Karen Postal, PhD, ABBP-CN, was nominated for her outstanding advocacy and leadership because of her work in establishing strategy and innovative grassroots techniques to combat the practice of proprietary science in evidence based clinical practices.
The issue came to the attention of Postal while she was the president of the Massachusetts Psychological Association (MPA). The state’s largest insurance company had decided to manage their neuropsychological assessment benefit. They bought a neuropsychological assessment medical necessity criteria set from the McKesson corporation. After a review of the criteria revealed arbitrary limitations on care not grounded in any known scientific literature, McKesson refused to comply with a request to reveal their scientific methods for developing the criteria. They claimed that the criteria were scientifically based, but the science was proprietary. As a result, no peer review or public review was possible.
Postal explained, “It appears to be an end-run strategy around requirements that insurance companies pay for procedures that are medically necessary. The insurance companies have begun to define 'medical necessity' for themselves, rather than allow physicians (and psychologists) to use their training and clinical judgment to make the medical necessity determination. While the practice is billed as supporting evidence-based medicine, corporations who are in the business of developing and selling medical criteria sets to insurance companies can refuse to reveal the science behind their criteria sets. If it is not transparent — it is not science. And when the public cannot view the evidence behind them, these criteria sets cannot be considered evidence-based medicine. ”
Postal has led, along with a dedicated group of neuropsychologists in Massachusetts and the executive director of MPA, an effort to make medical necessity criteria sets transparent. They have addressed this issue as one of primary consumer protection. One of several strategies has been to file legislation called the Transparency Bill. The bill stipulates that any such criteria must be data based; it would permit the Office of Patient Protection to conduct peer review of the criteria sets. The bill was filed in last two-year cycle of the Massachusetts legislature and Postal has testified on behalf of the MPA and the Massachusetts Neuropsychological Association.
To support the bill, Postal developed an innovative grassroots advocacy technique: video talking points. The premise is that talking to legislators can be nerve wracking, and we all are more willing to jump in if we see a model first. Her team created a short (less than five minutes) video clip that roleplays how to talk to legislators about this issue.
The link to the video clip was sent, along with a traditional set of talking points and a set of lobbying tips from the APA, through the state psychological and neuropsychological associations’ email lists. She also issued a standing invitation to her colleagues: “I will accompany anyone, in any corner of the state to have this conversation with their legislator if that’s what it takes to get this legislation passed.” This technique turned out to be very effective as the video models connecting with the legislator through real client stories.
Although the bill did not pass in the last session, she has remained optimistic that the bill is gaining traction and that the process of moving the bill — the education of the legislators about who psychologists are and how our work can help their constituents will win out — is in itself valuable for future advocacy efforts. She has turned to the very active body of neuropsychologists and psychologists in the state and encouraged joint advocacy with other MPA members.
During the legislative conversations, Postal and psychologists in the state noticed that many legislators wanted to know how the for-profit criteria sets compared with the guidelines for neuropsychology created by neuropsychologists. Postal notes, “Unfortunately, there were no specific ‘treatment guidelines’ for neuropsychological assessment that addressed the medical necessity issue. It was clear that part of the advocacy had to be ensuring that our national organizations create our own medical necessity criteria sets or treatment guidelines.” Postal has been very encouraged by APA’s focus on creating treatment guidelines and is a representative to the interorganizational guideline development group, including NAN, APA’s Division 40 and AACN that is creating those guidelines.