Introduction

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 2013 to July 2013, including key activities of both the APA Practice Directorate and the APA Practice Organization.

Playing an active role in health care reform

With health care reform moving forward at the federal and state levels, the Practice Directorate is working to promote the role of professional psychology in a changing marketplace and protect consumer access to needed psychological services. 

One of the main objectives of the Affordable Care Act (ACA) is to expand access to affordable health care coverage to the approximately 45 million Americans who currently have no coverage. To achieve this goal, the ACA creates health insurance exchanges (HIEs) and calls for the expansion of state Medicaid programs. The APA Practice Directorate is educating members about what psychologists need to know about HIEs through a series of articles addressing topics from a basic overview of HIEs to qualified health plans and federally facilitated, state-partnership and state-based exchanges. APAPO has also worked with SPTAs on parity and reimbursement issues regarding states’ development of HIEs under the Affordable Care Act.

On Feb. 25, 2013, the Department of Health and Human Services (HHS) released the final rule on essential health benefits (EHB) for inclusion in health plans offered through HIEs. The final rule became effective on April 26, 2013. The APA Practice Directorate submitted comments to the Centers for Medicare and Medicaid Services (CMS) in support of the earlier proposed rule on standards related to EHB packages. As did the proposed rule, the final rule specifies mental health and substance use disorder services, including behavioral health treatment, among 10 required health insurance benefit categories. Further, the rule includes several additional  key elements that will have a positive impact on people with mental health and addiction disorders. 

With health care reform encouraging greater consolidation among health service professionals and organizations, the trend is toward integrating mental health, behavioral health and substance use services in all kinds of treatment settings. In March 2013, the National Committee for Quality Assurance (NCQA) launched a Patient-Centered Specialty Practice (PCSP) Recognition program, which recognizes specialty practices, including mental health practices, that can demonstrate successful coordination of care. The APA Practice Directorate submitted comments during the development phase of the PCSP program supporting the goals of enhancing communication and coordination between specialist care and primary care providers. In addition, we recommended specific changes to the proposed standards to ensure that psychologist-led practices, including small mental health practices, would be eligible. The program standards and policies now contain language that clearly allows for participation by psychologists.

Monitoring parity implementation to protect patient access to services

Despite passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, and expansion of its provisions through the Affordable Care Act in 2010, parity issues still impede patient access to needed psychological care. Since the interim final parity rule went into effect in February 2010, the APA Practice Directorate and APA Practice Organization (APAPO) have worked to ensure parity, focusing major efforts on the adverse impact on patient access to care and patient financial burden caused by certain reimbursement practices that companies appear to apply only to mental health care. 

On April 24, 2013 APAPO sent a letter to the Department of Health and Human Services (HHS) and the Department of Labor (Labor) thanking the administration for moving forward toward a final parity rule and also urging several changes in the final rule to make it more enforceable.

Meanwhile, the Practice Directorate urged practitioners to send stories of how parity issues are affecting patient access to HHS and the Department of Labor, as well as to Practice Directorate staff. APAPO  also conducted a brief survey about potential insurance company violations of the federal parity law, the Affordable Care Act and related state parity laws to help identify offending company practices, as well as whether patients have been subjected to improper denial of mental health treatment.

