Psychology in the News

News From the APA Practice Directorate

On June 24th, APA announced that the "House passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) by an overwhelming majority of 355-59, including all Democrats present and 129 Republicans.

The APA Practice Organization strongly supported H.R. 6331, which would restore for 18 months $45 million to psychotherapy and related services cut as a result of the five-year review, halt the 10.6% Sustainable Growth Rate (SGR) cut, provide a 1.1% update for 2009, and phase in Medicare coinsurance parity. Once again, psychologists across America played an important role in this victory, sending more than 14,800 messages in support of the restoration provision this year and more than 2,600 messages in the past four days alone."

It is important to note that Congressmen Terry and Fortenberry supported this restoration, while Congressman Smith voted against it. Please take the opportunity to thank those that did support this effort and help educate the congressman that did not about the impact of these types of cuts on patients.

Psychologists Seek Reinstatement of Medical Staff Membership

By Glen A. Palmer, Ph.D.

Mary Lanning Memorial Hospital

In 2005, the Medical staff at Mary Lanning Memorial Hospital (MLHM) unanimously approved changes in hospital bylaws to include psychologists as full voting members of Medical staff.   Previously, psychologists were under the classification of "Allied Health" professionals.   Unfortunately, the Allied Health classification as outlined in our bylaws did not acknowledge psychologists as independent practitioners. The change in status from "Allied Health" to "Courtesy A Medical staff" was the result of three years of discussions among psychologists, members of the administration, and different committees on Medical staff.   The purpose of seeking voting membership on Medical Staff at our hospital was to 1) acknowledge psychologists as independent practitioners, 2) promote psychology's status to that of other independent practitioners, and most importantly 3) provide adequate representation for mental health patients.   One of the most important issues that psychologists raised during discussions was that 20% of the beds at our hospital are psychiatric beds.   Yet, there was no representation on the Executive Committee (i.e., the governing committee of Medical Staff) by psychiatry or psychology, and little representation on the entire Medical Staff.   Having psychologists as voting members on Medical staff would increase representation of the mental health patients at our hospital.

Soon after bylaws were approved to include psychologists as voting members of Medical Staff, steps were taken by some members of the Executive Committee to remove us from membership.   In September 2007, bylaws were revised; and we were removed from Medical staff status.   Rational given was that this would "open the door" for individuals with "lesser degrees" to have greater authority to influence hospital policy and "dilute" physicians authority to make healthcare decisions.    A new classification was created to include all individuals who do not have degrees of M.D. or D.O. as "Nonmember Privileged Practitioners."   We view this reduction in status an adverse action, and psychologists were not afforded the courtesy of due process guaranteed by our own bylaws.   We believe that this decision might have also violated Nebraska state statute; and we have acquired legal representation to assist us in our efforts to be reinstated.  

We are in process of soliciting funds from a variety of sources to help us with our cause.   Litigation will hopefully assist psychologists statewide regarding medical staff status.   The Nebraska Psychological Association and American Psychological Associated have been supportive in our efforts.   NPA has recommended that we establish an account for those who would like to contribute to offset legal costs (estimated to be up to $60,000).   Donations from individuals and/or organizations would be greatly appreciated.   Checks should be made out to "Psychologists for Responsible Practice."   Donations can be sent to Glen Palmer, 827 East 7 th Street, Hastings, NE   68901.        

A Very Enthusiastic Gathering

Pat DeLeon, former APA President

This January, NPA President-Elect Dan Ullman and I joined with approximately 65 colleagues from 25 states and Canada at the fourth annual Division 55 (American Society for the Advancement of Pharmacotherapy) Mid-Winter conference in Kansas City, Missouri.   Entitled National Unity For RxP-- Putting It Together In Missouri & Beyond, conference organizers Beth Rom-Rymer, Mario Marquez, Marci Manna, and Mark Skrade more than exceeded everyone's expectations.   The opening day reception at the State Legislature was an outstanding success, receiving considerable coverage in the local media.   The following week, the House version of the Missouri Psychological Association prescriptive authority legislation (RxP) was introduced with 85 co-sponsors.   Mario and his New Mexico colleague Elaine LeVine have the vision of a truly national strategy for enacting RxP, combing Division 55 expertise with local leadership and determination.   Participating in this year's conference were APA President-Elect Jim Bray, Treasurer Paul Craig, CAPP Chair (and now Executive Director for Practice) Katherine Nordal, Glenn Alley, and APA's Dan Abrahamson.   A definite highlight was the active involvement of a former state legislator, a physician, who emphasized that psychology would control its destiny by keeping focused upon the needs of our patients and society.   As Mario emphasized, obtaining RxP is the "right thing to do" and building personal relationships is the key to ultimate success.   One only wonders where next year's conference will be located.   Which state will be "ever so close" to enacting their RxP legislation?

Psychology's RxP agenda is the future.   The 21st century will be an era of educated consumers, utilizing the most up-to-date technology to ensure that they and their loved ones have timely access to the highest possible quality of care.   As highly educated experts in the behavioral sciences, it is psychology's responsibility to ensure that the critical psychosocial-cultural-economic gradient of care is appreciated (i.e., demanded) by clients and appropriately recognized by those "paying the bill."   We must make sure that our expertise becomes incorporated into society's definition of "Quality Care."   Ensuring the availability of necessary health care for all Americans reflects a fundamental societal value, to be determined by the political process.

A review of 40 years of health policy essays by a historian, who began her career in the British National Health Service, reveals the unprecedented change which our health care system is undergoing today; for example, the dramatically de-emphasized role of hospitals and the increasing need for care for those with chronic illnesses.   Perhaps most striking, however, is her emphasis upon the different expectations of Americans vs. the British as to what constitutes "health care."   The British system is much more holistic, providing many of the "wrap around" services (i.e., transportation, nutrition, and supportive care) which our nation's community health centers have demonstrated are so necessary for quality care.   Health, like housing, is still a social service accepted as such by both government and the population.   In contrast, we have historically viewed health care as allowing individuals to purchase various commodities (i.e., surgery, physical examinations, medications).   Financial risks are usually shared through health insurance; there being no such thing as "comprehensive medical care" as understood in Britain.   She noted that the political process responds to perceived crisis, not to long term strategies.   Thus, it has always been up to a few visionaries at any given moment in time to capitalize upon the crisis of the moment and help shape where national policy should evolve.   As the Kansas City participants emphasized, psychology must rise to the occasion.

Today, chronic illnesses account for nearly 70 percent of health care spending, and with the reality that the services presently available are simply inadequate to help patients manage their conditions, psychology faces an exciting opportunity to provide proactive and visionary leadership; thereby controlling our professional destiny.   By evolving into primary health care providers with comprehensive, data-based clinical skills (including RxP), our scientists and practitioners can become leaders for the 21st century.   The alternative, I would suggest, is for our clinicians to steadily slip into a mire of depression and unfocused anger, engaging in unproductive legislative battles, for example, over whether marriage and family therapists should be able to diagnose psychological conditions.   The future will be an interdisciplinary world.   Very few of our national leaders currently possess the broader health care policy perspective necessary to appreciate that it is our collective responsibility to shape our own destiny.   Accordingly, Mario's vision is absolutely critical for the future for our next generation.   Aloha,

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