State Leadership Conference

In 2006, Medicare unveiled a voluntary pay-for-performance initiative for physicians aimed to improve the quality of Medicare-reimbursed services. Under the program, physicians provide the Centers for Medicare and Medicaid Services (CMS) with a core set of measures in exchange for CMS assistance that aims to reduce unnecessary costs and improve the quality of care.

Although the program is voluntary and limited to physicians, APA Board of Directors Treasurer Carol D. Goodheart, EdD, warned 2006 State Leadership Conference attendees that legislators are floating a number of proposals on Capitol Hill to extend the programs to other professionals, including psychologists.

"Pay-for-performance is a move to measure quality," she said at a session on pay-for-performance and outcomes measurement in health care. "We need to define what the quality thresholds are that define adequacy. If we don't define adequacy, it will be defined for us."

Massachusetts Psychological Association Executive Director Elena Eisman, EdD, echoed Goodheart's message as she outlined how outcomes measures in Massachusetts, a state that has already linked clinical results and Medicare reimbursement, pose a unique challenge to psychologists.

"Rewarding high performers may improve quality for some practitioners-but not for all," she said.

The reason? The clinical result measures are not as valid as government officials would like, and psychologists often have difficulties using them to assess improvement in patients with chronic mental health conditions-especially when the measures need to encompass the full range of clinical orientations, Eisman said.

But psychologists can prepare for pay-for-performance initiatives, said Geoff Reed, PhD, assistant executive director of professional development in APA's Practice Directorate. One possibility, Reed said, is for practitioners to collaborate to find ways to meet pay-for-performance's large data-sharing needs.

For instance, the APA Practice Organization is collaborating with the New Jersey Psychological Association to conduct a three-month evaluation of a pilot program offering an affordable outcomes-management system for psychologists in a variety of practice settings. In doing so, the Practice Organization is interested in evaluating the usability and relevance of the system. The Practice Organization will also ensure that the data is confidential, secure and compliant with the Health Insurance Portability and Accountability Act of 1996.

-Z. Stambor

New Jersey psychologists who wish to participate in the New Jersey Psychological Association pilot study can visit