This year Div. 31 joined the Interdivisional Healthcare Committee (IHC). The IHC has been a coalition of seven divisions identifying as interested in issues of healthcare. It has been meeting for two decades and was established to promote the comprehensive approach to healthcare issues across the divisions. Up until recently, IHC consisted of divisions representing rehabilitation (22), health (38), pediatrics (54), family (43), clinical geriatrics (Div. 12 section 4), neuropsychology (40), and counseling (17). Last year it was expanded to include independent practice (42) and State Psychological Association Affairs (31). The meetings also include representatives from APA Practice staff who use their participation for information sharing and as a focus group around health issues. Finally, the Board of Professional Affairs sends a representative. Our division was accepted for membership based on the proposal that healthcare issues go beyond the clinical issues addressed by various branches of our professional landscape, but also must include a view to how state health policy can serve to enable the delivery of these important issues by psychologists. The IHC has two representatives per division and meets twice a year, once in January, and again at the APA convention in August. The driving force behind this group and its chair since its inception has been Rob Gluekauf, a rehabilitation psychologist.
IHC has worked on the cutting edge of health issues and has initiated or worked on significant issues such as the conception and development of the health and behavior codes, various issues in the promotion of new neuropsychological testing, and psychotherapy codes. It has also been supportive of the development and growth of clinical health registries at APA. It is not an APA group, and is self-funded by each of the participating divisions. It is wonderful that Div. 31 is now a member and that the issues of State Health Policy advocacy and strategy can be an integral part of the IHC discussions as well as highlighting the importance of maintaining strong SPTAs to carry out our partnership relationships to APA Advocacy on the local level. Currently, I represent the division in conjunction with Monica Kurylo.
The summary of the IHC meetings will be reported in our newsletter, and the complete minutes will be posted on our website. The virtual January meeting discussed the following issues:
Board of Professional Affairs
Ward-Zimmerman discussed the changes in BPA since the sunset of CAPP and the work done to subsume the CAPP mission into BPA. She defined BPA as the “strategy leader” in governance for practice and asked for collaboration with IHC as well as suggestions for BPA nominations. She described BPAs goals as policy development and implementation, practice innovation and applications, value promotion, workforce development and advocacy, all issues that fit well within the Div. 31 focus. Importantly, as a governance group, BPA monitors emerging issues and works with practice communities to advance policy within APA Council.
She further listed BPA current areas of focus and goals as:
- strengthening APAs standing as an authoritative voice for psychology;
- prepare discipline for the future;
- utilize psychology to make a positive impact on critical societal issues;
- elevate public understanding of, regard for, and use of psychology;
- psychologists becoming the national leader of evidence-based care;
- ensuring strong SPTAs;
- equipping psychologists to become leaders and specialists in MH/BH care and population health; decreasing disparities; and
- promote clinical operational and financial models and policies to further the viability of the profession and access to services.
Inter-professional collaboration on AMA Guides to Impairment Evaluation
This has been an ongoing piece of work to promote functional behavioral guidelines which fit nicely into much of the treatment work done by psychologists. Having measures to evaluate progress through appropriate functional measures has been a focus of APA, AMA and the World Health Organization (WHO) among others. In 2018 APA/IHC collaborated with the American College of Occupational and Environmental Medicine (ACOEM) and the National institute on Occupational Health and Safety (NIOSH) to put on a Focus on Function Symposium, which included representatives from many medical specialty groups, governmental agencies, businesses, and insurers. It resulted in a joint statement addressing advocacy for a focus on function. This work evolved into a collaboration with the AMA. APA’s role in these collaborations is as the expert in evaluating and recommending measures of impairment. Our guiding principle is to ensure that the best available psychological science informs policies, programs, products, and services. Dan Bruns, PhD, has been the guiding figure in this initiative based on his long collaboration with ACOEM past president Kathryn Mueller, MD. APA has been asked to identify experts to review and recommend appropriate measures to be included in the AMA document. Much more detail can be found in the official minutes on our website.
Collaborative care legislation—implications for psychological practice in integrated care
The American Psychiatric Association developed these codes as well as model legislation for each state to encode them in law. As they are not favorable to psychological practice since the model defines a psychiatrist playing the central role and social workers or NPs managing cases. Tynan reported that Delaware had proposed the legislation to include a fourth code for psychologists to bill psychotherapy, and H&B codes and screening tools. Gillaspy reported that APA has been partnering with states as these bills come up to add these services to the state bills. They are working through CESPPA and the DPAs in the states.
APA Office of Healthcare Financing
Gillaspy reported on advocacy regarding changes to E&M codes for physicians and the resultant impact on psychology due to the budget neutrality provision. After advocacy, APA was able to get an increase in the value for psychotherapy but a decrease in the conversion factor for other psychology codes. Only Congress can change this so APA continued to advocate there with success in decreasing impact of the change. Successful elimination of restrictions in telehealth and advocacy for telehealth audio were discussed. The success of the SPTA response when asked to send letters to respond to CMS proposals was praised, and a similar plan to engage the divisions was discussed.
Center for Psychology and Health
Erin Swedish reported that there is a focus on integrated primary care (IPC) and promoting the role of psychologists in this practice area. An IPC advisory group was formed and will meet monthly initially to discuss models, payment structures and other relevant issues. Membership will focus on mid-career psychologists and people who are new to APA leadership. Other areas of focus for the center include the Advisory Committee on Colleague Assistance, revision of the healthcare delivery guidelines, legislation for psychologist access to obesity codes in Medicare, alternative payment models in primary care including behavioral health, mental health and digital platforms and digital therapeutics, psychologist medical staff privileges. Also, in process is making the pain management workshop piloted at the Ohio Psychological Association available to SPTAs in 2021.
Preserving the viability of SPTAs and healthcare advocacy for psychological practice
I reported on the CESPPA survey of SPTAs with a view to how they were faring due to the changes brought on by the COVID-19 epidemic. Results showed that they were doing basically ok, however, with decreased convention income. Most had their dues collected before the pandemic so another review will be done in 2021 to see if this has changed. I will soon be sending a solicitation of ideas for SPTA programs to increase membership, income and participation that can be shared with other SPTAs. These will be listed on the Div. 31 website with contact people for more information. Also discussed was the crucial nature of the APA/SPTA collaboration and support for smaller SPTAs. The pain management workshop is a good example of the potential for mutual support as it meets the APA need for a workforce trained in pain management through the use of the SPTA network of CE provision.
Finally, the crucial role of SPTAs in aiding their members during the pandemic was discussed. This was exemplified through examples of advocacy for insurance reimbursement for telehealth, information-sharing about appropriate clinical digital platforms, and expansion of psychological service provision in multiple states, and adding psychologists as a priority group for vaccination.
Divisional reports
Each division gave a summary of their major health-related issues for the last 6 months.
As you can see, the participation in this groups is very important and relevant to Div. 31. Please feel free to contact me if there are issues you would like Monica and I to bring up at the next meeting.