Professional psychology confronts roadblocks on legislative advocacy path

APAPO continues to advance key issues related to SGR, the Medicare physician definition and electronic health records.

By Government Relations staff

Professional psychology has continued pressing forward on the legislative advocacy front in the couple of months since the March 2013 State Leadership Conference (SLC) when nearly 500 psychology leaders convened in Washington, D.C. Even so, political wrangling and inertia on Capitol Hill, combined with fiscal realities, continue to make it difficult for psychology to advance its top legislative priorities:

  • Halting plummeting Medicare reimbursement by fixing the payment formula, including repealing the Sustainable Growth Rate (SGR)
  • Passing bills to include psychologists in Medicare's "physician" definition, thereby removing inappropriate supervision requirements for psychologists and enhancing Medicare beneficiary access to psychological services, and
  • Making psychologists eligible for Health Information Technology for Economic and Clinical Health (HITECH) Act incentive payments for adopting electronic health records

During the 2013 SLC in mid-March, a record 339 meetings took place on Capitol Hill with psychology leaders from across the country and their members of Congress and staff. Reports from these meetings have facilitated APA Practice Organization (APAPO) follow-up with congressional offices on key legislative issues.

Psychology leaders reported that in 66 percent of their Capitol Hill visits, members of Congress indicated that they were either very supportive or supportive of repealing the SGR. Similarly, 55 percent of members were very supportive or supportive of psychology's position that the Medicare payment formula must be fixed.

Staff for APAPO have met with members on key House and Senate health committees with Medicare jurisdiction to discuss the Medicare payment formula. The meetings during SLC involving members of Congress and their psychologist-constituents greatly boosted APAPO's efforts. Professional psychology has gained considerable attention to the need to address the Medicare payment formula issue.

More on the SGR

A major factor influencing Medicare payment levels is the SGR. Every year, Congress must decide whether to let the SGR formula take effect. APAPO's advocacy, along with that of other health and mental health provider organizations, averted a drastic 26.5 percent cut from taking effect in January 2013. Even so, the legislative action that forestalled the cut simply postponed the payment reduction. A 25 percent Medicare cut is scheduled for January 2014 if the SGR remains in place.

APAPO continues to urge the Congress to replace the SGR formula with a more realistic way of addressing increasing Medicare costs. There's a recent ray of hope in this effort: The Congressional Budget Office drastically reduced the estimated cost of repealing the SGR formula from $310 to $138 billion. With the new score comes greater possibility that Congress may find the money to discontinue the SGR.

At present, the House Ways and Means and Energy and Commerce Committees are taking the lead on SGR repeal with a model that would end it, provide a period of "stable" though as yet unidentified payment updates (probably no or only slight increases in rates), create a system of payment based on quality measures, and later add provider efficiency, meaning providers who do well based on their performance score on quality measures and clinical improvement activities, as a criterion for additional payment. Throughout the process, the committees will be looking for ways to encourage providers to adopt alternative delivery models such as accountable care organizations (ACOs).

As a result of our meetings with committee leadership, members and their staffs about the SGR over the past year, the committees invited APAPO to submit comments on their proposal — which APAPO shared in an April 11 letter. Our comments focused on the need to repeal and replace the SGR, and the challenges of applying quality measures to mental and behavioral health services.

Medicare physician definition

In addition to our legislative advocacy focused on halting declining Medicare payment rates, including psychologists in the Medicare "physician" definition remains a top priority. Gaining this priority would enable psychologists to practice to the full extent of their licensure, without unnecessary physician supervision, in providing services to Medicare beneficiaries.

Jan Schakowsky (R-IL) reintroduced her bill (H.R. 794) on February 15 to include psychologists in the physician definition. With the help of grassroots psychologists, APAPO has been working on building co-sponsors — gaining new co-sponsors as well as securing those who sponsored the Schakowsky bill in the last Congress. Guided by the results of recent SLC visits to Capitol Hill, APAPO lobbyists have held many meetings on Capitol Hill with prospective co-sponsors. Reports from the SLC visits indicated that 51 percent of members were very supportive or supportive of co-sponsoring the Medicare physician definition bill to include psychologists.

In the Senate, Sherrod Brown (D-OH) has committed to taking over for retired senator Olympia Snowe as the lead sponsor of a bill to include psychologists in the Medicare definition of physician. Like Snowe, Sen. Brown is a key member of the Finance Committee.

Though professional psychology actively presses ahead, moving provider-specific Medicare legislation in a Congress looking to restructure the entire program is challenging.

Electronic health records

With regard to electronic health records (EHR), APAPO continues to pursue financial incentive payments for psychologists to invest in EHR since these systems represent the future of health services delivery. Incentive payments already are available to providers included in the Medicare definition of "physician," and APAPO is seeking these incentives for psychologists.

APAPO is working is coalition with community mental health centers, social workers, residential mental health facilities and psychiatric hospitals. Incentive payments can be significant — approximately $64,000 over five years.

Rep. Tim Murphy (R-PA) and Sen. Sheldon Whitehouse (D-RI) have signaled that they will soon reintroduce their bills from the last Congress. Professional psychology enjoyed substantial bipartisan support during the past two years, but pending legislation faces significant challenges.

The first obstacle is cost. Adding new categories of providers to eligibility for incentive payments will increase Medicare costs at a time when Congress is looking to contain costs. In addition, although physicians are adopting EHR, some Republican Senators are questioning whether the current incentive payment system is working to make interoperable electronic health records a reality.

We will continue keeping APAPO members informed about significant developments related to our legislative advocacy priorities.