State Leadership Conference

Health insurance companies are moving toward paying physicians and psychologists for clients' improvement. Psychologists who can show that their clients become significantly less depressed over time, for example, may soon receive higher reimbursement rates, said Ann Doucette, PhD, of the George Washington University's Center for Health Services Research and Policy at the 2008 State Leadership Conference.

And before picking a therapist, people may soon even be able to compare clinicians' success rates online, said Doucette.

"In one way or another, the pay-for-performance net is going to capture us," said Elena J. Eisman, EdD, executive director of the Massachusetts Psychological Association.

Yet these well-meaning programs have the potential to actually decrease patients quality of care and privacy, said speakers. For example, Eisman noted that one insurer instituted an outcomes-management program and released a report riddled with design and data analysis problems, such as no indication of statistical significance. Such faulty data can lead insurance companies to develop clinical policy that isn't appropriate to the clients psychologists treat.

Pay-for-performance data collection also raises confidentiality concerns, said Alan Nessman, JD, special counsel to the office of legal and regulatory affairs in APA's Practice Directorate. Insurance companies are sending out surveys to clients to assess their progress--which may include pointed questions about their sexual orientation and functioning, drug use and mental health. Patients may assume their answers are confidential, only to find out later that when the company collects the information directly from the patient, it may undercut patient privacy protections including psychotherapy notes under the Health Insurance Portability and Accountability Act and psychotherapist-patient privilege.

For these reasons, psychologists need to keep abreast of the pay-for-performance movement among private insurers as well as Medicare and Medicaid, said Katherine C. Nordal, PhD, APA's executive director for professional practice.

One of the best ways to ground pay-for-performance programs in the science of psychology and the reality of clinical practice is to get involved in their development, said Doucette. Psychologists can lend their expertise in program evaluation to ensure that measures of clinician success correlate to happier, healthier patients, she noted.

To this end, APA's Practice Directorate now has four APA members--including Nordal--on a working group to create new measures for the Physician Quality Reporting Initiative (PQRI), a nascent reporting program in Medicare that may evolve into a pay-for-performance program, said Diane Pedulla, JD, APA's director for regulatory affairs. Under the initiative, psychologists who successfully report on 80 percent of applicable cases can receive a 1.5 percent bonus on all of their Medicare claims.

By having a seat at the table, last year APA was able to help increase the number of measures psychologists can report under PQRI from one to eight. For more information on the PQRI program, visit

-S. Dingfelder