Perspective on Practice

The APA Practice Directorate and APA Practice Organization are continuing their strategic planning this summer as staff and members of the Committee for the Advancement of Professional Practice (CAPP) fine tune and advance our mission of enhancing, protecting and defending professional practice in its many venues.

One important issue we will consider is health services delivery. Psychologists remain challenged by marketplace forces in delivering their services, and those who need psychological care are often denied access. But with challenges also come opportunities:

Challenge: Approximately 47 million uninsured U.S. citizens and many underinsured are denied access to health-care services they need. Our health-care system is broken and badly in need of reform.

Opportunity: There is power in consumer groups that can effectively challenge barriers to care. For example, partnerships with consumer groups have been a very positive force in helping appropriately trained psychologists obtain prescriptive authority. The APA Practice Organization recently joined two coalitions, Health Care First and Divided We Fail, to form partnerships for advocacy on health-care reform.

Challenge: Harmful managed-care company practices preclude access to needed care for many insured individuals.

Opportunity: Partnering with consumer groups will enhance access to care and augment our successes in litigation against companies with egregious practices. Building on early work of the New York State Psychological Association, the Practice Directorate is planning for a report card on managed-care company practices that negatively impact access to care. This report card will aid consumers of and employers/purchasers of psychological services in making informed decisions about their selection of behavioral health care plans.

Challenge: Psychotherapy and other psychological services remain undervalued.

Opportunity: Building on our recent success in having testing codes revalued, our government relations staff is now working on the revaluation of psychotherapy codes by the Centers for Medicare and Medicaid Services. We're also pursuing the inclusion of psychologists in the "physician" definition under Medicare, a change that would enhance beneficiary access to the full range of services that psychologists provide.

Challenge: There will be increasing demand for psychologists as primary-care providers. This development will require expertise in models of brief interventions.

Opportunity: Growing demand means increased employment opportunities for psychologists in primary-care settings. More patients have access to appropriate care when psychologists are integrated in primary care.

Challenge: Consumers of psychological services are educated and will demand quality care while holding psychologists accountable for treatment outcomes.

Opportunity: Treatment outcomes improve when psychologists are given feedback about patient progress. We must proactively take ownership for developing measures that appropriately evaluate our outcomes. If we don't, the measures will be developed for us. Demonstrating the effectiveness of our treatments will increase consumer confidence in the quality care psychologists provide.

Challenge: Demands for electronic health record keeping, submission of electronic claims for reimbursement, and the use of technology in delivering health-care services will grow. These demands will require us to think about new practice models and will have implications for licensure portability.

Opportunity: Use of appropriate technology to deliver health-care services can remove geographic and other barriers to care. With appropriate safeguards, electronic records have the potential to facilitate more coordinated treatment.

I encourage you to contact me, my staff or CAPP members about your concerns as we engage in strategic planning. The challenges and opportunities iterated in this column are not exhaustive. Your concerns are our concerns and we want to be sure that your needs are considered fully in fine tuning our practice agenda.