State Leadership Conference

Psychology must help transform a health-care system that focuses on treating disease into one that concentrates on promoting wellness--and preventing disease in the first place--said Russ Newman, PhD, JD, APA's executive director for professional practice, at the APA Practice Organization's 2007 State Leadership Conference, March 3-6 in Washington, D.C.

In his opening keynote address, Newman advised the nearly 700 conference participants from states, provinces and territories to use their knowledge and training in human behavior to shift the focus to helping people lead healthier lives.

"Efforts to simply fix the broken health-care system must give way to efforts to truly create a new one....We must create a new culture to replace old traditions and ways of behaving," Newman said in discussing the conference theme "Positioning for Change: Expanding Psychology's Roles, Influence and Value."

This year's conference was the third consecutive gathering emphasizing the role that psychology can play in achieving the goal of improved health with controlled, or even lowered costs, and it again gave participants a chance to talk to policy-makers and members of Congress about psychology's legislative priorities regarding Medicare and mental health parity.

To illustrate why fundamental changes are needed, Newman cited the human and economic costs of the current health-care system: By recent estimates, 47 million Americans lack health insurance. This gap in coverage amounts to $100 billion in medical costs for treating uninsured patients, often for serious problems that could have been avoided with preventive care.

Nationally, about $1.9 trillion--16 percent of the nation's gross domestic product--is spent on health care annually, a share projected to increase to 20 percent of gross domestic product by 2015.

Despite such large expenditures, many people receive less care than they need or the wrong kind of care, and the Institute of Medicine estimates that 100,000 people die in hospitals every year because of medical errors, Newman said.

Healthier behavior, better health

Americans contribute to the health-care woes by the ways they cope with stress--often by smoking, drinking, eating too much and indulging in fast food, Newman noted. As a result, 65 percent of all U.S. adults are obese or overweight. The obesity trend contributes to the growing prevalence of diabetes, a condition costing the economy an estimated $132 billion annually.

Given that poor health is often cited by people beset by stress, psychology is drawing attention to ways people can reduce stress in their lives, through such programs as APA's national Psychologically Healthy Workplace Awards and the Mind/Body Health Public Education campaign.

The workplace awards recognize employers with organized efforts aimed at creating psychologically healthy work environments. A survey found that 19 percent of employees at award-winning companies reported high stress, compared with the national average of 33 percent. The job turnover rate at those companies was also less than one-third the national average.

Psychologists, said Newman, also need to continue to build relationships with groups outside of psychology. He cites as an example a program that matches psychologists with municipal employees who are first-responders in disaster situations. Building a relationship before a high-stress incident strikes means help will be welcomed when it's needed in the aftermath, he said.

"This is especially key at a time when the health-care system is changing when the world is changing, and when we are changing," Newman said.

National efforts

Besides briefing participants on how psychology is addressing national trends in health, Newman described the APA Practice Organization's efforts to advocate for psychology at the national level, such as:

  • The Health Insurance Marketplace Modernization and Affordability Act (HIMMA). Promoted as allowing small businesses to band together for health insurance coverage, HIMMA would have eliminated mental health consumer protections enacted state-by-state over the past 30 years. Led by the APA Practice Organization, a grassroots campaign in 2006 generated 19,000 emails opposing the bill and helped to stop it.
  • Non-physician health-care professionals. Legislation pushed by the American Medical Association (AMA) would have prohibited non-physician health-care professionals from representing themselves as having "equivalent education, skills or training" to a medical doctor. Opposing the legislation, Practice argued that doctoral-trained psychologists have more training than physicians for services they are licensed by state authority to provide.
  • Medicare payment cuts. Building on similar successes in recent years, the Practice Organization helped turn back a 5 percent cut in Medicare reimbursement rates for 2007, but is still fighting a 9 percent cut for Medicare reimbursement imposed by the Centers for Medicare and Medicaid Services (CMS) "five-year review" process.
  • Current procedural terminology (CPT) codes. Practice Directorate staff continues to work with AMA and CMS staff on appropriate implementation of the new psychological and neuropsychological testing CPT codes.
  • Mental health parity. Drawing a comparison with previous years when he said he was "optimistic," "hopeful" and "cautiously optimistic" on passage of comprehensive parity legislation for insurance coverage of mental health services, Newman described himself as "confident" that a bill to close loopholes in the current federal parity law will be passed this year, given the support from key business and insurance sponsors.

State efforts

On the state level, Newman cited progress related to:

  • Prescriptive authority. In Hawaii, prescriptive authority legislation recently cleared Senate and House committees, making it possible that this year the state will join Louisiana and New Mexico in obtaining prescription privileges for psychologists.
  • California hospital privileges. In the latest development in the struggle to allow psychologists to treat patients without the oversight of a psychiatrist in state hospitals, a court ruled that a medical group suing to invalidate state regulations was not entitled to attorneys' fees.