Introduction

Aug. 30, 2012—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 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 was created in 2001 as a 501(c)6 organization under IRS rules to enable 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 2012 to July 2012.

Convening the 29th annual State Leadership Conference

Nearly 500 psychology leaders participated in workshops, symposiums and networking opportunities at the 29th annual State Leadership Conference in Washington, D.C. March 10-13. On the final day of the conference, attendees took three key advocacy messages to the Hill and shared them in more than 300 meetings with members of Congress and staff: 

Playing an active role in health care reform and parity implementation

Much of the hard work of health care reform implementation will be carried out at the state level. Psychologists must be prepared to take advantage of developing opportunities, and state psychological associations must take an active role in directing and supporting the advocacy activities of their members. To this end, the theme of the March 2012 State Leadership Conference (SLC) held in Washington, D.C., was “Bringing Psychology to the Table: State Leadership in Health Care Reform.”

In February, the APA Practice Organization co-authored a comment letter from the Mental Health Liaison Group (MHLG) to the Department of Health and Human Services (HHS) regarding the federal agency’s proposed approach for health benefits rulemaking under the Patient Protection and Affordable Care Act (ACA). The focus of the letter was a December 2011 bulletin from HHS related to defining Essential Health Benefits (EHB) in state-level insurance plans.

The comment letter showed strong and broad support for upholding mandates embodied in the federal parity law. APA and its 57 co-signers thanked HHS for following through on the intent of the ACA that all exchange plans must include mental health and substance use disorder benefits and that they be provided at parity with medical/surgical benefits.

But the co-signers lamented the decision by HHS not to develop a national standard and addressed several concerns, including seeking further definitions that would shore up important consumer protections. For example, the coalition recommended HHS protect against restrictive access to services and reject insurance guidelines that fail to consider the individual needs of a beneficiary. The letter also urged the department to limit benefit design flexibility in the states so as not to lose the protection of existing state laws governing mental health coverage.

The APA Practice Organization’s State Implementation of Health Care Reform initiative works to generate resources and expertise that state psychological associations can use to position psychology for maximal participation in health care reform within their states. In March and May, Dr. Nordal addressed health care reform summits sponsored by the state psychological associations of North Carolina and Idaho, respectively.

Supporting medical staff membership for psychologists
In May, The Centers for Medicare and Medicaid Services (CMS) released new requirements for hospital participation in Medicare and Medicaid that maintain support for hospital medical staff membership for psychologists. The updated rules, which are consistent with an APA Practice Organization (APAPO) comment letter submitted to CMS in December 2011, state that the medical staff must include doctors of medicine or osteopathy and “in accordance with state law, including scope-of-practice laws…may also include other categories of non-physician practitioners determined as eligible for appointment by the governing body.”
Pursuing advocacy and education on behalf of professional psychology’s inclusion in incentive payments for electronic health records

On June 27, Representative Tim Murphy (R-PA) introduced The Behavioral Health Information Technology (BHIT) Act, legislation to extend eligibility for health information technology incentive payments to mental and behavioral health professionals and facilities. Similar to bipartisan legislation already introduced in the Senate by Sheldon Whitehouse (D-RI), the bill (S 539 / HR 6043) would amend the Health Information and Technology for Economic and Clinical health (HITECH) Act of 2009 to support mental and behavioral health by enabling psychologists and social workers to qualify for Medicare and Medicaid incentive payments for integrating electronic health records into their practices. It would also extend this eligibility to nationally accredited community mental health centers, residential mental health facilities, outpatient mental health treatment facilities and substance use facilities.

Recognizing mental health professionals as eligible “meaningful users” under the law would promote integration of psychology and mental health in primary care settings, reduce adverse drug interactions, reduce duplicative tests and provide necessary information to the emergency department at hospitals to triage patients more effectively.

Also related to the evolution of electronic health record keeping: 

  • APA Practice Directorate staff attended the second consensus-building meeting at the Substance Abuse and Mental Health Services Administration (SAMHSA) on April 13. The goal of these meetings is to begin constructing a framework for operating standards for behavioral/mental health in electronic health records, with the intention that behavioral health is seen as an integral component of health information technology. 

