Introduction

Feb. 28, 2013—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. 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. APAPO is housed administratively in the Practice Directorate.

Following are brief highlights of selected Practice Directorate activities and significant developments from August 2012 to January 2013, including key activities of both the APA Practice Directorate and the APA Practice Organization.

Preparing psychologists for new psychotherapy billing codes

Beginning Jan. 1, psychologists and other mental health professionals were required to use new CPT® code numbers for psychotherapy when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid and private health insurance carriers. APA was actively involved in the Centers for Medicare and Medicaid Service’s (CMS) Five-Year Review process to review current psychotherapy codes and recommend changes. Psychology’s representatives fought continuously to protect the profession’s interests throughout the code review process.

The APA Practice Organization continues to provide members with extensive information and resources to ease the transition to new psychotherapy codes. A 2013 Psychotherapy Codes for Psychologists section was added to the APA Practice Organization’s Practice Central website with resources including code lists, articles and answers to frequently asked questions from members. The new psychotherapy section can be accessed directly on the Billing and Coding webpage. As of Feb. 7, 2013, the section had generated more than 360,000 page views since its creation in Sept. 2012. Section content includes:

Playing an active role in health care reform and parity implementation

For the second year in a row, health care reform will be the theme of the annual State Leadership Conference to be held March 9 – 12 in Washington, D.C. Former administrator of the Centers for Medicare & Medicaid Services and former commissioner of the Food and Drug Administration Mark B. McClellan, MD, will be the keynote speaker. Workshops will cover topics such as innovative practice models, psychotherapy codes, integrated care in hospital settings and electronic health records. On the final day of the conference, attendees will take three key advocacy topics to meetings with members of Congress and staff on Capitol Hill:

  • Inclusion of psychologists in Medicare’s “physician” definition 

  • Psychologist eligibility for incentive payments in the Health Information Technology (HITECH) Act 

  • Medicare reimbursement for psychological services

As part of ongoing advocacy related to implementation of health care reform under the Patient Protection and Affordable Care Act (ACA), APA submitted comments in Dec. 2012 to the Centers for Medicare and Medicaid Services (CMS) in support of the proposed rule on standards related to essential health benefits (EHB). APA’s comment letter expressed support for CMS’ recommendation that the requirements under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) be used to satisfy EHB requirements. The letter also requested that CMS require strict adherence to the federal parity law as one criterion when evaluating states’ benchmark plans.

Millions of consumers are expected to move into the Medicaid system as the Affordable Care Act is implemented. The Practice Directorate has identified that, although additional psychologists will be needed in Medicaid and there are opportunities for the expansion of psychological services, several barriers to psychologist participation and reimbursement must be confronted. The Practice Directorate engaged a law firm with expertise in health care law to analyze and prepare a sampling of challenges to psychological services delivery in five states, as well as opportunities for overcoming those challenges. The result was an informational chart which overviews restrictive state provisions related to independent provision of services, scope of practice, reimbursement for services provided under supervision, payment for Health and Behavior (H&B) CPT® codes, same-day billing and telemedicine services.

APA participated on an International Advisory Council for CARF International, an independent, nonprofit accreditor of health and human services programs, to help with the development of standards for the accreditation of health homes. APA’s Aug. 2012 comments on the proposed health home standards, most of which were accepted, were aimed at making sure the language was inclusive of psychological services. APA also provided comments that promoted the integration of mental and behavioral health services in NCQA’s Patient-Centered Medical Home standards, which were released in 2012.

Supporting and partnering with state psychological associations to advance health care reform

As health care reform moves forward under President Obama and the Affordable Care Act (ACA), the hard work of implementation is taking place primarily at the state level. To help members become informed and get involved, the Practice Directorate launched an initiative in fall 2011 focused on state implementation of health care reform. 

APA Executive Director for Professional Practice Katherine C. Nordal, PhD has attended health care reform summits in 10 states, with more summits by state psychological associations planned for 2013.

