understand the benefits of including psychologists as part of
interdisciplinary teams of physicians, nurses and other medical
providers, she warns. That’s troubling given health-care reform’s
emphasis on new models of care, such as patient-centered
health homes and ACOs. In the patient-centered health home,
interdisciplinary teams work together to provide integrated
care to patients. In ACOs, individual health-care providers,
group providers and hospital systems come together to provide
services to a defined population.
APA and APAPO are tracking such developments and
working to ensure that psychologists are eligible to participate
in such models of care. For example, APA serves on the
executive committee of the Patient-Centered Primary Care
Collaborative, a huge coalition whose members include large
employers, primary-care physician associations, professional
groups, health benefits companies, academic centers and others.
And, as part of APA’s new strategic plan, APA will be hiring
a primary-care fellow to help identify integrated health-care
models, determine their effectiveness and work to promote the
adoption of successful models.
but might facilitate psychologists’ eligibility for future financial
incentives for adopting electronic records systems.
Another barrier is state corporate practice of medicine
statutes. These statutes prohibit psychologists from forming
integrated practice corporations with physicians and other
types of health-care professionals in about half the states,
including such large states as Florida, Illinois and New York.
“This in turn makes it harder for psychologists to form entities
that would have the size and diversity necessary for getting
involved with ACOs,” says Alan Nessman, JD, senior special
counsel for legal and regulatory affairs in APA’s Practice
Organization. APAPO has researched the statutes to find out
which states permit integrated professional corporations and
will work with SPTAs to change laws in those that do not or to
find alternative integrated practice structures.
Health-care reform will also reform payment systems, with
a shift away from fee-for-service models. “The government
believes the fee-for-service model encourages providers to bill
for procedures because the only way you get more money is to
bill more procedures,” explains Nordal.
One of APA’s top priorities in seeking health-care
reform was the belief in the mind-body connection
and the need for integrating patients’ physical, mental
and behavioral health care. The Affordable Care Act
reflects that vision by emphasizing primary care and
interdisciplinary health-care teams.
APA and APAPO are also working to eliminate barriers
that could keep psychologists from participating in these
new models of care. One such hindrance is the high cost of
electronic medical record systems, which Nordal calls “the
infrastructure that supports integrated care.” The Health
Information Technology for Economic and Clinical Health Act
(HITECH) — passed in 2009 as part of the stimulus package —
offered financial incentives to providers who adopted electronic
records, but doesn’t include psychologists and other mental
health professionals and facilities. APAPO is pushing legislation
that would include them.
Another of APAPO’s legislative priorities is to get
psychologists included in Medicare’s definition of “physician”
— a definition that includes such providers as podiatrists and
chiropractors. Doing so would not only remove requirements
that psychologists be supervised by physicians in some settings,
To lower those unnecessary costs, the government is now
exploring the idea of reimbursing providers based on their
outcomes. For instance, the government might contract with
ACOs to provide health care for a population of Medicare
beneficiaries for a set fee per patient per calendar year. If the
ACO can provide the care less expensively, the ACO would
share in the money saved. However, if the care costs more than
contracted for, the ACO would have to absorb those costs.
“We’re concerned about how those reimbursement systems
are going to impact psychologists, so we’re certainly watching
that,” says Nordal.
Investing in prevention
The Affordable Care Act also signals a new willingness to invest
“The law says, ‘We’re not just going to wait around until