  • In meetings with members of Congress and their staff, attendees of SLC conveyed APA’s key advocacy message that Congress should make psychologists eligible for incentive payments through the HITECH Act. 

  • APA members and staff led a workshop at the 2012 State Leadership Conference (SLC) entitled, “Electronic Health Records in Practice: What Are They? What Should You Know, What is APA Doing?” 

  • The winter 2012 issue of Good Practice magazine included an article entitled, “Charting the Course of Electronic Health Records.”

Seeking appropriate Medicare reimbursement for psychological services

On Feb. 17 Congress passed the Middle Class Tax Relief and Job Creation Act of 2012. The new law signed by President Obama averts the Medicare Sustainable Growth Rate (SGR) payment cut of 27.4 percent scheduled to take effect on March 1 for the remainder of 2012. However, the legislation failed to include a provision to extend a Medicare psychotherapy payment boost of five percent, despite active advocacy by the APA Practice Organization (APAPO) and grassroots psychologists throughout the U.S. As a result, psychologists and other mental health professionals experienced a 5 percent decline in reimbursement for Medicare outpatient psychotherapy services beginning March 1.

The Centers for Medicare and Medicaid Services (CMS) slashed Medicare psychotherapy payment rates as part of its Five-Year Review in 2006. Since that time, due to persistent pressure from the APA Practice Organization and grassroots psychologists, professional psychology has succeeded in gaining four laws that restored 5 percent of the payment. Two-thirds of the resulting $110 million in Medicare psychotherapy reimbursement accrued to psychologists before the February 2012 law was enacted.

In late April, APA was one of the only non-physician organizations approached by the House of Representatives Committee on Ways and Means as part of its effort to review value-based measures and practice arrangements to look for ways of changing payments to improve health outcomes and efficiencies in the Medicare program. The committee asked for comments and data on a series of questions dealing with rewarding quality and efficiency, alternative payment methods and patient involvement and regulatory relief. On behalf of both APA and APAPO, APA CEO Norman Anderson, PhD, and APA Executive Director for Professional Practice Katherine C. Nordal, PhD, wrote a May 25 letter (PDF, 362KB) urging the Ways and Means Committee and the Centers for Medicare and Medicaid Services to replace the flawed Medicare Sustainable Growth Rate (SGR) formula and alter the existing payment formula that reimburses expensive technology-based specialty services at a higher rate than lower-cost mental health and primary care.

Challenging inappropriate health insurance company and managed care practices

On July 6, the APA Practice Organization (APAPO) and ten state psychological associations sent a letter to the federal agencies that regulate parity, the Departments of Health & Human Services, Labor and Treasury. The letter asserts that unprecedented rate cuts over the last few months by Humana and its behavioral health subsidiary LifeSynch violate the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

In an April 4 letter to the Illinois Department of Insurance, APAPO and the Illinois Psychological Association (IPA) requested investigation of an apparent parity violation by Humana and its subsidiary LifeSynch regarding the companies’ rate cut in Illinois. That letter was sent before the latest round of Humana cuts that prompted the July 6 letter.

In a March 23 letter to the Florida Office of Insurance Regulation (FLOIR), APAPO and the Florida Psychological Association (FPA) addressed urgent concerns with Blue Cross Blue Shield of Florida’s (BCBS FL) including the company’s failure to pay psychologists for more than three months. Some of these concerns arose from the company’s rate cut last year that prompted APAPO and FPA to write to the federal parity regulators asserting a parity violation.

Key mental health groups supported the letter: National Alliance on Mental Illness (NAMI), NAMI Florida, Inc., Mental Health America, American Academy of Child and Adolescent Psychiatry, and the TeenScreen National Center at Columbia University.

The letter was bolstered by data from an informal survey of more than 500 patients and providers launched in February 2012 on which APAPO and FPA had collaborated with the American Psychiatric Association and some of the mental health groups listed above. The survey was aimed at gauging the impact of BCBS FL’s drastic changes to its mental health and addiction recovery services in order to provide information to legislators and enforcement agencies.

