APA Action Alert: Include Psychologists in the Medicare Physician Definition

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http://capwiz.com/apapractice/issues...ertid=17359501

Date: June 4, 2012
To: Division Federal Advocacy Coordinators
From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations American Psychological Association Practice Organization
Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice
SPTA Executive Directors, SPTA Directors of Professional Affairs and CAPP

Re: Take Action for Physician Definition Inclusion!


The American Psychiatric Association and American Medical Association are seeking to prevent psychologists from operating independent of inappropriate physician supervision and have been pushing back against legislation to include psychologists in the Medicare physician definition (HR 831 and S 483). This is despite bipartisan support and the fact that psychologists are the only Medicare providers required to have doctoral training who are still excluded from the definition.

The good news is that during this year’s State Leadership Conference state and territorial delegations held more than 300 meetings with their members of Congress and staff, generating positive feedback about this important initiative. We need your help to turn these expressions of support into solid cosponsors. Your profession needs you to take action NOW to ask your legislators to cosponsor psychology’s Medicare “physician” definition inclusion bills and end inappropriate physician supervision requirements that hinder the delivery of psychological services.

Take Action!

Click here to urge your Senators and Representative to cosponsor
the Medicare “physician” definition inclusion bill

If you are not able to reach the Legislative Action Center from the above link, please visit

http://capwiz.com/apapractice/issues...ertid=17359501.

Take action by Friday, June 15.

Done.

Don't complain about APA and then neglect to add your voice on stuff like this.

Done. I hope everyone else is taking the time to do so as well. It literally took two minutes and is the only way to get things done.

i'm trying to do my part, but the form is requiring the extra 4-digit number after my zip code. how would i even find out what that is???

You can look it up on the USPS website.

Originally Posted by Ollie123

You can look it up on the USPS website.

thanks! it just occurred to me and smacked myself on the forehead! i'm all set!

Originally Posted by Shatani

i'm trying to do my part, but the form is requiring the extra 4-digit number after my zip code. how would i even find out what that is???

Also it is just trying to verify your address because your zipcode crosses congressional district boundaries. If you ever do this again and don't want to look it up every time you can just type in your number/street and it'll figure it out.

Originally Posted by edieb

http://capwiz.com/apapractice/issues...ertid=17359501

Date: June 4, 2012
To: Division Federal Advocacy Coordinators
From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations American Psychological Association Practice Organization
Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice
SPTA Executive Directors, SPTA Directors of Professional Affairs and CAPP

Re: Take Action for Physician Definition Inclusion!


The American Psychiatric Association and American Medical Association are seeking to prevent psychologists from operating independent of inappropriate physician supervision and have been pushing back against legislation to include psychologists in the Medicare physician definition (HR 831 and S 483). This is despite bipartisan support and the fact that psychologists are the only Medicare providers required to have doctoral training who are still excluded from the definition.

The good news is that during this year’s State Leadership Conference state and territorial delegations held more than 300 meetings with their members of Congress and staff, generating positive feedback about this important initiative. We need your help to turn these expressions of support into solid cosponsors. Your profession needs you to take action NOW to ask your legislators to cosponsor psychology’s Medicare “physician” definition inclusion bills and end inappropriate physician supervision requirements that hinder the delivery of psychological services.

Take Action!

Click here to urge your Senators and Representative to cosponsor
the Medicare “physician” definition inclusion bill

If you are not able to reach the Legislative Action Center from the above link, please visit

http://capwiz.com/apapractice/issues...ertid=17359501.

Take action by Friday, June 15.

Part of me says, "great, let's be good advocates for professional psychology!" The other part of me says, "well, it's Medicare." We're essentially fighting for a shrinking share of a pile of table scraps. I've billed Medicare (a few years ago). It's even worse now.

I know, I'm being negative.

Originally Posted by JeyRo

Part of me says, "great, let's be good advocates for professional psychology!" The other part of me says, "well, it's Medicare." We're essentially fighting for a shrinking share of a pile of table scraps. I've billed Medicare (a few years ago). It's even worse now.

Many providers still accept Medicare, though they are also losing a growing % of providers because of rate cuts. Here is a good article on the topic: http://www.nepsy.com/articles/leadin...r-withdrawals/ The #'s for neuropsych are at least as bad if not worse. I don't have the stats in front of me, but dwindling rates are a HUGE concern for many.

I think the larger insurance issue, whether most people realize it or not, is the role ACOs will play in the coming years. I think it is important to get on equal footing with Medicare because that will provide additional reason to have a seat at the table when the ACO details are being discussed. We are late to the dinner party, but I'd rather be late than completely excluded.