Also part of this initiative, an APA Practice Health Care Team comprised of key Practice Directorate staff and an external advisory group representing various practice-related constituencies began using APA’s online professional collaboration tool “APA Communities” to connect state leaders with resources on health care reform. The APA Practice Initiative on State Implementation of Health Care Reform created a group on APA Communities in late 2012 to serve state leaders as a central hub for information containing resources geared toward psychology in health care reform. The State Health Care Reform Group on APA Communities contains downloadable reports, issue briefs, journal articles and other publications that address mental health and health care reform, as well as a discussion forum and real-time alerts about newly-added resources or discussion threads.

Seeking appropriate Medicare reimbursement for psychological services

The APA Practice Organization and many other health care organizations advocated aggressively to prevent the drastic 26.5 percent Sustainable Growth Rate (SGR) cut from going into effect on Jan. 1. Congress finally enacted the “American Taxpayer Relief Act” (HR 8) on Jan. 2, 2013 which blocked the cut through 2013 and delayed through early March an additional across-the-board cut to all Medicare provider payments of up to two percent.

The Medicare final fee schedule which was released in November 2012 projected a 2 percent average reduction in payments to psychologists for 2013 in addition to the cuts scheduled to go into effect in March. Prior to the release of the final rule, APA submitted an August 2012 comment letter to the Centers for Medicare and Medicaid Services (CMS) took strong issue with the fact that psychologists would be ineligible for reimbursement under the proposed new “transitional care management” (TCM) services code. The comment letter also expressed “strong concerns” that the language in two of the proposed new quality reporting measures in the Physician Quality Reporting System for 2013 failed to recognized psychologists’ scope of practice and threatened their ability to successfully participate in PQRS for 2013. Both measures involve timely follow-up to the coordination of care for adult patients with major depressive disorder who have co-morbid conditions. The APA letter specified revisions to the wording of the two measures needed to reflect the services that psychologists provide. That language of one measure was changed to the term “clinician” rather than “physician” so that psychologists are eligible to report for that measure.

Preparing members for participation in Medicare quality reporting program

Since 2007, Medicare has offered bonus payments to practitioners who participate in the Physician Quality Reporting System (formerly the Physician Quality Reporting Initiative). Beginning in 2015, practitioners who do not participate in the reporting program will face payment penalties of 1.5 percent in 2015, and 2 percent in 2016. To help psychologists avoid payment penalties, the APA Practice Organization has published a number of resources to educate practitioners about the program and help them begin participating in 2013:

  • A Dec. 19 PracticeUpdate article “Getting started in Medicare quality reporting: Resources for practitioners” compiled a set of resources for psychologists participating in PQRS for the first time. 

  • The winter 2013 issue of Good Practice magazine contained a step-by-step guide for new participants called “Critical Update: Quality Reporting for Medicare Providers in 2013.” 

  • APA Practice Organization staff created a video called “The Physician Quality Reporting System: An update for 2013,” the third video in a series on participating in the PQRS program.

Challenging inappropriate health insurance company and managed care practices

On Dec. 7, 2012, Aetna agreed to a proposed $120 million settlement of a class action lawsuit filed by psychologists, other health care professionals and patients in federal court in New Jersey. The APA Practice Organization (APAPO) has collaborated on the lawsuit with the New Jersey Psychological Association (NJPA), a named plaintiff in the case, since 2009. The APA Practice Organization will provide detailed guidance for members on how and when to submit claims at the appropriate time.

The APA Practice Organization has been collaborating with 11 state psychological associations to challenge unprecedented rate cuts by Humana. On Nov. 2, 2012 the APA Practice Organization and the Illinois Psychological Association sent a letter the Illinois Department of Insurance (DOI) providing detailed arguments to counter Humana’s position that the federal mental health parity law does not apply to provider reimbursement.

APAPO and the collaborating state psychological associations launched a survey to gather data on the effect of rate cuts on network participation and subscriber access to care. Information from the survey will be used in advocacy with the Illinois DOI, other federal and state agencies and interested legislators.

