Middlemen in mental health care have a deservedly unsavory reputation. Any practicing clinician is too painfully aware of the arduous necessity of qualifying patients for treatment, and the seemingly endless cycle of denials and appeals orchestrated by low-level employees of major HMOs. All too often, clinicians and patients gave up out of sheer exhaustion if nothing else, which in effect makes a mockery of state and national parity legislation. As we are all aware, even though national parity legislation exists, this is quite variably applied and enforced.
From the Executive Officer’s Desk: Who Gets Left Behind Without Combined Treatments? Practically Everybody.
Combining psychopharmacological and psychological interventions for most mental disorders works. Whatever the outcome measure chosen, the accumulated evidence is convincing that pharmacotherapy alone is a suboptimal treatment for most forms of mental disorder. We as psychologists have probably intuited this throughout our professional lives, and those of us who were fortunate enough to be practicing during the heyday of combined treatment acquired early clinical evidence that such interventions were effective.
It’s been an odd spring in our nation’s capital. Following a very mild winter, our only significant snow storm bore down upon us in early March, bringing drifts and several days of freezing temperatures. Unfortunately, our famous cherry blossoms had been encouraged by the abnormally warm winter to pop out a bit early and were literally nipped in the bud, disappointing those who make the annual pilgrimage to the Tidal Basin. But we’ve had lots of other things going on to keep us busy.
From the Executive Officer’s Desk: Is Health Care Reform Possible? Yes, If We Focus On The Real Problem
The health care debate in this country is currently focused on who gets health care and how much they must pay for it. Both are incredibly important questions, but ignore a larger issue: quality. What are we getting in return? The American Health Care Act of 2017 is the first attempt by the current Congress to make good on campaign promises to repeal the Patient Protection and Affordable Care Act. The National Register is a non-partisan organization, and it is not my intention to provide a partisan analysis of what is, admittedly, a very partisan bill. That said, I’d like to provide a few highlights of this 122 page piece of legislation that by any objective standard should be of significant concern to psychologists and our patients.
From the Executive Officer’s Desk—Moral Hazards and Moral Obligations: Mutually Incompatible Goals in Healthcare?
A hazard that we are likely to hear more about as the “Repeal and Replace” debate heats up in Washington may not exist: the moral hazard in healthcare. Briefly put, the moral hazard in healthcare is derived from an economic concept that holds that individuals will take more risks if others pay the consequences of such risks. Translated to healthcare, the argument posits that people will consume more healthcare if they don’t have to pay for the costs of such care. For example, a patient with a “Cadillac” plan will visit their healthcare provider more often than one whose insuror places caps on the number of visits.
In my clinical training I was often frustrated by the requirement to comment on both “mood” and “affect” in my patient evaluations. It’s not that I didn’t get the distinction. “Mood,” it was explained, was like weather, fickle and changeable but current; “affect” was climate, the more-or-less characterological outlook of a patient. (Since I worked predominantly on inpatient wards, the weather was usually stormy). From time to time, it’s always useful for an organization to review is vision and mission statements. These are, after all, de rigeur in the modern organizational environment. In the current political weather pattern, which promises to bring climactic change to American healthcare, I think that it is appropriate for us to re-examine our mission and vision to see if they will assist in charting the direction ahead.