Originally Posted by JeyRo

Part of me says, "great, let's be good advocates for professional psychology!" The other part of me says, "well, it's Medicare." We're essentially fighting for a shrinking share of a pile of table scraps. I've billed Medicare (a few years ago). It's even worse now.

I know, I'm being negative.

Now please forgive me for being naive here because I am not planning on private practice or much clinical work at all, but isn't Medicare tied to a government entity (CMS), and don't their definitions and rates set the tone for the rest of the healthcare industry? Or am I mixing it up?

I never have had to do much billing but I thought Medicare policies and rates were important to the rest of the industry.

Originally Posted by Pragma

I never have had to do much billing but I thought Medicare policies and rates were important to the rest of the industry.

Private insurance definitely take cues from Medicare & Medicaid. It still amazes me that providers in high cost of living areas can even afford to take insurance.

Could someone explain this the implications in this in more detail? What is the "inappropriate supervision?" what are the implications of it? who are the "outside interests" (i'm guessing psychiatry?) seeking to prevent psychologists from having the physician definition and what is their argument for doing so? My knowledge of medicare is very limited and the information in the link is pretty brief and vague. I know this is important but I just want to have a better understanding of the issue so I can feel more confident advocating. Thanks!

Originally Posted by 54321

Could someone explain this the implications in this in more detail? What is the "inappropriate supervision?" what are the implications of it? who are the "outside interests" (i'm guessing psychiatry?) seeking to prevent psychologists from having the physician definition and what is their argument for doing so? My knowledge of medicare is very limited and the information in the link is pretty brief and vague. I know this is important but I just want to have a better understanding of the issue so I can feel more confident advocating. Thanks!

30 second explanation...

Here is the language that CMS uses in regard to psychological/neuropsychological assessment, I assume psychotherapy is similar:

Originally Posted by CMS

Under the diagnostic test provision as authorized under Medicare law at section 1861(s)(3) of the Social Security Act (the Act) and interpreted under regulations at 42 CFR 410.32, all diagnostic tests are assigned a certain level of supervision. Generally, regulations governing the provision of diagnostic tests require a physician to provide the appropriate level of supervision for such tests. That is, the physician must either provide general, direct, or personal supervision. However, for diagnostic psychological and neuropsychological tests (96101-96120), there is a regulatory exception at 42 CFR 410.32(b)(2)(iii) that allows either a clinical psychologist (CP) or a physician to provide the required general supervision for diagnostic psychological and neuropsychological tests. Moreover, nonphysician practitioners (NPPs) such as nurse practitioners (NPs) and clinical nurse specialists (CNSs) under 42 CFR 410.32(b)(2)(B)(v), and physician assistants (PAs) under 42 CFR 410.32(b)(3) who personally perform diagnostic psychological and neuropsychological tests are excluded from the supervision requirements for diagnostic tests. However, they must meet the collaboration and physician supervision practice requirements under their respective benefits.

So there is an exception for actual supervision, but there still needs to be a collaboration, which I believe functions as getting a referral. One of the issues is the referral and collaboration are barriers to care for many patients because of scheduling to see the primary physician/referrer and also the bottlenecking because of the limited providers who take Medicare. I'm still learning the insurance In's and Out's, so YMMV on the above.

Outside interests I believe are the AMA and AP-iatry A. Anything that remotely comes close to doing anything to step on their turf they will fight. I wish the A -ology A fought half as much for us. It is a basic guild/turf issue. Their argument is that it will be confusing. It is worth noting that podiatrists, chiropractors ( ), and similar are all included under the plan....just not psychologists. It should have been fixed long ago...but see above.

T4C put up a good explanation.

My clientele outside of private practice are all medicaid and medicare. The biggest issue, I believe, this concerns is the right of the patient to have access to treatment. I know that in order for medicare to reimburse us, there has to be referral for psychotherapy from the patient's treating physician and that referral has to be re-ordered periodically.

Originally Posted by Therapist4Chnge

30 second explanation...

Here is the language that CMS uses in regard to psychological/neuropsychological assessment, I assume psychotherapy is similar:



So there is an exception for actual supervision, but there still needs to be a collaboration, which I believe functions as getting a referral. One of the issues is the referral and collaboration are barriers to care for many patients because of scheduling to see the primary physician/referrer and also the bottlenecking because of the limited providers who take Medicare. I'm still learning the insurance In's and Out's, so YMMV on the above.

Outside interests I believe are the AMA and AP-iatry A. Anything that remotely comes close to doing anything to step on their turf they will fight. I wish the A -ology A fought half as much for us. It is a basic guild/turf issue. Their argument is that it will be confusing. It is worth noting that podiatrists, chiropractors ( ), and similar are all included under the plan....just not psychologists. It should have been fixed long ago...but see above.

