APA Practice Organization safeguards Medicare reimbursements for psychologists

APA Access | December 11, 2012

Editorial note: APAPO dollars working for you!

Advocates also targeted managed care rate cuts as a violation of federal parity rules.

APAPO made ensuring appropriate Medicare reimbursement for psychologists its top legislative advocacy priority in 2012. Along with grassroots psychologists, APAPO lobbyists called for alteration of the Medicare payment formula with letters and visits to officials in the Centers for Medicare and Medicaid Services and members of key health-related congressional committees. The current flawed formula reimburses expensive technology-based specialty services at a higher rate than lower-cost mental health and primary care services.

APA’s Practice Directorate continued its multi-year initiative to evaluate the psychotherapy billing codes and recommend “work relative value units” for the new set of psychotherapy codes that take effect Jan. 1, 2013.

The entire story is here.

Parity for Behavioral Health Coverage Delayed by Lack of Federal Rules

By Michael Ollove
Stateline/Kaiser Health News
Originally published on December 2, 2012

Here are some excerpts:

A Law but No Rules

Congress recognized that equivalence in 2008 when it passed the Mental Health Parity and Addiction Act, which requires insurers to cover mental illness and substance abuse treatment on an equal basis with physical ailments. The law, which passed with substantial bipartisan support, was supposed to eliminate two-tiered systems for co-pays, deductibles or treatment limitations.

The Obama administration's Affordable Care Act will vastly extend the reach of the 2008 law. The older law does not require health insurance plans to offer behavioral health coverage, although if they do it must be on par with benefits provided for medical and surgical care. But the ACA does require that all health plans sold on the soon-to-be-created state health insurance exchanges eventually offer mental health coverage. Those plans, then, will all be required to observe the federal parity act.

The problem, behavioral health advocates say, is that more than four years after President George W. Bush signed the parity bill into law, the Obama administration has yet to complete the federal rules that would enable states to enforce it.

As a result, behavioral health may actually have fallen further behind since passage of the law. In May, the U.S. Government Accountability Office released a report showing that health insurance plans have actually increased the number of exclusions for mental health and addiction treatments since the law was enacted. In 2010 and 2011, for example, 15 percent of the plans surveyed by the GAO were excluding residential mental health, a significant increase from 2008.

"Hundreds of thousands of Americans are being denied their rights under the federal parity law," says James Ramstad, a former Republican congressman who originally introduced the House version of the bill in 1996 at the request of his friend and fellow Minnesotan, the late Democratic Senator Paul Wellstone, whose name is memorialized on the law. Wellstone was killed in a plane crash in 2002. "It took 12 years to pass that parity act and four years later, we still have no rules and therefore no enforcement," says Ramstad. "It’s unconscionable."

The entire article is here.

Gay 'Conversion Therapy' Faces Test in Courts

by Erik Eckholm
The New York Times
Originally published November 27, 2012


Gay "conversion therapy," which claims to help men overcome unwanted same-sex attractions but has been widely attacked as unscientific and harmful, is facing its first tests in the courtroom.

In New Jersey on Tuesday, four gay men who tried the therapy filed a civil suit against a prominent counseling group, charging it with deceptive practices under the state's Consumer Fraud Act.

The former clients said they were emotionally scarred by false promises of inner transformation and humiliating techniques that included stripping naked in front of the counselor and beating effigies of their mothers.

They paid thousands of dollars in fees over time, they said, only to be told that the lack of change in their sexual feelings was their own fault.

In California, so-called ex-gay therapists have gone to court to argue for the other side.

They are seeking to block a new state law, signed by Gov. Jerry Brown in September and celebrated as a milestone by advocates for gay rights, that bans conversion therapy for minors.

In Sacramento on Friday, a federal judge will hear the first of two legal challenges brought by conservative law groups claiming that the ban is an unconstitutional infringement on speech, religion and privacy.

Since the 1970s, when mainstream mental health associations stopped branding homosexuality as a disorder, a small network of renegade therapists, conservative religious leaders and self-identified "life coaches" has continued to argue that it is not inborn, but an aberration rooted in childhood trauma.

The entire article is here.

SPLC files groundbreaking lawsuit accusing conversion therapy organization of fraud

Press Release

November 27, 2012

The Southern Poverty Law Center filed a first-of-its-kind lawsuit today accusing a New Jersey organization of consumer fraud for offering conversion therapy services – a dangerous and discredited practice that claims to convert people from gay to straight.

The lawsuit, filed in the Superior Court of New Jersey, charges that Jews Offering New Alternatives for Healing (JONAH), its founder, Arthur Goldberg, and counselor Alan Downing violated New Jersey’s Consumer Fraud Act by providing conversion therapy claiming to cure clients of being gay.

It is the first time a conversion therapy provider has been sued for fraudulent business practices. The lawsuit describes how the plaintiffs – four young men and two of their parents – were lured into JONAH’s services through deceptive practices.

“JONAH profits off of shameful and dangerous attempts to fix something that isn’t broken,” said Christine P. Sun, deputy legal director for the SPLC. “Despite the consensus of mainstream professional organizations that conversion therapy doesn’t work, this racket continues to scam vulnerable gay men and lesbians out of thousands of dollars and inflicts significant harm on them.”

The lawsuit describes how the underlying premise of conversion therapy – that a person can “convert” to heterosexuality – has no basis in scientific fact. Conversion therapy has been discredited or highly criticized by all major American medical, psychiatric, psychological and professional counseling organizations. It is the longstanding consensus of the behavioral and social sciences that homosexuality is a normal and positive variation of human sexual orientation.