Providing input to congressional committees considering Medicare payment reform
APAPO was invited by the House Energy and Commerce and Ways and Means Committees and the Senate Finance Committee to address questions related to a congressional proposal to repeal the Sustainable Growth Rate (SGR) formula, a key element of Medicare payment. On April 11, APAPO submitted a letter to the House committees addressing several questions on quality improvement and measurement, provider participation in new payment models and changes that could be made to current law regarding health care delivery for Medicare beneficiaries. A May 29 letter from APAPO to the Senate Finance Committee discussed necessary reforms to the physician fee schedule; policies to ensure that health care providers’ services are valued appropriately; and ways that Medicare can effectively incentivize providers to make changes needed to participate in alternative payment models.
Supporting bills to include psychologists in the Medicare definition of ‘physician’
On May 23, Senator Sherrod Brown, D-Ohio, introduced a bill to include psychologists in the Medicare physician definition. S. 1064 would amend title XVIII of the Social Security Act to treat clinical psychologists as physicians for the purposes of furnishing clinical psychologist services under the Medicare program. The Brown bill and the companion bill introduced in the House by Rep. Jan Schakowsky, D-Ill., will allow psychologists to be treated like all other non-physician providers already included in the Medicare physician definition, thereby ending unnecessary physician supervision without increasing Medicare costs. APAPO staff has worked hard to gain 23 bipartisan cosponsors in the first four months since Rep. Schakowsky re-introduced her bill in February. The APAPO continues reaching out to additional prospective co-sponsors for both the House and Senate bills.
Convening the 30th annual State Leadership Conference
Approximately 500 psychology leaders participated in workshops, symposiums and networking opportunities at the 30th annual State Leadership Conference in Washington, D.C., on March 9-12. On the final day of the conference, attendees took three key advocacy messages to the Hill and shared them in more than 330 meetings with members of Congress and staff: 
Preparing members for participation in Medicare’s physician quality reporting program

Since 2007, Medicare’s PQRS program has offered bonus payments to eligible professionals, including psychologists, who successfully report data on designated outpatient service measures. Beginning in 2015, Medicare providers who do not participate in Medicare’s Physician Quality Reporting System (PQRS) 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 continued to publish a number of resources in the PracticeUpdate e-newsletter and on APAPO’s Practice Central website to educate practitioners about the program and help them begin participating in 2013. 

Along with resources that include a new quick reference guide for PQRS measures, procedure codes and G-codes and more frequently asked questions about PQRS, APAPO also produced a four-page insert for the June 2013 issue of Monitor on Psychology.

Challenging inappropriate health insurance company and managed care practices
During the spring of 2013, APAPO wrote letters to insurers who are not reimbursing, or not recognizing the increased value of, the new procedure codes for psychotherapy. Those letters question whether these reimbursement policies are at parity with the companies’ payment policies for medical/surgical procedure codes.
Collaborating on the Clinical Practice Guidelines Initiative with the Science Directorate

Consistent with best practice for guideline development, the Board of Directors, in collaboration with the APA Clinical Practice Guidelines Advisory Steering Committee (ASC), approved the appointment of two community members to serve as full members of the Guideline Development Panel (GDP) for Depressive Disorders. Two community members each are also being recruited to serve on the GDP for PTSD and the GDP for obesity. 

A contract has been signed with RTI International to provide technical assistance during Phase One of the systematic review process for the GDP for Depressive Disorders. The GDP for Depressive Disorders continues to have monthly conference calls. The PTSD GDP had its first online teleconference in May 2013. They are continuing to read educational material via a series of educational modules as well as read the systematic reviews that will serve as the evidentiary basis for their written guidelines. The PTSD GDP will have two additional online teleconferences prior to their first in-person meeting. The PTSD GDP and Obesity GDP are scheduled for their first in-person meetings in October 2013. The ASC continues to have monthly conference calls. 

Informed by best practice for guideline development, revisions and restructuring are underway for the Conflict of Interest form and policy for the Clinical Practice Guidelines Initiative. A Manual of Procedures for the initiative is also under development. 

APA staff, together with a representative from another association heavily involved in guideline development, presented a symposium on Clinical Practice Guidelines at the State Leadership Conference in March. Staff also met with members of the COPPS at their meeting in April to provide an update on the initiative and help distinguish between Clinical Practice Guidelines and Professional Practice Guidelines. A presentation on APA’s Clinical Practice Guidelines Initiative was accepted for presentation at the Guidelines International Network conference (APA is a member) and will be presented at their annual conference in August 2013. A presentation on the Clinical Practice Guidelines Initiative will also be given at 2013 APA convention. 

We are saddened to report the loss of a key staff team member with the Clinical Practice Guidelines initiative, Dan Galper, PhD.

