State Leadership Conference

Full implementation of the Affordable Care Act is coming quickly, Katherine C. Nordal, PhD, cautioned at the opening session of the 2013 State Leadership Conference.

"But Jan. 1 is really just a mile marker in this marathon we call health-care reform," added Nordal, who is executive director for professional practice at APA and the APA Practice Organization.

Sponsored by APA's Practice Directorate and APAPO, the 30th annual conference in Washington, D.C., March 9–12, brought together nearly 500 representatives from state, provincial and territorial psychological associations, APA divisions and governance and the American Psychological Association of Graduate Students, as well as early career and diversity delegates.

In addition to participating in educational and networking sessions, attendees also made more than 330 visits to members of Congress and their staffs on Capitol Hill. There, they shared APAPO's legislative agenda — improving the Medicare reimbursement formula, including psychologists in Medicare's definition of "physician" and making psychologists eligible for financial incentives for adopting electronic health records.

Professional psychologists are experiencing challenges at all levels, Nordal said at the conference's kick-off session. As the government feels pressure to slash Medicare and other entitlement spending, for instance, psychologists face declining reimbursement rates. And health-care reform means psychologists need to adapt to new and emerging practice models.

They also face barriers to participation in Medicaid just as health-care reform brings millions of consumers into the system. Sixteen states don't recognize private-sector psychologists as Medicaid providers, for example, while others restrict psychologists' participation.

(top to bottom)Executive Director of APA’s Practice Directorate Dr. Katherine C. Nordal and Dr. Mark B. McClellan, of the Engelberg Center for Health Care Reform at the Brookings Institution.To address these and other challenges, Nordal said psychologists must promote the strengths they bring to health care. They must also be open to opportunities for applying their expertise in new ways and settings, such as in the integrated practice models health-care reform promotes.

APAPO is helping to make that possible, said Nordal. The organization is working with states to change laws preventing psychologists from forming multidisciplinary practices with other health-care professionals, promoting legislation to allow psychologists to join hospital medical staffs and working to overturn laws restricting psychologists' participation in Medicaid. APAPO is also helping states push for full inclusion of psychological services within the essential health benefits packages in the new health insurance exchanges.

Grassroots advocacy by psychologists now is key, Nordal said, pointing out that it took them almost 25 years to be included as providers in Medicare. "We can't afford to be left out of health care again and then have to spend decades playing catch-up," she said.

Mark B. McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform and chair of health policy studies at the Brookings Institution, also encouraged psychologists and other health-care professionals to take the lead in reforming health care. "The public doesn't trust government or insurers," he said. "The people they trust are you: psychologists, physicians, nurses and others involved in care."

That means psychologists and other clinicians shouldn't focus their advocacy energy on trying to boost reimbursement rates, said McClellan, a former administrator of the Centers for Medicare and Medicaid Services. It's true, he said, that the traditional response to runaway health-care costs has been to squeeze provider reimbursement. But that approach is unsustainable, McClellan said, because professionals are already getting paid less or not at all for the services that make the most difference to patients and because professional services account for only a small percentage of costs. Instead, psychologists should offer a vision of what a truly reformed health-care system could look like.

The good news is that health-care reform offers an alternative to saving money by paying providers less, McClellan said. "We're moving away from paying providers based on volume and intensity and instead paying providers based on what we really want: better results with lower costs."

But getting there will require a new emphasis on measurement. The new health-care system will demand evidence that patients benefited from services — a marker more difficult to quantify than number of office visits or tests performed, McClellan said. To address the difficulty of proving long-term improvements to mental health, he called for an incremental approach, with interim indicators such as percentage of clients screened for depression.

With better measurement, McClellan said, new reimbursement systems become possible. In accountable care organizations, for example, clinicians who can demonstrate better quality and lower costs can share in the savings.

"The goal is not about short-term savings," said McClellan. "It's about value — how to improve health without spending more money overall."

Rebecca A. Clay is a writer in Washington, D.C.