The States With the Worst Healthcare Systems

Nearly a quarter of West Virginians have lost six or more teeth, and other findings from a new Commonwealth Fund report.

By Olga Khazan
The Atlantic
Originally published May 1, 2014

Here is an excerpt:

Healthcare in Mississippi and in other Southern states is unlikely to become more equitable anytime soon, however. As the study authors note, 16 of the states in the bottom half of the ranking have opted not to expand Medicaid under the Affordable Care Act to adults making up to 138 percent of the federal poverty level.

The entire article is here.

In Health Care, Choice Is Overrated

By Ezekiel J. Emanuel
The New York Times
Originally posted March 5, 2014

Here is an excerpt:

Second, we need more transparency. Insurance companies should have to publish the measures they use to select their “high performing” or “efficient” networks. This will discourage them from looking at price alone. And consumers should be able to easily find which doctors and hospitals are included in a network. The size of a plan’s network should be as transparent as its premium.

Third, we need more reliable ways of measuring the quality of networks and the doctors and hospitals within them. The N.C.Q.A. or Consumer Reports could develop a grading system, from A to F. When comparing different plans, no one should have to rely on U.S. News and World Report’s flawed rankings or hearsay from acquaintances.

The entire story is here.

Learning From Litigation

By Joanna C. Schwartz
The New York Times - Op Ed
Originally published May 16, 2013

MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.

Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.

New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.

I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.

The entire story is here.

CMS Issues Sunshine Rule

By Joyce Frieden, News Editor, MedPage Today
Published: February 01, 2013


The Centers for Medicare and Medicaid Services issued a long-awaited rule Friday finalizing the details for a database that will list payments made to physicians by pharmaceutical and device manufacturers.

"You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need," Peter Budetti, MD, the agency's deputy administrator for program integrity, said in a statement. "Disclosure of these relationships allows patients to have more informed discussions with their doctors."

The rule, a provision of the Affordable Care Act known as the Physician Payments Sunshine Act, "finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children's Health Insurance Program to report payments or other transfers of value they make to physicians and teaching hospitals to CMS," the statement explained. "CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests."

Data collection will start on Aug. 1, CMS said, noting that "Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by Sept. 30, 2014. CMS is developing an electronic system to facilitate the reporting process."

The rule "is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers," the statement continued.

The American Medical Association responded cautiously to the release of the final rule. "The AMA will carefully review the new Physician Payment Sunshine Act rule," AMA President Jeremy Lazarus, MD, said in a statement. "Physicians' relationships with the pharmaceutical industry should be transparent and focused on benefits to patients ... As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process."

The entire story is here.

Who Knew? Patients’ Share Of Health Spending Is Shrinking

By Jay Hancock
KHN Staff Writer
Originally published January 13, 2013

Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.

But consumers may not have as much skin in the game as experts thought, new government figures show.

Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.

"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."

True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.

But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.

The entire article is here.

Employers Must Offer Family Care, Affordable or Not

By ROBERT PEAR
The New York Times
Originally published: December 31, 2012

In a long-awaited interpretation of the new health care law, the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers.

The requirement for employers to provide health benefits to employees is a cornerstone of the new law, but the new rules proposed by the Internal Revenue Service said that employers’ obligation was to provide affordable insurance to cover their full-time employees. The rules offer no guarantee of affordable insurance for a worker’s children or spouse. To avoid a possible tax penalty, the government said, employers with 50 or more full-time employees must offer affordable coverage to those employees. But, it said, the meaning of “affordable” depends entirely on the cost of individual coverage for the employee, what the worker would pay for “self-only coverage.”

The new rules, to be published in the Federal Register, create a strong incentive for employers to put money into insurance for their employees rather than dependents. It is unclear whether the spouse and children of an employee will be able to obtain federal subsidies to help them buy coverage — separate from the employee — through insurance exchanges being established in every state. The administration explicitly reserved judgment on that question, which could affect millions of people in families with low and moderate incomes.

The entire story is here.

A Regular Checkup Is Good for the Mind as Well as the Body

By Ann Carrns
The New York Times
Originally published November 13, 2012

EVERYONE is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.

The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
      

“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”

 

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Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.

 

The entire article is here.

Missouri, Kansas Reject State-Run Health Insurance Exchanges

By Alana Gordon
Kaiser Health News, in cooperation with NPR
Originally published November 19, 2012

Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov. Jay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange.

Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement. These governors' moves open the door for increased federal involvement in health care in both states.
President Barack Obama's health law has never had any easy time in this part of the country.

"Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program," Brownback said in a statement.

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Some health policy experts find the situation in Missouri ironic. "We have a state that is very much committed to state rights and state control," notes Thomas McAuliffe, with the Missouri Foundation for Health. "Yet we’re willing to just blindly cede all creation and administration of a health exchange or insurance state marketplace to the federal government." The foundation helped fund efforts to plan an exchange.

The entire story is here.

Abortion Rates Fall When Birth Control Is Free

By Salynn Boyles
WebMD Health News 
Originally published on October 4, 2012


Abortions and unplanned pregnancies dropped dramatically in a new study when women and teenaged girls were provided birth control at no cost.

The women and girls were also more likely to choose IUDs or contraceptive implants when cost was not an issue.

Family planning advocates say the study shows the potential of the health reform law (now known by both supporters and opponents as Obamacare) to reduce unplanned pregnancies nationwide.

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About half of all pregnancies in the U.S. are unplanned, and about half of these pregnancies happen when birth control is not used.

The rest happen when contraception is used only some of the time or is used incorrectly.

The new study, published online today in the journal Obstetrics & Gynecology, included close to 9,300 sexually active women and teen girls at risk for having an unplanned pregnancy.

While the women were offered any FDA-approved method of contraception at no cost, the researchers made sure they knew that IUDs and implants were the most effective.

Researcher Jeff Peipert, MD, of Washington University in St. Louis, says around 3 out of 4 study participants opted for the long-acting methods.

“That was a shocker,” he says. “We had hoped to get maybe 15% of the women to choose IUDs or implants, but it was closer to 75%. That made all the difference.”

The entire story is here.

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice opinion can be found here.

Technological Imperative

By Pat DeLeon
Posted with permission

One direct consequence of the advent and steadily increasing presence of technology within the health care arena will be the need for psychology to finally seriously address the issue of licensure mobility. The Department of Veterans Affairs (VA) recently announced its plan to increase veterans’ access to mental health care by conducting more than 200,000 clinic-based, telemental health consultations by mental health specialties this fiscal year. Earlier the VA indicated that it would no longer charge a copayment when veterans receive care in their homes from VA health professionals using video conferencing. The Secretary: “Telemental health provides Veterans quicker and more efficient access to the types of care they seek. We are leveraging technology to reduce the distance they have to travel, increase the flexibility of the system they use, and improve their overall quality of life. We are expanding the reach of our mental health services beyond our major medical centers and treating Veterans closer to their homes.” Since the start of the VA Telemental Health Program, VA has conducted over 550,000 patient encounters.

The Fiscal Year 2013 budget request for the Office of Rural Health Policy, which is located within the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services, notes that there has been a significant Departmental focus on rural activities for over two decades. Historically, rural communities have struggled with issues related to access to care, recruitment and retention of health care providers, and maintaining the economic viability of hospitals and other health care providers in isolated rural communities. There are nearly 50 million people living in rural America who face ongoing challenges in accessing rural health care. Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts. Rural areas also continue to suffer from a shortage of diverse providers for their communities’ health care needs and face workforce shortages at a greater rate than their urban counterparts. Of the 2,052 rural counties in the nation, 77 percent are primary care health professional shortage areas (HPSAs), where APA’s Nina Levitt reports that psychologists are eligible for the National Health Service Corps Loan Repayment Program which places health professionals in underserved rural communities. 

HRSA’s Telehealth Grants initiative is designed to expand the use of telecommunications technologies within rural areas, seeking to link rural health practitioners with specialists in urban areas, thereby increasing access and the quality of healthcare provided. Telehealth offers important opportunities to improve the coordination of care in rural communities by linking its providers with specialists and other experts not available locally. The strengthening of a viable rural health infrastructure is viewed as critical for long-term success, including facilitating distance education experiences. The budget request for the office of rural health office once again proposed $11.5 million, which has subsequently been approved by the Senate Appropriation Committee, and thus allows the continuation of the Licensure Portability Grant initiative, in order to assist states in improving clinical licensure coordination across state lines. This particular initiative builds on HRSA’s 2011 Report to Congress indicating: “Licensure portability is seen as one element in the panoply of strategies needed to improve access to quality health care services through the deployment of telehealth and other electronic practice services (e-care or e-health services) in this country…. Overcoming unnecessary licensure barriers to cross-state practice is seen as part of a general strategy to expedite the mobility of health professionals in order to address workforce needs and improve access to health care services, particularly in light of increasing shortages of health professionals. ” 

