On Your Behalf

APAPO continues its work to protect Medicare payments

At press time, the American Psychological Association Practice Organization (APAPO) was mobilizing members to fend off significant cuts in Medicare reimbursement to psychologists and other providers.

Following the passage of the Budget Control Act, a joint committee was created to identify $1.2 trillion in further budget cuts. If the committee fails to reach an agreement that can pass both chambers, Medicare provider payments would be cut by up to 2 percent in addition to the already pending 29.5 percent sustainable growth rate (SGR) cut. Psychologists could face a triple hit because the 5 percent psychotherapy payment restoration — which psychologists have secured through several tough fights since 2008 — is scheduled to expire at the end of 2012 if Congress fails to act.

Further complicating the picture, the Medicare Payment Advisory Committee, which was created by Congress for its advice in this area, will soon recommend replacing the SGR with an 18 percent cut to psychologists and other providers over the next three years followed by a payment freeze for seven more years.

In late September, APAPO testified before the House Ways and Means Subcommittee on Health to urge representatives to back the psychotherapy extender, which is also supported by the American Medical Association. APAPO asserts that extending psychologist payments is crucial to protecting patients' access to Medicare mental health services. Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, and providers have indicated that they may have to reduce their caseloads or leave Medicare if these cuts are enacted. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

U.S. needs more psychological preparation for disasters

The psychological damage caused by tornadoes and terrorist attacks can outlast the harm done to buildings, bridges and people's physical health, according to psychologist Jerry Suls, PhD, of the University of Iowa.

Dr. Jerry Suls asked federal legislators to invest in the nation’s “psychological infrastructure” to ensure people are prepared to face the challenges of natural disasters and terrorist attacks. (credit: Lloyd Wolf)Attending to the public's mental health needs is nearly as important as securing clean water and providing emergency medical care, Suls told the standing-room-only crowd at a Sept. 12 congressional briefing on disasters and public health.

"It's easy to look at buildings that have been destroyed," said Suls. "You can at least get in there and try to fix that. It's not so easy to fix people's attitudes and feelings."

At the briefing, sponsored by the Coalition for Health Funding, a group of 72 nonprofit organizations including APA, Suls shared his research showing how floods, tornados, terrorist attacks and other disasters cause many people to feel fatalistic, pessimistic and depressed. This is especially true of people who are already vulnerable, such as poor and elderly people, as well as those who live in rural areas and can't reach service providers, Suls said. Most public health departments don't have the funding or staff to conduct mental health outreach, interventions and assessments, and so vulnerable people often turn to drugs, alcohol and cigarettes to cope, he added.

"You need programs to make sure that people don't use the bad, unhealthy approaches to cope with their situation, but we don't have the resources for that," Suls said.

Speaker Clayton Williams, who oversees Louisiana's Office of Public Health, echoed Suls's concerns.

"Sustaining and enhancing investments in public health is not only smart because ... it prevents more costly and more severe problem down the road, but because they translate into investments in a community's ability to respond and recover from a disaster," Williams said.

—S. Dingfelder

APA presses for more funding for diabetes prevention and treatment

Diabetes costs the U.S. health-care system $174 billion a year, making it a critical time to expand research on treatment and prevention, said psychologist Rena R. Wing, PhD, at a congressional briefing on the link between obesity and diabetes.

Twenty-six million American children and adults have diabetes and 79 million have pre-diabetes — elevated blood glucose levels — which also puts them at risk for developing heart disease and stroke.

Dr. Rena R. Wing explained how the Diabetes Prevention Program is almost twice as effective as a commonly used drug. (credit: Lloyd Wolf)"It's critical that we do everything we can to maintain adequate funding for basic, clinical and translational research on these issues," said Wing, of the Warren Alpert Medical School of Brown University. "It's particularly important to support the next generation of researchers so they can continue the process of discovery and implementation. You don't want to have an intergenerational gap."

At the Sept. 15 briefing, sponsored by the Ad Hoc Group for Medical Research and co-sponsored by several of its members including APA, the American Diabetes Association and a dozen other nonprofit groups, Wing reviewed findings from the Diabetes Prevention Program study funded by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). Wing and fellow researchers randomly assigned more than 3,000 participants with pre-diabetes to one of three conditions: moderate exercise paired with calorie reduction and healthy eating; taking metformin, a drug used to reduce the blood sugar level of individuals with Type-2 diabetes; or taking placebo. They followed the group over three years and found that metformin reduced people's risk for developing diabetes by 31 percent, but the lifestyle intervention of exercise and diet reduced people's risk by 58 percent.

Now, the institute is disseminating her exercise and weight loss intervention across the country, said NIDDK Director Griffin P. Rodgers, MD, who also spoke at the briefing. "We have developed education efforts based upon this and are trying to translate these clinical studies into the community settings," he said. "We are using the YMCA because over 60 percent of the American population lives within a six-mile radius of one."

Fellow speaker Anastasia Albanese-O'Neill, a nurse whose 9-year-old daughter, Cassidy, has Type-1 diabetes, urged lawmakers to boost support for the NIDDK, describing how her daughter's insulin pump — developed by institute researchers — has dramatically reduced the number of finger pricks and insulin shots that would otherwise disrupt her daughter's life.

"She's a happy kid, she is a terrific student and an all-star volleyball player," she said. "Diabetes doesn't define her, and that's because of research."

—J. Chamberlin