I think I read here a while back that even aromatherapists (or was it acupuncturists?) come under the physician heading, but not psychologists. Did make that up? I know I read it somewhere, but it may not have been in regards to medicare/caid

Originally Posted by Sanman

T4C put up a good explanation.

My clientele outside of private practice are all medicaid and medicare. The biggest issue, I believe, this concerns is the right of the patient to have access to treatment. I know that in order for medicare to reimburse us, there has to be referral for psychotherapy from the patient's treating physician and that referral has to be re-ordered periodically.

Here's my problem (somewhat afield from the issue of physician definition in medicare issue) - *all* of my potential client base are on medicare (I'm in geropsych.) and unless I opt out, I'm required to bill from it and use it and deal with all of the nonsensical administrative and paperwork headaches involved. And I watch the yearly (or twice-yearly sometimes) fight over the SGR and the regular cutting of the pittance in billables psychologists enjoy from medicare and I just wonder what the point of it all is.

I've been thinking for quite awhile that I want to start a private practice based around a geriatric care management service that vertical integrates estate planning and capacity assessment / conservatorship assessment features within in and basically avoids all forms of medicare billing headaches. No problem, I'll just do it in my spare time in between taking care of my two kids and working my full-time VA job....

Originally Posted by JeyRo

Here's my problem (somewhat afield from the issue of physician definition in medicare issue) - *all* of my potential client base are on medicare (I'm in geropsych.) and unless I opt out, I'm required to bill from it and use it and deal with all of the nonsensical administrative and paperwork headaches involved. And I watch the yearly (or twice-yearly sometimes) fight over the SGR and the regular cutting of the pittance in billables psychologists enjoy from medicare and I just wonder what the point of it all is.

I've been thinking for quite awhile that I want to start a private practice based around a geriatric care management service that vertical integrates estate planning and capacity assessment / conservatorship assessment features within in and basically avoids all forms of medicare billing headaches. No problem, I'll just do it in my spare time in between taking care of my two kids and working my full-time VA job....

I'm in geropych as well and understand where you are coming from. I definitely agree that it is hard for a veteran psychologist to agree to medicare pay. The only thing that makes my life any better is a lack of overhead (nursing home work) and it is acceptable pay for an early career person such as myself. I had the same thought regarding capacity evaluations/ conservatorship, etc., so great minds may think alike.

Originally Posted by JeyRo

Here's my problem (somewhat afield from the issue of physician definition in medicare issue) - *all* of my potential client base are on medicare (I'm in geropsych.) and unless I opt out, I'm required to bill from it and use it and deal with all of the nonsensical administrative and paperwork headaches involved. And I watch the yearly (or twice-yearly sometimes) fight over the SGR and the regular cutting of the pittance in billables psychologists enjoy from medicare and I just wonder what the point of it all is.

I've been thinking for quite awhile that I want to start a private practice based around a geriatric care management service that vertical integrates estate planning and capacity assessment / conservatorship assessment features within in and basically avoids all forms of medicare billing headaches. No problem, I'll just do it in my spare time in between taking care of my two kids and working my full-time VA job....

I've always been curious about who can afford to pay out of pocket instead of using insurance - it seems like it would really limit your clientele to a very specific segment of the population. How does this look in Gero - I'd assume most people wants to use their Medicare and that much of the population is on a fixed income.

I am starting a full time academic job, but have considered part time private practice.

Originally Posted by Sanman

I'm in geropych as well and understand where you are coming from. I definitely agree that it is hard for a veteran psychologist to agree to medicare pay. The only thing that makes my life any better is a lack of overhead (nursing home work) and it is acceptable pay for an early career person such as myself. I had the same thought regarding capacity evaluations/ conservatorship, etc., so great minds may think alike.

PM me if you ever want to talk about it more. I'm licensed in CA and soon to be licensed on Oregon.

Originally Posted by JeyRo

PM me if you ever want to talk about it more. I'm licensed in CA and soon to be licensed on Oregon.

I PMed you, I'm glad to talk more about it.

I received a reply from my Senator that had very little (nothing?) to do with the issue at hand including that he does not support increasing the debt ceiling. Actually the response email had more to do with not increasing debt than anything else. I'm not sure if including psychologists in the definition would increase debt?

I re-contacted the Senator reminding him about the specific issue I asked about and requested a reply to that question. We'll see what happens!!!

i got a canned response too....my guy supports it, though, so it was about the topic at hand....