Some of the APAPO letters discussed above have resulted in agency investigations which are currently ongoing. The agencies have indicated that they can better perform their investigation outside of the spotlight and accordingly have asked that we not provide details regarding the investigation to our membership. We will provide further information when we are able to do so.

Advocating for inclusion of psychologists in the Medicare definition of “physician”
Inclusion of psychologists in the Medicare definition of “physician” continues to be a priority. Bills sponsored by Sen. Snowe (S. 483) and Rep. Schakowsky (HR 831) to include psychologists in the definition have gained bipartisan support. This effort was bolstered by the 2012 State Leadership Conference, during which psychology leaders held more than 300 meetings with their members of Congress and staff, generating positive feedback about professional psychology’s initiative. Thanks in part to activation of an enhanced advocacy tool (see next section) APAPO secured six new House co-sponsors for HR 831.
Enhancing legislative advocacy by grassroots psychologists
On May 1 APAPO implemented an enhanced software program to more efficiently communicate with and mobilize grassroots psychologists in legislative advocacy. As part of a nationwide mobilization launched in June to persuade to persuade Congress to include psychologists in Medicare’s “physician” definition, grassroots psychologists have to date sent more than 30,400 messages to their legislators on the issue, compared to approximately 13,000 emails about this issue sent in all of 2011.
Playing an active role in treatment guidelines development and promotion
Staff in the Practice and Science Directorates collaborate in managing the APA effort to develop treatment guidelines, including providing staff support to the Advisory Steering Committee for the Development of Treatment Guidelines (ASC). The ASC was appointed by the Board of Directors and reports as well to the Board of Professional Affairs, Board of Scientific Affairs, and the Committee for the Advancement of Professional Psychology. Thus far in 2012, the ASC has selected the members of a guideline development panel for depressive disorders and has received nominations for panels for PTSD and for obesity. The ASC, with staff assistance, has also developed further the policies and procedures by which guidelines will be developed. In addition, the ASC and staff have made progress toward selection of the outside entities that will provide the systematic reviews of scientific literature that will underpin guideline development.
Participating in psychotherapy codes survey

The APA Practice Organization has been involved in a complicated and highly confidential process of reviewing and revising the CPT psychotherapy codes and surveyed psychologists to help establish work values for the revised codes. A random sample of approximately 1400 psychologists was invited to take the American Medical Association (AMA) survey online. In addition, approximately 100 psychologists attending the State Leadership Conference March 10-13 participated in a “convenience sample.”

The survey portion of the AMA/Specialty Society Relative Value Scale Update Committee valuation process for the psychotherapy codes is now complete. The Relative Value Update Committee (RUC) will use the AMA survey data to determine values for the codes. After that, CMS will decide whether to accept the RUC’s recommended code values when it sets the 2013 Medicare reimbursement rates, which may ultimately affect rates throughout the private sector as well.

Affirming psychology’s role in behavior analysis for autism
At its February 2012 meeting, the APAPO Board approved a Statement on Behavior Analysis and Behavior Analysts which includes the following: "[Q]ualified licensed psychologists should be allowed to provide behavior analysis and to call the services they provide "behavior analysis" or "applied behavior analysis” without obtaining additional credentials or licensure.” This APAPO Board statement provides support for state-level advocacy that promotes consumer safety and protects psychology’s scope of practice. The Practice Directorate is continuing to monitor legislation in this area and to provide resources and consultation to state psychological associations. In addition, a governance-staff workgroup has been convened and is working to develop legislative priorities and to enhance communication and collaboration with interested groups both inside and outside psychology.
Developing telehealth guidelines for psychologists
APA is part of the Joint Task Force on the Development of Telepsychology Guidelines for Psychologists, which is working to develop guidelines for the professional use of technology in the delivery of psychology services. It is anticipated that the Joint Task Force's draft guidelines will be available for public comment in late summer 2012 and included on the Board/Committee Cross-Cutting Agenda during the fall consolidated meetings.
Meeting the needs of service members, veterans and their families

In April, the 2012 VA Psychology Leadership Conference brought together more than 200 Department of Veterans Affairs psychology leaders to share best practices and promote leadership opportunities. The theme of this year’s conference was “VA Psychology Advancing the Transformation: New Directions and Technologies for Care.”

