors.
On June 25, the governor of Illinois signed legislation (SB 2187) authorizing licensed clinical psychologists, with advanced, specialized training, to prescribe certain medications for the treatment of mental health disorders. Illinois is the third state in the country to grant prescription privileges to psychologists, joining New Mexico and Louisiana. APAPO provided financial support to the Illinois Psychological Association through legislative and emergency grants as well as strategic/technical support through ongoing staff consultations.
The 2014 Stress in America survey was released Feb. 11 by APA. Findings from the survey, which was conducted online by Harris Interactive Inc. (on behalf of APA) among 1,950 adults and 1,018 teens in the U.S. in August 2013, suggest that unhealthy behaviors associated with stress may begin manifesting early in people’s lives, and that teens report experiences with stress that follow a similar pattern as adults. Accompanying the survey launch, APA released an informative animated video entitled "Conquering your stress" which has been viewed more than 36,000 times as of July 2014. The survey findings were reported in major news outlets such as USA Today, Time magazine, CBS News, NPR and Huffington Post.
In recognition of Mental Health Awareness Month in May, the APA Practice Directorate put together a range of resources, including fact sheets on how psychologists help patients manage a range of chronic conditions, for psychologists to use with patients, clients and in community outreach.
According to results from a recent APA surveyopens in new window (PDF, 652KB), only four percent of Americans say they are aware of the Mental Health Parity and Addiction Equity Act, which was passed in 2008. To help patients understand mental health parity, APA developed free resources, including a consumer guide and a new informative videoopens in new window to educate the public about their mental health coverage. The materials are available on the Psychology Help Center to APA members and state psychological associations for distribution to patients and others in your community.
“Getting a good night’s sleep: How psychologists help with insomnia” is the latest in a series of fact sheets about how psychologists can help patients manage a range of chronic health conditions. APA and the APA Practice Directorate offer fact sheets on a variety of topics which can be downloaded by members for distribution to clients and for public education purposes. The fact sheets include a downloadable version for printing and distribution through psychologists’ offices or public education activities. Select fact sheets are available in packets of 50 for free to APA members. To order packets, visit the Psychology Help Center.
As part of a new partnership between APA and the National Parent Teacher Association (PTA), materials were created to provide families with resources and tips on emotional and behavioral health issues. Resources include a webinar on “How to Tell If Your Kid Is Struggling Emotionally” and a tip sheet, “Talking With Kids When They Need Help.”
Psychologists in the Massachusetts Disaster Response Network (DRN) and other mental health professionals from the Massachusetts Red Cross Disaster Mental Health (DMH) activity were invited to join the Boston Athletic Association's Medical Team in offering care at the first anniversary of the Boston Marathon bombing on April 21. To increase the availability of psychological support at the marathon, approximately 20 DRN members were at posts in medical tents or at the finish line starting at 7 a.m. on race day to offer assistance to runners and staff.
Psychologists Mary M. McCrae, PhD, Glenn L. Pollack, PsyD, and Donna M. Hastings, PsyD, were chosen by the American Red Cross to offer disaster mental health assistance beginning May 16, 2014, during the opening week of the 9/11 museum in NYC. The New Hampshire Disaster Assignment Support from Home (DASH) team, created by Hastings, also offered phone, text and email support to Red Cross mental health volunteers working at the museum.
Psychologists also responded to local incidents including the devastating mudslide in Oslo, Washington, in March, tornadoes near Little Rock, Arkansas, in April and preparations for the first hurricane of the season “Arthur” in North Carolina and Virginia over the July 4 holiday weekend.
APA's Disaster Response Network (DRN) is a group of approximately 2,500 licensed psychologists across the U.S. and Canada who have expertise in the psychological impact of disasters on individuals, families and communities. Informed by psychological research, DRN members voluntarily engage in preparedness, response and recovery activities. To find out more about your state or provincial DRN program and how you can become involved, please contact the APA DRN Officeopens in new window.