For some colleagues, and particularly for those who are not comfortable with fundamental change, the relationship between telemental health and licensure mobility might seem to be a tenuous one. And yet, we would suggest that they are intimately linked. The public policy rationale for professional licensure is to protect the public from untrained and/or unethical practitioners, not to enhance the status or economic well-being of the profession. Historically, and we would expect for the foreseeable future, licensure decisions and qualification criteria have been made at the individual state level, where each of the professions plays a major role in determining its requirements for membership and its scope of practice, albeit through the political process. Within the federal system the governing statutes and implementing regulations generally require licensure in at least one state (regardless of practitioner geographical location) and facility approval (i.e., being credentialed). As improvements in technology allow for increasingly higher quality utilization, the congressional committees with jurisdiction have been systematically “cleaning up” potential lingering statutory restrictions. And, at both the state and federal level, expanding reimbursement paradigms are evolving. APA estimates that 13 states now require private sector insurance companies to pay for telehealth services. Over the years, we have not been aware of any objective evidence which suggests that the quality of care being provided via telehealth is in any way compromised. To the contrary, as the VA, the Department of Defense (DoD), and the federal criminal justice system are demonstrating, access has been significantly enhanced and new state-of-the-art clinical protocols have been developed and implemented. 

A First Hand View -- From Tripler Army Medical Center: “I joined the Telebehavioral and Surge Support (TBHSS) Clinic in February, 2011 during its infancy. At that time, the program was fully staffed with providers and support staff, making us 24 strong. TBHSS provides healthcare access by connecting eligible beneficiaries to providers who are able to indentify and treat their clinical needs. These services are provided through secured video technology which allows accessibility from remote locations worldwide. I was very excited to have the opportunity to work in a clinic that has the ability to reach out to those off island, typically in areas where the demand for services is far greater than that of the availability. To date, the clinic has been able to support Alaska, Texas, Korea, Japan, Okinawa, and American Samoa, as well as various sites on the island of Oahu and in the Continental United States. As a provider, it was refreshing to be able to provide multiple services such as therapy, consultation, administrative evaluations, and both neuropsychological and psychological assessments. In addition, we provided surge support during different points within the ARFORGEN cycle whenever there was a need for augmented behavioral health resources. In February, 2012 I was fortunate to be commissioned in the USPHS as a Lieutenant (0-3) and detailed to Tripler. As a clinical psychologist, I was able to utilize all the skills within the Department of Psychology that I acquired from my time at TBHSS. Recently, I had the honor to be promoted to the position of Clinical Director of TBHSS. Returning back to my roots has been exciting as I get to work with individuals who have a passion and commitment to serve service members and their families. My journey as a clinical psychologist civilian contractor to active duty clinical director has just begun and I am looking forward to the ongoing relationships that the TBHSS team forges with the different regions” [Sherry Gracey, Lt. USPHS]. 

ASPPB: We were very pleased to learn from Steve DeMers that the Association of State and Provincial Psychology Boards (ASPPB) was successful in its application this year for one of the licensure portability grants issued by HRSA. ASPPB will receive approximately $1 million over the next three years to provide support for state psychology licensing boards addressing statutory and regulatory barriers to telehealth, focusing upon continuing the development and implementation of its Psychology Licensure Universal System (PLUS) initiative. As an integral means of addressing the present barriers associated with telepsychology, ASPPB has developed an on-line application system, the PLUS, that can be used by any applicant who is seeking licensure, certification, or registration in any state, province, or territory in the United States or Canada that participates in the PLUS program. This also enables concurrent application for the ASPPB Certificate of Professional Qualification in Psychology (CPQ) which is currently accepted by 44 jurisdictions and the ASPPB Interjurisdictional Practice Certificate (IPC). All information collected by the PLUS is deposited and saved in the ASPPB Credentials Bank, a Credentials Verification & Storage Program (The Bank). This information can then be subsequently shared with various licensure boards and other relevant organizations. Therefore, streamlining future licensing processes. 

