Washington, D.C. – If the nation’s new Affordable Care Act (ACA) can help mental health professionals increase their services, it will be up to psychologists to make it happen by being key players in whatever venue they choose to participate.
The government is not going to make it easier for psychology to take its rightful place at the health care table, nor will organized medicine and insurance companies be leaders in welcoming psychologists into the coming integrated care system, a series of speakers at the 122nd APA annual convention said.
The ACA is not the first major challenge that practicing psychologists have faced over the years, but it may turn out to be the latest development with potential to increase the roles psychologists play in providing health care, said Jana Martin, Ph.D., CEO of The Trust.
She led off a session on Preventing and Solving Problems in Independent Practice under the ACA during the opening day of the convention, which was attended by about 13,000 psychologists. She was joined on the panel discussing the impact of ACA on independent practice by Robert Woody, Ph.D., J.D., of the University of Nebraska and Florida; Jeffrey N. Younggren, Ph.D., of Rolling Hills Estate, Calif., and Gerald Koocher, Ph.D., of Chicago.
Different aspects of the ACA were discussed in several workshops, including anti-trust implications, treatment of the seriously mentally ill and telemental health opportunities.
Martin was optimistic as she presented her views and challenged psychologists to assume larger roles in the emerging health care field, which will see considerable changes in the years ahead.
While adhering to its core values, psychologists must take advantage of acquiring new skills, such as learning how to make diagnoses in 30 minutes rather than the 50 minutes they were trained for in such tasks, Martin added. Psychologists must learn how to bill for collaborative work in order that their skills are not seen as ancillary activities, but as an important part of delivering health care. And, psychologists should not let medical doctors decide who will be the leaders in accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).
“There is no reason psychologists shouldn’t be the leaders in whatever integrated care system they become involved with,” Martin said. Psychologists also need to become more politically active than they have been in the past if they are going to succeed in getting the attention of those who can help them increase awareness of the importance of psychology in health care.
Koocher and Younggren pointed to the potential dangers inherent with required new electronic record requirements of the ACA.
“Do you want to share your psychotherapy records with your proctologist?” Koocher asked, pointing out that until electronic record keeping becomes more sophisticated, everyone involved in an ACO, PCMH or other integrated health care system will have access not only to a patient’s physical health record, but their mental health records as well. Learning how to avoid accidentally emailing sensitive material is a growing problem under HIPAA.
Koocher explained that in 2013, there were 147 instances of electronic health records contributing to “adverse events” affecting patients, including hybrid record conversion, inability to access data and systems design not aligned with need.
Younggren said the biggest danger of the new mandated electronic record keeping is the potential to break the chain of trust between therapists and clients. He pointed to a case where an insurance company was sued for refusing to pay for injuries a client sustained in an automobile accident. When her medical records were sent by a university hospital to confirm the injuries, they included her mental health treatment that had been received at the same hospital. The insurance company declined to pay based on her mental health treatment.
Another case involved treatment of a woman who told the emergency room bruises on her body resulted from an accident but told her mental health counselor at the same hospital she was the victim of domestic violence. Again, an insurance company got hold of both sets of records and refused to pay for her injuries.
“What we do is different,” Younggren said. “As we move toward integrated care, we must insure that physical health records and mental health records need to be kept separately.” He noted that some health care providers are beginning to separate the physical from the mental treatment someone receives in the same setting, but not every provider is doing so.
Koocher said psychologists who are in independent practice should ask themselves if they are prepared to seek additional credentials, including board certification; integrate their practice; co-locate and/or become an employee.
During his presentation, Woody said it is important that psychologists in independent practice remain realistic about their futures. “It’s not going to be our world. It’s going to be a medical world,” he said.
Woody said the public perception is that psychology is not that important to them, but some psychologists seem to think their superior training dictates that they receive more money than other mental health professions. “Our arrogance and defensiveness make us ignore the public attitude that they can get the same treatment we provide for less.”
Woody said attendance at the Florida Psychological Association convention has been cut in half during the last two years because so few psychologists can afford to attend, since their practices are being hurt by services provided by social workers and other mental health professionals. He predicted that independent practice will cease to exist before long.
In a workshop on how the increased millions of covered lives under ACA will impact on the treatment of the seriously mentally ill (SMI), Susan Pickett, Ph.D., of Advocates for Human Potential in Chicago, said it was important to help that population navigate the health care system since they have not had access to or follow-up treatment from medical personnel for years. Under ACA, many states are increasing their Medicaid budgets to include the SMI population for the first time.
People with SMI die 25 years earlier than non-SMI populations as a result of neglecting their health, primarily due to poverty and homelessness. Once their physical health needs are addressed, it will be easier to treat this population’s need for mental health services, Pickett said.
Katherine C. Nordal, Ph.D., head of the APA Practice Directorate, drew a round of applause when she said she is lobbying to elevate concerns of SMI treatment to a committee-level within the APA. She also urged those in attendance to join their state psychological associations to increase their lobbying and political activities.
“State psychological associations are where the rubber hits the road,” Nordal said. “States determine funding and regulations regarding Medicaid spending, not the federal government. This is where change happens – at the state level. This is where advocacy for the seriously mental ill population can make a difference.”
In a workshop dealing with telemental health and the ACA, the Veterans Administration’s use of the newest technology was lauded by Sherilyn Z. Pruitt, MPH, of the Health Resources and Services Administration in Rockville, Md. She explained the growing trend toward using telemental health technology to treat mental illness, particularly in rural areas.
Pat DeLeon, Ph.D., of the Uniformed Services University of the Health Sciences and a former APA president, spoke about the rapid changes in technology and telemental health. He urged psychologists to take advantage of the new technologies if they want to stay relevant.
“If you don’t want to go the route that technology can take you, you might as well go home and watch television, because you are not going to make any money,” DeLeon said.
In other action at the convention:
Stephen M. Robinson, Ph.D., of Needham, Mass.; James T. Carpenter, Ph.D., of Hyde Park, Mass., and Brendon Winters of Onstream Media Corporation in Pompano Beach, Fla., showed how the APA and other large organizations could double the audience at its annual conventions by creating a virtual conference using Onstream technologies that would be broadcast and which could be viewed by psychologists in their offices or homes. The technology would permit those viewing the convention’s program live to interact with the presenters. However, Robinson said, no large organization has taken advantage of the technology. They are concerned such technology would increase costs and decrease the number of members attending the conventions, both of which can be refuted by research, Robinson said.