Educating members about electronic health record keeping by professional psychologists
As health care reform moves forward with an emphasis on integrated care, the ability for mental health professionals to collaborate with other health providers across practice settings will be critical to participation in the health care system. Electronic health records are an integral component of provider collaboration on patient care. The 2013 State Leadership Conference featured a workshop on privacy and security concerns related to electronic health records, and the Spring/Summer 2013 issue of Good Practice magazine highlighted practical guidance about privacy and security for psychologists, along with a quiz practitioners can take to test their knowledge of EHRs.
Keeping members up-to-date on changes related to ICD and DSM
A new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association was released in May 2013. Transition to using the ICD-10-CM published by the World Health Organization in the U.S. is now currently set for Oct. 1, 2014. The APA Practice Directorate is providing information and resources about the new codes and the transition to ICD-10-CM to members as it becomes available. The May 16, 2013 PracticeUpdate e-newsletter article on nine frequently asked questions about DSM and ICD had been viewed nearly 10,000 times as of mid-June.
Playing an active role in telepsychology guidelines development
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. On May 6-7, 2013, the APA/Association of State and Provincial Psychology Boards/APA Insurance Trust Joint Task Force on Telepsychology Guidelines met in Washington, D.C. The task force finalized its draft of the Guidelines for the Practice of Telepsychology and forwarded the document to the APA Board of Directors for review at the Board’s June 2013 meeting.
Educating the public about psychology and the value of psychological services

Results of the Practice Directorate’s annual Stress in America survey conducted online by Harris Interactive were released during a press webinar on Feb. 7, 2013. Findings from this year’s survey suggest that people are not receiving what they need from their health care providers to manage stress and address lifestyle and behavior changes to improve their health. In addition to an interview of APA CEO Norman B. Anderson, PhD by USA Today, the survey also received media coverage on "CNN Newsource," "NBC Nightly News" and other media outlets throughout the U.S.

Further, the Practice Directorate is involved in a joint prevention initiative involving APA and the YMCA of the USA (Y-USA). The directorate is working with the Y-USA to develop educational resources to help 18,000 full-time Y staff and 49,000 summer employees who work with youth identify the signs of depression and other mental health problems in young people. Related resources include a late June webinar led by APA member Mary Alvord, PhD, along with fact sheets and information on referral sources such as the APA Practice Organization’s Psychologist Locator and state psychological associations’ referral services. 

An online poll was designed by the Consumer Reports National Research Center in partnership with experts provided by the American Psychological Association. The Consumer Reports poll surveyed 1,328 licensed psychologists in September 2012 who provide direct patient care about their work and professional opinions regarding weight loss. The survey results, which suggest that dieters should pay attention to the role emotions play in weight gain and loss if they hope to succeed, were published in the February 2013 issue of Consumer Reports Magazine® and online at the Consumer Reports website. 

A new fact sheet from the APA Practice Directorate educates consumers and health care professionals about how psychologists help patients manage their weight. The fact sheet was published in the APA Practice Organization’s Good Practice magazine and is available for download from the Practice Central website and the Psychology Help Center. 

In awareness of Mental Health Month in May, the APA Practice Directorate spotlighted a range of issue. Activities including a parenting anxieties and mental health Facebook chat and APA’s annual Mental Health Blog Day were intended to help people recognize the importance of good mental health, overcome stigma and encourage the public to seek out professional mental health services when needed.

Providing resources and support through the Disaster Response Network

Members of APA’s Disaster Response Network across the US and Canada have been busy in 2013 responding to regularly occurring local disasters. In Texas, for example, there were tornadoes in January, a plant explosion in April, and first responders’ deaths in a Houston motel fire in May. For these local incidents, DRN members work with their local Red Cross chapters to provide emotional support to survivors, other Red Cross workers and community members. 

In addition, after the  Boston Marathon bombings 26 Massachusetts DRN members and psychologists from neighboring states participated in care team hospital visits to offer emotional support to survivors and their families, consoled mourners at memorial services, helped organize and attended several vigils, and coordinated with the Boston Marathon medical director to follow up on community requests for psychological support. 

In May, almost 100 Oklahoma psychologists volunteered with the Red Cross or other relief agencies in response to the central Oklahoma tornadoes. DRN members assisted the American Red Cross by recruiting and scheduling local mental health volunteers for the relief efforts and conducted a Psychological First Aid training for the Oklahoma Department of Mental Health and Substance Abuse Services to agency, contract employees and community mental health providers responding with ODMHSAS disaster relief efforts.