ASPPB is an active participant in the APA/ASPPB/APAIT Joint Task Force for the Development of Telepsychology Guidelines for Psychologists, established by former APA President Melba Vasquez and co-chaired by Linda Campbell (APA) and Fred Millan (ASPPB). The members have backgrounds, knowledge, and experience reflecting expertise in the broad issues that practitioners must address each day in the use of technology -- ethical considerations, mobility, and scope of practice. Several of the meta-issues discussed to date center on the need to reflect broadness of concepts when incorporating telecommunications technologies and to provide guidance on confidentiality and maintaining security of data and information. In addition, a number of meta-issues focus on the critical issue of interjurisdictional practice. The underlying intent behind the proposed guidelines is to offer the best guidance to psychologists when they incorporate telecommunication technologies in the provision of psychological services, rather than be prescriptive. The Task Force met twice in 2011, June of 2012, and plans to meet once more this Fall. Feedback on their recommendations will be sought at the Orlando convention, throughout the APA governance, and continuously from the membership at large. Their goal is to have the guidelines adopted by APA as policy and approved by ASPPB and APAIT sometime in 2013. 

The U.S. Supreme Court: As we all must be aware, this summer the U.S. Supreme Court upheld the underlying constitutionality of the President’s landmark Patient Protection and Affordable Care Act of 2010 (ACA), including it’s far reaching individual mandate provision, by a 5-4 vote. For legal scholars, the most critical issue was probably the Court’s deliberations regarding the federal government’s power to regulate Commerce vs. its power to raise Taxes, as a government of limited and enumerated powers. “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions. 

For health policy experts and practitioners, the Court’s musings on our nation’s health care system makes for particularly intriguing reading. * “Everyone will eventually need health care at a time and to an extent they cannot predict, but if they do not have insurance, they often will not be able to pay for it. Because state and federal laws nonetheless require hospitals to provide a certain degree of care to individuals without regard to their ability to pay, hospitals end up receiving compensation for only a portion of the services they provide. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. Congress estimated that the cost of uncompensated care raises family health insurance premiums, on average, by over $1,000 per year.” * “Indeed, the Government’s logic would justify a mandatory purchase to solve almost any problem…. (M)any Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance. The failure of that group to have a healthy diet increases health care costs, to a greater extent than the failure of the uninsured to purchase insurance…. (T)he annual medical burden of obesity has risen to almost 10 percent of all medical spending and could amount to $147 billion per year in 2008. Those increased costs are born in part by other Americans who must pay more, just as the uninsured shift costs to the insured.” * “In enacting [ACA], Congress comprehensively reformed the national market for health-care products and services. By any measure, that market is immense. Collectively, Americans spent $2.5 trillion on health care in 2009, accounting for 17.6% of our Nation’s economy. Within the next decade, it is anticipated, spending on health care will nearly double. The health-care market’s size is not its only distinctive feature. Unlike the market for almost any other product or services, the market for medical care is one in which all individuals inevitably participate.” * “Not all U.S. residents, however, have health insurance. In 2009, approximately 50 million people were uninsured, either by choice or, more likely, because they could not afford private insurance and did not qualify for government aid.” 

Bringing Psychology To The Table – State Leadership In Health Care Reform: At this year’s impressive State Leadership conference, Katherine Nordal exhorted our state association leaders to appreciate that: “We’re facing uncharted territory with proposed new models of care delivery. New financing mechanisms that we’re going to have to understand and appreciate, and the ways that they are going to impact practice, whether it’s private practice or institutional practice. We know that the states are in the drivers’ seat, and most of what happens about health care reform is going to happen back home. We know that we can’t do it alone. Our advocacy depends on effective collaborations and effective partnerships. We have to be ready to claim our place at the table. We need to be involved at the ground level. You’ve got to get involved in coalitions. If we don’t participate, then we abdicate our responsibility there and we let other people – physicians, nurses, social workers, MFTs, whoever – define what our future is going to be as a profession. And that’s just not an option for us. If we’re not at the table, it’s because we’re on the menu…. When you get home and you turn your focus to health care reform, I want you to remember that other groups don’t automatically think about psychology and invite us to the table when they’re having these discussions. We have to identify health care reform initiatives that impact psychological practice and our patients and get involved in those in a proactive way. If you wait….” Aloha,

5% of Americans Spend 50% of Health Care Dollars

By Merrill Goozner
The Fiscal Times
Originally published July 31, 2012

The key argument in favor of the individual health insurance mandate, which was upheld last month by the Supreme Court in a 5-4 vote, was that everyone uses health care eventually. Therefore, it is only fair that everyone pays into the insurance pool. Without a mandate, when access to affordable coverage becomes guaranteed in 2014, some people will simply wait until they get sick before buying a plan.

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A new issue brief from the National Institute of Health Care Management adds grist to the mill of those who rebelled against the universal insurance mandate. The study showed that in 2009 half the population – fully 150 million people – spent an average of just $236 per person on health care. That was a paltry $36 billion for the entire group out of $1.3 trillion in personal health care expenditures.

