APA continues strong opposition to scope of practice limitations

At the close of the 109th Congress, a bill backed by organized medicine fails to gain traction in the House of Representatives

by Government Relations and Communications Staff

As the gridlocked second session of the 109th Congress draws to an end, a number of high priority issues for organized psychology remain unresolved, including the need to close loopholes in federal mental health parity legislation and to reduce substantial planned cuts in Medicare payment.

The fact that certain other legislative initiatives have stayed on the back burner of Congress’ agenda is good news for psychology. One such pending bill is H.R. 5688, known as the “Healthcare Truth and Transparency Act of 2006,” sponsored by Rep. John Sullivan (R-OK). There is no companion in the Senate to this House bill.

Earlier this year, APA Executive Director for Professional Practice, Russ Newman, PhD, JD, wrote to Rep. Sullivan to express the APA’s strong opposition to the bill. Supported by organized medicine, the bill would govern communications between non-physician health care professionals and consumers.

The Healthcare Truth and Transparency Act prohibits any licensed health care service provider who is not a medical doctor, doctor of osteopathic medicine, dental medicine or dental surgery from making any statement or engaging in any activity that misleads or deceives the public or a prospective or current patient into believing that such person is a doctor or has the same or equivalent education, skills or training. The bill requires the Federal Trade Commission to investigate health care providers who engage in such acts.

In his letter, Dr. Newman characterized the bill as unnecessary. Federal and state laws already exist to prohibit physician and non-physician health care professionals from engaging in deceptive or misleading acts related to their credentials, education and training. In addition, he noted, APA’s own "Ethical Principles of Psychologists and Code of Conduct" expressly prohibits such conduct by APA members.

Despite its intent to the contrary, this legislation would actually prevent consumers from receiving accurate information about psychologists. Notwithstanding the bill's prohibition against a non-physician health care professional representing that he or she has "equivalent education, skills, or training" to that of a medical doctor, Newman noted, psychologists have more training than physicians to prepare them for the services that they are licensed by state authorities to provide.

Further, Newman emphasized that the bill interferes with beneficial competition in the health care marketplace by putting physicians' financial interests ahead of consumer protection. The Health Care Truth and Transparency Act discriminately targets non-physician health care professionals and prevents them from providing important, accurate information to consumers. Physicians are not similarly limited by the bill.

State psychology leaders including Oklahoma Psychological Association (OPA) Executive Director Richard Hess, CAE, and Federal Advocacy Coordinator Stewart Beasley, PhD, shared concerns about the bill directly with Rep. Sullivan. Their communications began this past summer and included a face-to-face meeting in August with Rep. Sullivan in his Tulsa office.

According to Hess, the meeting was productive. He said that Rep. Sullivan invited suggestions from OPA for changes to the legislative language that they would consider satisfactory. During the same meeting, they thanked Rep. Sullivan for his support of federal mental health parity legislation as a co-sponsor of the Paul Wellstone Mental Health Equitable Treatment Act.

There has been no movement, such as committee hearings, on the Health Care Truth and Transparency Act in recent months. According to government relations staff in the APA Practice Directorate, there is no indication whether the bill will be reintroduced in 2007.

The bill enjoys the strong support of organized medicine. The American Psychiatric Association has publicly lauded the Health Care Truth and Transparency Act as "helping to safeguard patients from misleading claims by healthcare providers about qualifications and training." In its June 2006 press release, the national psychiatric association noted use of the term "medical psychologists" in Louisiana as "among the most egregious cases" of non-physician providers who have "failed to help settle patients' confusion over which providers offer which services." ("Medical psychologist" is a statutory term that applies to licensed psychologists in Louisiana who have gained the required additional training and credentials to prescribe psychotropic medications in collaboration with a patient’s primary care physician.)

Further, Newman noted that the American Medical Association’s support for the Healthcare Truth and Transparency Act is part of a much broader initiative targeting non-physician scope of practice. He emphasized that the APA remains unwavering in its opposition to efforts by organized medicine to limit non-physicians' scope of practice.

APA is one of 34 organizational members of the Coalition for Patient Rights (CPR). The group began forming earlier this year to ensure patient access to quality health care providers of their choice, while countering efforts by AMA Scope of Practice Initiative to limit such access.

Meanwhile, psychology advocates do not foresee Congress taking action toward passing the Healthcare Truth and Transparency Act. "The bill isn’t getting any traction," observes Doug Walter, JD, legislative and regulatory counsel for the APA Practice Organization, "That’s because most lawmakers see this legislative proposal for what it is – a turf issue for organized medicine."