Bad Bill Before Congress

[wolfvgang22]

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The VA is considering granting psychologists prescribing authority in all 50 states. The American Psychiatric Association opposes this.

Here is a link to the APA's action center if you would like join me in sending an email to your legislators opposing this legislation.

Error Code: 404

 

[TexasPhysician]

For some reason, it doesn’t recognize my address.

 

[FatherPsychiatry]

Signed and sent.

 

[Peace of Mind]

Well color me surprised

 

[swamzi]

done, spread the word

 

[Merovinge]

Sent!

 

[ExecutiveDysfunction]

Ugh. As a psychologist, I wish this was not a thing. The situations in which a psychologist would have similar outcomes to a psychiatrist (uncomplicated mild-moderate disorders with limited medical comorbidities) can likely be covered by PCPs.

There are many things the APA (psychology) could get behind, like reimbursement parity with E&M codes, which they are, but this just takes time/money away from other endeavors.

 

[Sushirolls]

It further exemplifies, that if this passes and Psychologists start prescribing by state laws, too; what's the point? What's the point of medical boards when ARNPs, Psychologists, Natropaths, are all prescribing and even practicing independently? Why have any regulation at all when standard of care is so low? May as well end the state medical boards and let the snake oil flow.

 

[Tstanfi2]

Done. Thanks for sharing.

 

[Stagg737]

Done, thank you for bringing this to our attention. I added and personalized the letter a little bit for anyone interested in straying from the stock letter a bit. I think it frames psychologists in a better light and emphasizes the importance of the role they already have in treatment (psychotherapy), which has a far greater need than prescribing at the VA(s) I've worked at:

As a psychiatrist living and working in *****, I'm writing to express my concern regarding a proposal being considered by the House Veterans Affairs Committee, which would allow psychologists to prescribe and manage medication in the Veterans Health Administration (VHA).

I value psychologists' expertise and the role they play in the mental healthcare system which includes aiding with diagnoses and providing high-quality and evidence-based psychotherapy to patients in need, but they are not physicians and do not have the requisite education or training to provide medical treatment to patients. Our Veterans often have acute mental illness as well as other medical conditions that require medication management by a physician who has received over 12,000 hours of clinical training and knows how to medically treat patients with mental and physical health needs. If enacted, this proposal would jeopardize the safety and welfare of our most vulnerable patients and create a lower, sub-standard of care for Veterans in the VA system.

Additionally, allowing this bill to pass would shift an essential member of the healthcare team away from a desperately needed treatment which already has dire shortages (psychotherapy) to another role which numerous other individuals already provide. This would be a travesty to our veterans and actually diminish the role of psychologists as part of the mental health team.

Additionally, I work with several psychologists at our local VAs who are not comfortable with this responsibility themselves and feel they would not be appropriately utilized to provide veterans the the best possible care.

No state allows psychologists to prescribe or manage medications without medical clinician involvement given their lack of education and training. Our Veterans deserve the highest level of care and given the existing over-prescription problem within the VA, adding more prescribers to the system will only make this problem worse. Many veterans also deserve and NEED high-quality psychotherapy, sometimes far more than medications, to achieve control of their mental health problems. I urge you to work with your colleagues on the House Veterans Affairs Committee to ensure that this misguided proposal does not move forward.

 

[Horners]

This is just madness on every level... do psychologists even want this or want to push for this? Most psychologists I know don’t want to deal with medications at all. They directly see how dangerous bad or ill-informed prescribing can be.

 

[nexus73]

This is just madness on every level... do psychologists even want this or want to push for this? Most psychologists I know don’t want to deal with medications at all. They directly see how dangerous bad or ill-informed prescribing can be.

Some psychologists absolutely do want this. I’ve talked to them and they say it’s “easy” to learn. And the numerous Psy.D programs are pushing for this too. Easier to justify $100k or more tuition if when you’re done you take a night and weekend course for two years to get certified for “prescribing”.

 

[Horners]

Some psychologists absolutely do want this. I’ve talked to them and they say it’s “easy” to learn. And the numerous Psy.D programs are pushing for this too. Easier to justify $100k or more tuition if when you’re done you take a night and weekend course for two years to get certified for “prescribing”.

Honestly that’s just asinine. I’m in training now as a psychiatry resident. I can’t imagine why anyone would want to try and practice medicine without going through proper residency training. You’re practically asking to kill someone at that point... being a physician isn’t free. You can’t read a PowerPoint and learn clinical judgement, things don’t work like that.