APA continues to partner with Give an Hour, with the Practice Directorate helping spread the word about their mission, commitment and the process by which psychologists can volunteer their services to military personnel and their families.

Educating the public about psychology and the value of psychological services

The Practice Directorate in collaboration with the Science Directorate worked on an APA survey on willpower released in mid-February in conjunction with the report, “What You Need to Know about Willpower: The Psychological Science of Self-Control.” The survey found that 93 percent of Americans made a resolution to change some aspect of their behavior in 2012. Yet people consistently report that a lack of willpower is the top reason they fall short of their goals to lose weight, save more money, exercise or make other lifestyle changes. Conducted online on behalf of APA by Harris Interactive among 566 adults in December 2011, the survey is a continuation of APA’s annual Stress in America™ poll, which found that many Americans report lack of willpower as a significant barrier to achieving their goals. The willpower survey and report were covered in stories by USA Today and the Wall Street Journal radio network.

The Practice Directorate worked on an APA workplace survey released in March in which half of all employees who say that they do not feel valued at work report that they intend to look for a new job in the next year. Conducted online among 1,714 adults between Jan. 12 and 19, 2012 on behalf of the APA by Harris Interactive, the survey was released in tandem with the 2012 Psychologically Healthy Workplace Award winners. David Ballard, PsyD, MBA, assistant executive director of marketing and business development, recorded 15 radio interviews on the survey, airing 7,520 times and reaching 14.5 million listeners.

On May 16, bloggers from around the world came together to blog about mental health as part of APA’s third annual Mental Health Blog Party. The party — a virtual event where bloggers wrote on a particular topic to promote a specific cause — generated more than 120 blog posts from throughout the United States and abroad in one of the many events held by APA in support of Mental Health Month.

Affirming the value of psychologically healthy workplaces

In recognition of employers who understand the link between employee well-being and organizational performance, the American Psychological Association honored eight organizations at its seventh annual Psychologically Healthy Workplace Awards in Washington, D.C., on March 10.

APA’s Psychologically Healthy Workplace Program presented its 2012 Work & Well-Being Conference June 28 in Chicago. Designed for employers and the psychologists who work with them, the conference offered sessions that provided practical, relevant information to help employees and organizations thrive.

Providing psychological support through the Disaster Response Network
In 2012, Disaster Response Network members, working as Red Cross Disaster Mental Health volunteers, provided psychological support following Tropical Storm Debby in June, wildfires in several western states in June and July, and tornadoes across several central states in January through March. British Columbia DRN members were activated to support community members following two consecutive saw mill explosions in northern British Columbia in January and April. DRN members helped the Chicago Red Cross chapter strengthen and expand its disaster mental health teams in advance of the May NATO Summit. Acknowledging the start of hurricane season, the DRN program published an entry on the Your Mind Your Body blog on how to prepare psychologically for hurricanes and other disasters. Throughout the year DRN members and staff continued to further our partnership with the American Red Cross on both a local and national level. A presentation entitled “Disaster Response: Helping Communities Plan for, Respond to, and Recover from Disasters” was prepared for and delivered at the 30th International Congress on Psychology in Cape Town, South Africa in July.
Debuting PsycLINK on APA Communities
Since its August 2010 release, PsycLINK: The Practice Wiki has brought members together to share resources, material and experiences germane to clinical practice. The platform has also encouraged discussion regarding contemporary policy issues relevant to psychological science. Beginning the last week of February 2012, APA members have had access to PsycLINK on APACommunities.org through their APA online account. The revamped PsycLINK offers new tools: Users can now start a blog on the wiki and post polls, as well as track progress and assign tasks when collaborating with fellow APA colleagues on research or other projects.