Morgan T. Sammons, PhD, ABPP I spent the latter part of last week at the Texas Psychological Association (TPA) annual convention in Austin, TX, speaking with current and prospective Registrants at our exhibit booth. Obviously the aftermath of the election was the topic du jour. I was struck by two recurring themes in conversations with psychologists and doctoral students. First was the uncertainty about how the results might impact racial equality and social justice issues. Secondly, the specific concerns about what a drastic change or dismantling of the Affordable Care Act might mean for psychologists and the healthcare system, and more importantly, consumers. None of us have sufficient data to opine on either topic at this point, but the conversations and some of the contrasts between what I heard from students and ECPs and more seasoned professionals brings me to the point of my column – the importance of mentorship and involvement in uncertain times. Our profession generally does a good job with mentorship. Our training model dictates that doctoral faculty and supervisors are essentially mentors for life, which was evident by the number of renewed relationships on display at the TPA meeting. We have excellent peer-to-peer support, and our professional associations create strong interpersonal networks. But there are many ways in which professional mentorship and graduate education can be modified to better support the future of the profession. I get too many questions from new psychologists and doctoral students about essential healthcare concepts such as billing, coding and basic constructs like a National Provider Identification (NPI) number. This is essential information that new psychologists need on day one when they walk into an institutional or integrated healthcare setting. Predoctoral interns, particularly in those states that allow intern reimbursement (e.g., Ohio, Oregon, Hawai’i and others) will require this information the first day of training – yet it is inconsistently communicated. Employers of psychologists complain that far too few students are exposed to evidence based interventions in their graduate programs. Such information should not be relegated to post-doctoral “on the job” training. At the post-doctoral level, there remains a lack of nuts-and-bolts knowledge about managing a career and practice. More seasoned psychologists do a great job of passing this practice lore down, but we need more systematic mechanisms for acquiring knowledge about the nuances of reimbursement rules under CMS and private insurors, parity legislation and the like. On the individual practitioner level, questions abound regarding CE requirements, applying for licensure in different jurisdictions, malpractice and practice liability insurance, and marketing a digital-age practice. Two asides here: First, I was delighted to see Registrant Tim Peterson addressing the last item in his excellent ‘Website Deficit Disorder’ presentation at TPA. Second, the...
Health care is getting more complex. Psychologists feel these complexities daily, and they affect us all—one more reason to work closely with our primary care physician colleagues to ensure that mental healthcare is accessible to all who need it. I recently attended the annual meeting of the Collaborative Family Healthcare Association (CFHA), an organization that is now well into its third decade. Originally started by a group of physicians and mental health providers interested in promoting the integration of mental health into primary care, it has evolved into an association of more than 800 members. While it is nice to see psychology and other behavioral health care specialists becoming so involved in primary care, it was a bit worrisome to see that attendance among physicians has dropped off at some of these integrated care meetings. This was the subject of some informal discussion over the course of the weekend: Have physicians lost interest in integrated care?
I’m glad to see so many Registrants and Trainee Registrants have already checked out the National Register’s new Integrated Healthcare Training Series and have earned free continuing education from these video modules. Last week, we released the first three modules of this video series, which includes luminaries like Parinda Khatri, Neftali Serrano, Natalie Levkovich, Jeff Goodie, Kent Corso, Armando Hernández, Marlin Hoover, Jeff Reiter, and Bob McGrath. Take a moment and see what the buzz is all about. Below you’ll find two great segments from the series: The Behavioral Health Consultation with Parinda Khatri, PhD, and The Triple Aim with Kent Corso, PsyD.
Colleagues, I’m delighted to announce that we just launched our new continuing education website: CE.NationalRegister.org. You can earn more than 100 free CE credits on this site from archived issues of The Register Report. The site also introduces a tremendous new innovation: You now have the capability to electronically bank all of your CE certificates, regardless of where you earned them.
The summer of 2016 may very well go down as the “Summer of Outrage.” National elections are never the calmest of events, but this particular cycle seems to be marked by heated passion (to say nothing of unbridled invective) in degrees not seen for quite some time. And it’s not a uniquely American phenomenon. Outraged Britons have chosen to depart the European Union, a passionate decision that they apparently may be coming to regret. But closer to home (and to the theme of this column), it seems that psychologists are increasingly joining the ranks of the outraged. Listservs seem replete with outraged comments about this thing or that, this insurer or that new therapy, this new drug or that new medical device. Read more.
According to a recent report in the journal Health Affairs, Americans spend $201 billion dollars annually on mental healthcare, far more than we pay for any other medical condition. It is quite appalling that we spend this much with so little to show for it. Recently, I attended the Senate Summit on Mental Health hosted by Sens. Chris Murphy of Connecticut and Bill Cassidy of Louisiana. The purpose of the event was to advocate for a comprehensive mental health reform act that promises to expand training of healthcare providers and increase funding and access to mental health services. But we must ask: Is psychology ready to meet these challenges?