Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

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

Wednesday, November 30, 2011

Three Weeks to Stop Medicare Cuts

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!

Message:

 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:

CONGRESS SHOULD PROTECT MEDICARE MENTAL HEALTH PAYMENT

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.

People May Lie More Often in Emails, Instant Messages

By Randy Dotinga
MedicineNet.com

New research suggests that people are more likely to lie to strangers when they're communicating via email or instant messages rather than when they are talking face-to-face.

"It's not news that we lie. What's new is that we lie even more online," said study author Mattitiyahu Zimbler, a graduate student and senior researcher at the University of Massachusetts-Amherst.

In the study, the researchers recruited 220 undergraduate students and told them to converse with people of the same gender for 15 minutes, via email, instant message or face-to-face.

The participants introduced themselves to each other and researchers recorded their conversations. Then the researchers asked the participants to look at transcripts and note when they lied.

The researchers found that the participants averaged about 1.5 lies during each 15-minute period.

The lies tended to be minor, often matters of omission. One said, "I am short, credit-wise," instead of acknowledging the failing of classes. Some said they were doing "well" or "good" when that wasn't actually the case; one said "I wanted to be a waitress," when that wasn't true.

The entire article can be found here.

Tuesday, November 29, 2011

Doing the Ethical Thing May Be Right, but It Isn’t Automatic

By ALINA TUGEND
The New York Times

FOR the last few weeks, the sex abuse scandal at Penn State and the harassment claims against the Republican presidential candidate Herman Cain have been fodder for discussion at my house. The same is true, I assume, around the country.

Putting aside the specifics of each case, one question that has come up is, “What would I do?”

That is, if I saw what seemed to be a crime or unethical act committed by a respected colleague, coach, teacher or friend, would I storm in and stop it? Would I call the authorities immediately? Would I disregard the potentially devastating impact on my job or workplace or beloved institution?

Absolutely, most of us would probably reply. I think so, others might respond. And the most honest answer? I don’t know.

As much as we would like to think that, put on the spot, we would do the right — and perhaps even heroic — thing, research has shown that that usually isn’t true.

The rest of the article is here.

Monday, November 28, 2011

Ohio State Board of Psychology Telepsychology Rule Amendments

Ohio SBOP Telepsychology Rule Amendments

Editorial: Ricky Wyatt

By Lawrence Downes

Ricky Wyatt
After Ricky Wyatt died, the circle that gathered around him to say goodbye was small. Just a clutch of people in a funeral chapel in Tuscaloosa, Ala., friends and family members and some of those who had traveled beside him on a long journey toward justice for the mentally ill and disabled.

The journey was Wyatt v. Stickney, the federal class-action lawsuit filed in 1970 against an Alabama state hospital and later expanded to other facilities. It was the first and most consequential of the legal challenges to the abuse and neglect that had doomed hundreds of thousands of patients to hellish lives in public psychiatric hospitals. It threw open the doors to treatment and to new homes in the community and, for the first time, established standards of adequate care and patients’ rights to receive it.

The whole editorial is here.

Another more detailed article on Ricky Wyatt is here.

A summary of Wyatt v. Stickney is here.

Sunday, November 27, 2011

Canadian Model Standards for Telepsychology Service Delivery

Adopted June 4, 2011

Canadian Model Standards for Telepsychology

Report: 1 in 5 of US adults on behavioral meds

NEW YORK (AP) — More than 20 percent of American adults took at least one drug for conditions like anxiety and depression in 2010, according to an analysis of prescription data, including more than one in four women.

The report, released Wednesday by pharmacy benefits manager Medco Health Solutions Inc., found that use of drugs for psychiatric and behavioral disorders rose 22 percent from 2001. The medications are most often prescribed to women aged 45 and older, but their use among men and in younger adults climbed sharply. In adults 20 to 44, use of antipsychotic drugs and treatments for attention deficit hyperactivity disorder more than tripled, and use of anti-anxiety drugs like Xanax, Valium and Ativan rose 30 percent from a decade ago.

The statistics were taken from Medco's database of prescriptions and is based on 2.5 million patients with 24 months of continuous prescription drug insurance and eligibility.

The entire story is here.

Saturday, November 26, 2011

Texas Lawsuit Identifies Problems In Medicare Hospice Provisions

By Jordan Rau
Kaiser Health News Staff Writer
Originally published 11/16/11

A lawsuit filed in Dallas against one of the nation's largest hospice companies identifies how Medicare's payment methods can offer unintended financial incentives to inappropriately move patients from HMOs into hospice programs and then into hospitals.

In a complaint unsealed last week in a federal court, a former general manager of Vitas HealthCare Corp.'s San Antonio office alleged the company defrauded Medicare through a "conspiracy" with two HMO companies. Vitas and the companies have denied the allegations. The Department of Justice and the state of Texas have declined to join with the plaintiffs in the suit "at this time."

Here's how the complaint alleges the arrangement worked: Since Medicare Advantage pays HMOs monthly per-patient fees, the HMOs had a financial incentive to avoid chronically ill patients, who need lots of treatments. So the HMOs referred many of their chronically ill patients for hospice care at Vitas, which accepted them even though their conditions weren't considered terminal.

The entire story can be read here.

Friday, November 25, 2011

Report of the Ethics Committee, 2010

American Psychologist
July-August 2011
Volume 66, No. 5, 393-403


Here is some data from APA's Ethics Committee.
APA Ethics Committee 2010