Unsung Hero Fights for Psychologists

By Paula Hartman-Stein, Ph.D.
September 12, 2012

Exhibiting qualities similar to those needed as an athlete at the University of Alabama about 40 years ago, Jim Georgoulakis, Ph.D., of San Antonio, is the same determined, stalwart and highly respected athlete. But now he is on the line for a different kind of team.

For more than 15 years he has been the voice of psychology at the table of intellectual heavyweights on the Relative Update Committee (RUC) of the American Medical Association (AMA) that advises the federal government on reimbursement for health care. The following is an interview with him at the recent APA convention:

Q: What is your history with the RUC?

A: I was the second psychologist appointed to the RUC, following the term of Dr. Nancy Wilcoxon. I was her alternate, and after I had completed 20 years of active duty in the Army, APA appointed me to the RUC about 15 years ago. In the early ’90s, I was the representative from the Department of Defense to the Health Care Finance Administration (HCFA).

In July this year I was asked to take an additional responsibility to serve a three-year term with the Research Subcommittee of the RUC. There are a total of 10 of us, and I’m the only non-MD on this committee. We are to assure that the code surveys are done appropriately and to review any request for changes in survey content or methodology. The AMA and the RUC have appreciation of psychologists’ understanding of methodology.

Q: What is it like to be a RUC member?

A: First and foremost it is an honor to represent psychology and to have the opportunity to work with such an outstanding group of individuals. It is also a ton of work. The specialty societies pay expenses, but that’s all. None of the people who have responsibility for voting get paid. We have four meetings a year. It is a tough schedule, and there is a lot of prep work in between.

Q: The RUC has come under scrutiny recently because of its closed deliberations. What comments do you have about that? Recently there have been a series of articles about the RUC in The Wall Street Journal, on NPR, and letters to the editor in different medical journals with some specialties expressing upset with the RUC. It’s been interesting. Are the proceedings of the RUC done in secrecy?

A: If you are not a member of the RUC, and if you have not been approved to attend as an observer, you cannot attend. You can ask to observe, but there is no guarantee. Every observer has to be approved and every observer is introduced. I don’t believe the minutes or reports are disseminated to the public. Only recently through the Freedom of Information Act have the members of the different specialty societies been disclosed. A lot of it is to protect the members, so the members are not lobbied.

Q: So it is a closed meeting?

A: Yes, you do have to get a badge to get in, so to speak. There are no members of the press, no drug reps, no politicians. Every quarter I have to write a disclosure statement that I have no conflict of interest.

Q: Can you describe the proceedings in a general way?

A: This is a net zero sum game, meaning if psychology gets an increase in work values, that will trigger an increase in payment and another specialty will take a hit – receive a reduction. We all understand this is not personal; however, it is very difficult to keep this in mind especially when you have 30 people questioning you and telling you about your specialty. It is tough to swallow. You have to keep telling yourself this is not personal while individuals pummel you unmercifully, criticizing your data hour after hour. Physicians are very tough on other physicians. The RUC process is brutal.

Q: Why is it brutal?

A: If someone gets an increase, someone else doesn’t. It is an adversarial forum. When we presented the data regarding the psychotherapy codes, we prepared more than 150 pages of support for our recommendations, The RUC appoints two people who spearhead the questioning of the presenters. They will know the data as well as you do. We get books that are so big there are no binders large enough to hold the amount of information provided to us. This is where the time goes into play. The members of the RUC are extremely dedicated and knowledgeable. They want to be there. Their specialty society recognizes their ability.

Q: What about the criticism that the RUC doesn’t give adequate weight to primary care?

A: The RUC’s position is that everyone should have equal say, so we don’t have domination by single specialties. In a recent lawsuit by some individuals, the court went along with that.

Q: Is there talk of more oversight of the RUC?

A: Not from the RUC’s perspective. There has to be some way for the members to have the latitude to vote in the best interest of patient care. I believe that is the common denominator. I continually ask myself what is the best thing to do for the patient. .

Q: In your work outside the RUC, do you provide any psychological services?

A: On a periodic basis I volunteer work with soldiers with Post Traumatic Stress Disorder. What I do a lot is review medical records, a quasi-legal and psychological service. I think that has been extremely beneficial when I’m at the RUC meetings. In the last month I have probably reviewed 500 psychological charts, and I have reams of Xeroxed charts waiting for me back home.

Q: What is your greatest strength in representing psychology on the RUC?

A: I think psychology has to be truly involved in health care, not just mental health. We are in the health care business. Because I have an MBA with an emphasis in health care I have had the opportunity to teach health care policy at the graduate level and that has been helpful in under- standing the broader scope of health care. Psychologists tend to be too narrow in scope. We have to learn to think in the broader context of health care.

Q: Is the RUC a forum for lobbying what psychologists can do in health care?

A: No, the RUC is not a forum for lobbying. For example we do not bring scope of practice issues to this table.

Q: How can psychology make the most impact on reimbursement rates?

A: CMS over the history of the RUC has accepted more than 96 percent of recommendations made. Lobbying to legislators has a place, but the place where we can make great impact is at the RUC. We have to be in tune with and be a partner with the AMA. The Big Elephant is in the room. We’re better off to ride him than be trampled by him.

Q: In addition to RUC, what do you do?

A: I’m regional academic director, the equivalent of a provost, for Webster University in San Antonio. I have nine graduate departments with responsibility for the academic integrity of the grad programs. About 70 percent of our students are active duty or retired military. My office is on Fort Sam Houston, on a military installation. I also teach assessment, my area of expertise. I’ll teach the Rorschach, Thematic Apperception Test, the MMPI.

Q: You mentioned reviewing medical records. What is your role in regard to that?

A: A lot of law firms hire me as a consultant. I’ve testified as expert witness for government cases or for individual psychologists. I accept two or three large cases a year.

Q: What is a thumbnail sketch of your training and background?

A: I earned an undergrad degree from the University of Alabama where I played some football and my senior year was selected as co-captain of the track team. At the University of Alabama I also was a member of the Army ROTC counterguerillas, which was designed to prepare you for service in the special forces. I have an MSW, an Ed.S. in counseling from Western Kentucky University, an MBA from Our Lady of the Lake University, a Ph.D. in psychology from Kansas State University and a Juris Doctorate degree in law with a concentration in health law. I have had the pleasure of serving in the military – in the Army with 20 years of active duty. I feel the military has been very good to me. I want to pay back wherever I can.

Q: Any honors you wish to mention?

A: I was inducted in the MBA National Business Honor Society, was named as a distinguished scholar in law school. I am a Fellow of the American Psychological Association and have received the APA’s Presidential Award as well as recognition for the APA’s Division of Neuropsychology.

Further research reveals Georgoulakis also completed a post-doctoral program from the University of Colorado in research and multivariate statistics, was the chief consultant in developing the Army Medical Department’s Ambulatory Classification System and internationally was once a consultant to the Canadian government on the federal inpatient and out-patient payment system and assisted the governments of Australia, Great Britain and Bahrain in developing their outpatient payment systems.

Georgoulakis’ background and years of dedication as a behind-the-scenes warrior may well qualify him as Most Valuable Player on the national psychology health care team.

Paula Hartman-Stein, Ph.D., is a geropsychologist in Kent, Ohio. She is co-editor of Enhancing Cognitive Fitness for Adults (2011) and editor of Innovative Behavioral Healthcare for Older Adults(1998). Her website is www.centerforhealthyaging.com.

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