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 clinical practice guidelines (formerly referred to as 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 BPA, BSA and CAPP. The ASC has selected members of the guideline development panels (GDPs) for depressive disorders, obesity and post-traumatic stress disorder (PTSD).

The GDP for depressive disorders held its first formal meeting in December 2012. The other GDPs will meet in 2013. 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.

Pursuing advocacy and education regarding electronic health record keeping by professional psychologists
As part of the Practice Directorate’s ongoing efforts to educate psychologists about electronic health recording in their practices, the Practice Directorate created a video primer for practitioners which provides an introduction to basic terminology related to Electronic Health Records (EHRs), dispels some common myths about EHR systems and underscores the benefits for psychologists of using EHRs in professional practice. Additional practical guidance is planned for 2013.
Educating the public about psychology and the value of psychological services

The Practice Directorate’s annual Stress in America survey was conducted online by Harris Interactive in August 2012, and results were released during a press webinar on Feb. 7, 2013. This year’s survey looked more broadly at the relationship between health care, stress and behavior to better understand how people’s behavioral health needs could be better supported in the US health care system. Early coverage of the report was featured on USA Today and detailed information is available online at Stress in America webpage.

Countless studies over the past decade have shown a growing trend toward drug therapy as the most common course of treatment for people living with depression and anxiety. In an effort to balance that trend, the APA Practice Directorate launched a psychotherapy awareness initiative to educate consumers about psychotherapy’s effectiveness and encourage them to ask their physicians about it as a treatment option.

The psychotherapy awareness initiative consists of a multichannel communications effort including media outreach as well as digital and social media. APA has also introduced an animated video series, Psychotherapy: More Than a Quick Fix about a fictional miracle drug called “Fixitol.” The videos, which have been viewed more than 25,000 times on YouTube as of early February 2013, parody recent drug ads, drawing attention to the value of psychotherapy as a treatment option. Additionally, press and social media materials have been developed specifically for state, provincial and territorial psychological associations (SPTAs) and their Public Education Campaign (PEC) Coordinators to use for local public relations activities.

Beginning in the fall of 2012, the APA Help Center featured prominent links to the Psychologist Locator, an online service that connects consumers seeking psychological services with APA Practice Organization members. From January 2012 to January 2013, the number of APAPO members listed in the Locator increased nearly 20 percent.

Providing resources and support through the Disaster Response Network

As Superstorm Sandy headed toward the northeastern seaboard, psychologists with APA’s Disaster Response Network were among those who were prepared and ready to assist survivors. Disaster Response Network (DRN) members assisted on-site disaster workers in managing the communities completely destroyed by the Superstorm, many of which were without basic necessities. Through the association’s 20-year partnership with the American Red Cross, the DRN provided each state coordinator with updates from the Red Cross on disaster mental health training, recruitment and response.

DRN coordinators in New York and New Jersey, who are appointed by their state psychological associations, received guidance and consultation from the Disaster Response Network office. These coordinators participated in local planning meetings and asked their local members to help at Red Cross shelters and mobile emergency aid stations in the storm-ravaged areas. Available DRN members followed Red Cross deployment procedures to travel to and assist in relief operations, using handbooks, fact sheets, articles and outcome research from previous natural disasters. In states where the storm had less impact, the DRN programs were prepared to assist as needed.

As news of the tragic elementary school shooting in Newtown, Conn. broke, APA’s Disaster Response Network worked quickly to distribute resources to APA members and the public. Information on managing distress and ways to listen to and inform children about mass shootings was posted prominently on the APA website, sent out on listservs and distributed via social media sites. APA collaborated with the Connecticut DRN Coordinator and our partner, the American Red Cross, on response needs. APA used social media networks to disseminate information to the public quickly and efficiently, including the Psychology Help Center article “Helping your children manage distress in the aftermath of a shooting,” which was viewed by an estimated audience of more than four million within days of the shooting.