Customers of JONAH’s services typically pay a minimum of $100 for weekly individual counseling sessions and another $60 for group therapy sessions. The lawsuit describes sessions that involved clients undressing in front of a mirror and even a group session where young men were instructed to remove their clothing and stand naked in a circle with the counselor, Downing, who was also undressed. Another session involved a subject attempting to wrest away two oranges, which were used to represent testicles, from another individual.

“Sadly, there is no accountability for those who practice conversion therapy,” said Michael Ferguson, a conversion therapy survivor and plaintiff in the lawsuit. “They play blindly with deep emotions and create an immense amount of self-doubt for the client. They seize on your personal vulnerability, and tell you that being gay is synonymous with being less of a man. They further misrepresent themselves as having the key to your new orientation.”

The entire press release is here.

Thanks to Gary Schoener for this information.

Report Urges ‘Cultural Shift’ as Hockey Coaches Defy Concussion Specialists

By JEFF Z. KLEIN
The New York Times
Originally Published: November 30, 2012

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The entire article is here.

Witness

One Case at a Time Blog

observations from an anesthesiologist and mother of two

Originally published January 2012

 

The anesthesia scheduling office accidentally placed me in an operating room tomorrow with a patient who is a Jehovah’s Witness. It was a paperwork slip-up; I am new and someone forgot to put my name on the “never” list. There are three options for anesthesiologists at my hospital: You will provide anesthesia for Jehovah’s Witnesses

1. For all operations
2. Only for operations that are not expected to involve great blood loss
3. Never

Of course, all anesthesiologists agree to care for Jehovah’s Witnesses who have a life-threatening emergency if we are the only one available.

I had chosen number three: never. I called the scheduling office and they apologized and switched me to a different operating room.

My lack of faith in any nameable higher being is so firm that I can not reconcile it with what Jehovah’s Witnesses would ask me to do. Their practice comes, of course, from the bible. According to watchtower.org, the official website of the Jehovah’s Witnesses, the belief that “Taking blood into body through mouth or veins violates God's laws” comes from three biblical passages: Gen. 9:3, 4; Lev. 17:14; Acts 15:28, 29.

 

(cut)

 

I am morally incapable of letting someone bleed to death. In my operating room, when I am delivering anesthesia, I am responsible completely for that person’s life. This responsibility weighs heavily on me until each patient is safely out of the operating room. I welcome the weight. I care for each person deeply.

 

The entire blog post is here.

 

Thanks to Ed Zuckerman for this information.

Psychologist surrenders license over custody evaluation

Psychiatric Crimes Database
Published on November 29, 2012

On July 20, 2012, psychologist Charlotte Higgins-Lee surrendered her license to practice to the Oregon Board of Psychologist Examiners According to the Board’s document, in late 2010, Higgins-Lee received a referral to conducted a psychological evaluation of a father and his nine-year-old daughter and to testify in a January 2011 hearing concerning custody and parenting time. Though the custody matter concerned the father, daughter and father’s ex-spouse (the daughter’s mother), Higgins-Lee did not interview the mother (though she interviewed the father, daughter and others). Nonetheless, she concluded that the father should have sole custody and that “more information should be obtained on the mother’s alcohol use/abuse and violence,” among other statements critical of the mother, whom she had never met or interviewed. The Board proposed a reprimand, civil fine of $7,500 and requirement to practice under supervision for a minimum of six months. However, Higgins-Lee later agreed to a new stipulated agreement to surrender her license to the Board.

The board order is here.

Arizona studies envision telemedicine on smartphones

By: Lorri Allen
Cronkite News Service
Originally published: Nov 21, 2012


Until now, telemedicine has largely involved capital-intensive studios and cameras isolated to one area of a hospital. But the Mayo Clinic and a University of Arizona center dedicated to telemedicine are pioneering work aimed at moving care to smartphones.

That means practicing medicine in remote and underserved communities will become cheaper, quicker and more effective, according to Dr. Bart Demaerschalk, a neurologist at Mayo Clinic Hospital.

"What we're attempting to do is to make it even easier for the clinical specialist to insert themselves in a virtual manner for the patient in the remote environment," he said. "A mobile device should fulfill that goal."

Dr. Ronald Weinstein, director of the Arizona Telemedicine Program, sees it as a natural progression.

"Telemedicine is rapidly evolving into being next-generation or even a generation beyond by going to mobile health or e-health, and the concept du jour is that the smartphone is the telemedicine workstation," he said.

That's happening at Benson Hospital, where health care workers use Skype on iPads to save time.

"It's very low-cost and it's to facilitate communication between our ER docs and admissions," said John Roberts, information technology director.

The entire story is here.

Vignette 20: Has the Psychologist Done too Much?

Dr. Plenty lives and practices psychology in a rural area.  She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression.  After six sessions, Mr. DiMencha suffered a significant concussion while at work.  His impairment is noticeable by Dr. Plenty without any type of testing.  He struggles with understanding concepts and becomes tangential during the next two sessions.

Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected.  Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet.  From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is.  The patient has never met the attorney face-to-face, just by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits.  He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn't appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services.  She is not sure that he completely understands what is happening or her version of informed consent for the additional services.  The psychologist has been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.

In the midst of all of this activity, the psychologist contacts you for an ethics consultation.

What are the potential ethical issues with this case?

What are the competing ethical principles?

Is Dr. Plenty acting beyond the limits of her competency?

Is she practicing outside of her scope of her license?

What problems may occur as a function of Dr. Plenty engaging in a multiple relationship role in Mr. DiMencha’s care?

What suggestions would you make to Dr. Plenty?