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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Tuesday, December 20, 2011

Legislative Concerns at the Current Moment

Hi Blog Followers!!

Just to let folks know, I called my Republican Representative, Todd Platts, to express my extreme displeasure that the Speaker of the House, Mr. Boehner, will not run an up or down vote on the current Senate bill that will extend Medicare payments for 2 months (as well given the middle class tax relief).  The Senate bill had 90% of the votes in favor of this bill.  In other words, it is truly bipartisan.

For psychologists who participate in Medicare, they will receive a 32% cut in reimbursement as of January 1, 2012 if this bill is not voted on or if this bill is defeated.

The reimbursement cut is part of both PPA's and APA's agenda.

The best that we can hope for is that the current bill is passed.  My Representative's health liaison aide indicated that they are aware of the problem for ALL Medicare recipients, not just those with mental health issues.  She also indicated that she does not know if the Speaker can be swayed.

If you have a Republican Representative, my suggestion is to contact him or her to encourage speaker Boehner to run the bill.  Time is of the essence.

Here is a reminder of the Legislative Action Alert sent on November 30, 2011.

John Gavazzi, PsyD ABPP
Concerned Psychologist
Ethics is more than a code.  Ethical behavior extends beyond treating our patients to advocating on behalf of our patients.

Even if you do not work with Medicare patients, many insurance companies base reimbursement schedules on Medicare rates.

TO:   All Psychologists 
RE:    Three Weeks to Stop Medicare Cuts

Legislative leaders have begun to discuss options to address critical, time-sensitive issues by the end of the year, including the expiration of unemployment benefits, the Alternative Minimum Tax patch, tax extenders and Medicare extenders.

Now is the time for psychologists to make their voices heard and remind Congress that their patients and practices will soon face a 5% cut to psychotherapy payments in addition to a 27.4% Sustainable Growth Rate (SGR) cut to all services scheduled for 2012 if they fail to act. 

Congress has blocked the SGR cut 12 times since 2001 and the APA Practice Organization has successfully secured the psychotherapy restoration 3 times since 2008, but practitioners face a tougher climate this time around in light of the unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

Your profession needs you to take action NOW to ensure legislators are attentive to these critical priorities.

Take Action Now!

Click here to urge your Senators and your US Representative to halt Medicare cuts to psychological services.

Please TAKE ACTION by Tuesday December 6.

Feel free to leave a comment on this blog so that other psychologists know how easy and simple the process really is......as well as the importance of this advocacy effort!


 My patients and practice are only a few weeks away from major reimbursement cuts that will impact patient access and put my small business at risk.  As a psychologist and constituent, I urge you to extend the Medicare mental health add-on through 2012.

 Congress has repeatedly found extension of the 5% psychotherapy payment restoration necessary to address the unintended impact of CMS's last Five-Year Review on access to Medicare mental health services.  An extension is necessary until completion of the current Five-Year Review of psychotherapy codes, which has been delayed into 2012.

 As Congress works toward end-of-year action on several pressing priorities, please make my patients and the mental health extender a priority, as well as halting the 27.4% Sustainable Growth Rate (SGR) cut.  Thank you for your time and consideration.

 Additional Background:


To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender.  Congress restored payments temporarily but they now need to be extended.  Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) "Five-Year Review" through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012.  Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services.  Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing.  A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to "rebasing" of the Medicare Economic Index (MEI).  In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider's time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology.  Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.
These cuts are not related to the Sustainable Growth Rate.  Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011.  Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare.  In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.