Data show psychology training already meets criteria for funding

By Lisa Rabasca
Monitor staff

Data from a survey conducted by the APA Research Office is expected to bolster the association's long-standing argument that psychologists should be eligible for millions of dollars in training funds that physicians, nurses and other health providers access through the federal Graduate Medical Education (GME) program under Medicare.

APA believes that the survey results--compiled from the responses of 240 hospitals and other Medicare facilities--reveal that psychology training programs in these facilities substantially meet the criteria for GME funding as determined by the Health Care Financing Administration (HCFA).

If APA is able to convince HCFA that psychologists should be eligible for these federal training funds, hospitals and other Medicare facilities would have the money they need to support hospital-based psychology internships. The move could help put psychologists on a level playing field with other health professionals who now receive GME funding. The result would be more training for psychologists and increased access to psychologists for Medicare beneficiaries.

APA sent HCFA the survey data as part of a December letter, which spelled out the reasons why psychologists should be eligible for the funds. APA's request already has congressional support--in fact, a recommendation that psychologists be eligible for GME funding was included in the report language of the 1997 Balanced Budget Act.

The association is hopeful that the congressional support and the new data will encourage HCFA to reconsider its stance on the issue.

"We've received some assurance from HCFA that the agency wants to be responsive to Congress and find a way to include psychology in GME funding," says Marilyn Richmond, APA's assistant executive director for government affairs in the Practice Directorate.

HCFA officials are expected to respond to APA's request in the next few months, Richmond says.

Why psychology has been ineligible

Historically, HCFA has suggested that psychology isn't eligible for GME funding because its internship programs do not meet the following criteria:

* A hospital or Medicare facility must control the daily operations of the internship program including the cost of training, administration of the program, employment of the teaching staff and classroom and clinical instruction; and

* The entire doctoral-degree program must be housed within a hospital.

But APA believes its survey results show that hospital and Medicare-facility based psychology internship programs do meet these conditions. Psychologists are trained differently than physicians with part of their training provided in an academic setting and part of it provided in a hospital or Medicare-facility setting. APA believes its survey demonstrates that training done in a hospital or Medicare-facility setting does meet the necessary requirements for GME funding. APA's survey found that:

* Almost all hospitals or Medicare facilities offering psychology internships had full authority over the daily operations of their training programs.

* About 98 percent of the hospitals or Medicare facilities reported they incurred all or most of the operating costs.

* Nearly all of the hospital or Medicare facilities assumed full responsibility for furnishing courses, hiring psychology teaching staff, devising the curriculum and implementing and enforcing policies, procedures and final decisions that were relevant to the curriculum.

APA spelled out these findings in its December letter to HCFA, from Executive Director for Practice Russ Newman, PhD, JD, and Executive Director for Education Jill Reich, PhD. In addition, the letter points out that psychologists' inability to access the GME program leads to less income for hospitals and Medicare facilities and has forced many hospitals to reduce their financial support for psychologists' training.

GME grants hospitals about $7 billion to train physicians and $330 million to educate nurses, physical therapists and other allied health professionals. Based on the estimated 375 hospitals and other Medicare facilities that house psychology internship programs in the United States, the cumulative cost of operating these internships programs is estimated at $45 million, according to APA. Psychology internship programs are housed in a variety of institutional settings, including academic health centers, Veterans Administration and military hospitals, psychiatric hospitals, comprehensive outpatient rehabilitation facilities, skilled nursing facilities and home health agencies.

Other key findings from APA's survey are:

* Changes in the health-care marketplace over the last five years have resulted in revenue loss for nearly 60 percent of psychology-internship programs.

* Three out of four programs have reduced the number of staff psychologists who provide services to patients.

* Two out of three programs have cutback the number of staff psychologists who train interns.

* Nearly 60 percent of the program's training directors say they were less able to effectively operate psychology internship programs because of these changes.

Congressional support

"HCFA's exclusion of psychologists from GME funding makes it more expensive for hospitals to provide such training and may well result in reduced access to psychologists for Medicare beneficiaries," states a letter to HCFA signed by Rep. Ted Strickland (D­Ohio) and Rep. John Dingell (D­Mich.).

According to Strickland, lawmakers need to understand the role of psychologists in health-care delivery. Once that is understood, he says, the exclusion of psychologists from GME funding will not make sense.

Many psychologists point out that if psychology is included in GME funding, the profession will gain more than just federal monies.

"In some senses GME funding establishes legitimacy for the profession," says George Taylor, PhD, an APA board member.

Bob Frank, PhD, dean of the College of Health Professions at the University of Florida, agrees. "When we are not included in GME funding, it implies we are not a vital health profession." For example, he believes it affects the type of services HCFA will reimburse psychologists for under Medicare. (See related articles on page 27.)

But if HCFA rejects APA's request, the association will have another opportunity to pursue GME funding in late spring when Congress debates Medicare reform, APA's Newman says. If HCFA denies APA's recommendation or doesn't respond by the time that Medicare reform is debated in Congress, APA will ask lawmakers to specifically legislate GME funding for psychologists, he says.

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