On the other side of the use spectrum, however, just five percent of the population – about 15 million people – spent a whopping $623 billion or about half of all personal health care expenditures. That came to nearly $41,000 per patient.

The entire story is here.

Doctor Shortage Likely to Worsen With Health Law

By Annie Lowrey and Robert Pear
The New York Times
Originally published July 28, 2012

In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

The entire story is here.

Affordable Health Care's Individual Mandate ruled Constitutional

By Lynn Sweet and Dave McKinney
Chicago Sun Times

In an historic decision, the U.S. Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.

The decision means the overhaul will continue to go into effect over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Chief Justice John Roberts announced the court’s judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The court found problems with the law’s expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states’ entire Medicaid allotment if they don’t take part in the law’s extension.

The court’s four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

 

The entire story is here.

Here’s why health insurance is not like broccoli

By Ezekiel Emanuel

The Great Debate - Reuters

Originally published March 29, 2012

The fate of universal healthcare coverage that the United States has been trying to achieve for over 100 years may boil down to broccoli.

The broccoli argument is simple and was frequently referred to in the recent Supreme Court arguments: If the government can require people to buy health insurance, why couldn’t it require people to buy broccoli, which also enhances people’s health? This question, at the heart of the conservative objection to the individual mandate to buy health insurance, illustrates the so-called limiting principle the Supreme Court must rule on: Under the Commerce Clause, does Congress have the constitutional power to compel people to act, in ways they might object to, when their inaction can harm others?

The High Court never got clear on why health insurance is not like broccoli and can thus be constitutionally regulated. There are two important differences that inform the principle for limiting congressional power to compel people to purchase goods and services.

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The difference between broccoli and health insurance is simple. It leads to a clear limiting principle. Congress can urge people to eat their broccoli, but not compel them to buy it, because the broccoli market will function regardless of what people do. Congress can compel people to buy their health insurance because otherwise there will be no health insurance market.

The entire story is here.

APA calls for psychologists inclusion in ACOs

Part of a psychologist's aspirational ethic is to urge government agencies to help our patients access appropriate psychological care.  This form of advocacy also advances our profession.  Here is a press release from the American Psychological Association that illustrates an important part of our collective professional responsibility.

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June 9, 2011—This week, APA sent a comment letter (PDF, 265KB) to the Department of Health and Human Services (HHS) regarding a draft proposal to establish Accountable Care Organizations (ACOs) in Medicare. Section 3022 of the Affordable Care Act requires the establishment of the Medicare Shared Saving Program, which is intended to encourage the development of ACOs.

ACOs, one of the reforms included in the Affordable Care Act, will allow hospitals, physicians and other Medicare providers and suppliers of services to establish a network that emphasizes primary and coordinated care. Medicare beneficiaries will enroll in an ACO as an alternative to fee-for-service delivery, where the ACO will coordinate their care in an effort to improve quality and contain cost increases. Medicare beneficiaries may still see providers of their choice but their care will be more carefully coordinated by the ACO.

The letter from APA Chief Executive Officer Norman B. Anderson, PhD, and APA Executive Director for Professional Practice Katherine C. Nordal, PhD, to HHS Secretary Kathleen Sebelius, dated June 6, 2011, addresses a specific portion of the proposal regarding health care professionals who may participate in ACOs.

In the letter, Drs. Nordal and Anderson urge inclusion of clinical psychologists as participants in ACOs, therefore ensuring better access of Medicare beneficiaries to mental health, substance use disorder and behavioral health services. The letter is a recent example of APA’s ongoing advocacy to promote psychologists as key players in primary care as it develops.

Among Anderson and Nordal’s comments:

- APA agrees with Sebelius’ decision to expand the list of providers eligible to

  participate in ACOs to include clinical psychologists and other providers not

  specifically named in the statute. 

- Clinical psychologists should be incentivized to provide care as part of the ACO

  primary care team. 

- Including clinical psychologists in ACOs ensures the integration of mental,

  substance use disorder and behavioral health with physical health and a more

  comprehensive integrated care system.

APA is asking HHS to retain and implement this provision in the proposed rule in the final draft. We anticipate that HHS will finalize the rule in the coming months.

APA and the APA Practice Organization will continue to evaluate and provide input on proposed rules of interest to practicing psychologists. 

For more information, contact the Government Relations department by email or at (202) 336-5870.