 

[calvnandhobbs68]

Done, thank you for bringing this to our attention. I added and personalized the letter a little bit for anyone interested in straying from the stock letter a bit. I think it frames psychologists in a better light and emphasizes the importance of the role they already have in treatment (psychotherapy), which has a far greater need than prescribing at the VA(s) I've worked at:

That's what I put in mine too. INCREASE INCENTIVES FOR PEOPLE TO DO PSYCHOTHERAPY. We don't need more people putting pills into hands at the VA. We need more incentives and appreciation of high quality psychotherapy and incentivize patients to stay engaged in psychotherapy. Not incentivize patients to bounce around looking for a medication only fix for their PTSD.

The ONLY only reason this is even an idea is because the incentive right now is to prescribe. To do 20 minute med checks and adjust someone's SSRI pays a lot more per hour than hour long psychotherapy sessions. All our organizations should be pushing together for true mental health carveout parity in insurance plans. What's interesting is that this is going through the VA where reimbursement isn't a thing...but I think the psychology national organizations are using this to crack open the door. Once they get it in the VA, it's like NPs...why not roll it out everywhere then?

 

[Merovinge]

Honestly that’s just asinine. I’m in training now as a psychiatry resident. I can’t imagine why anyone would want to try and practice medicine without going through proper residency training. You’re practically asking to kill someone at that point... being a physician isn’t free. You can’t read a PowerPoint and learn clinical judgement, things don’t work like that.

In some cases these psychologists are pretty smart folk who worked very hard for their PhD. Sure it was in research design and not very likely to be clinically relevant research, but they then see 24 year old joe smoe who took night nursing classes into night NP school, knows nothing about mental health but works as a FPNP "specializing" in mental health.

The above is not hyperbole, it's a discussion I had in the past year with a very seasoned psychologist I trust. They feel like if those folks are appropriate to do this work, why shouldn't they be able to as well. The comparison point is not us.

 

[nexus73]

A

In some cases these psychologists are pretty smart folk who worked very hard for their PhD. Sure it was in research design and not very likely to be clinically relevant research, but they then see 24 year old joe smoe who took night nursing classes into night NP school, knows nothing about mental health but works as a FPNP "specializing" in mental health.

The above is not hyperbole, it's a discussion I had in the past year with a very seasoned psychologist I trust. They feel like if those folks are appropriate to do this work, why shouldn't they be able to as well. The comparison point is not us.

A psychologist can get a PA or NP degree and manage meds all they want.

 

[wolfvgang22]

The VA doesn't have much problem finding LCSWs to do psychotherapy and NPs to prescribe meds as the pay for those levels of education in the VA is decent. They do have trouble attracting MDs, and to a lesser degree (no pun intended) Phds and LPCs.

Instead of incentivizing the best trained people to do the jobs they are trained to do the best, they are trying to address the "shortage" by recruiting people with less training and giving them more and more authority. It's even worse than that - at my VA they ran out of parking because they hired lots of ancillary staff (all veterans). Other organizations also do this to a lesser extreme, of course.

The result is sub-par care for veterans who are patients.

 

[Horners]

In some cases these psychologists are pretty smart folk who worked very hard for their PhD. Sure it was in research design and not very likely to be clinically relevant research, but they then see 24 year old joe smoe who took night nursing classes into night NP school, knows nothing about mental health but works as a FPNP "specializing" in mental health.

The above is not hyperbole, it's a discussion I had in the past year with a very seasoned psychologist I trust. They feel like if those folks are appropriate to do this work, why shouldn't they be able to as well. The comparison point is not us.

Please don’t take my comment about that as promotion of NPs or disregarding psychologists’ competence. They’re just different disciplines.

Psychologists don’t look at ECGs, don’t know what QTc is, they don’t learn how to analyze labs such as CBCs, LFTs, BMPs, CMPs, PTT. Why is hyponatremia a big deal? How do you correct it? When do I call a consult? When is the presenting symptom organic? When do vitals start to get scary for an alcohol withdrawal? What am I looking at when I look at vitals?

These questions are all life and death questions and without proper training, they can spell death or severe injury for the patient. I don’t like to see things as “protecting my turf.” If you work hard and are good, you’re always going to get rewarded. But to push someone into a position that they aren’t ready for is just irresponsible to patient care.

Moreover, I’m noticing a trend where everyone wants to do exactly what physicians do without medical school and residency. It’s really disheartening. I didn’t spend years of life doing this and training correctly and adequately for someone to try and shortcut it and potentially kill a patient.

I don’t mean to sound harsh or bitter and I hope it’s not coming off that way, but without proper training and education, people don’t even know what they don’t know.

 

[Merovinge]

Please don’t take my comment about that as promotion of NPs or disregarding psychologists’ competence. They’re just different disciplines.

Psychologists don’t look at ECGs, don’t know what QTc is, they don’t learn how to analyze labs such as CBCs, LFTs, BMPs, CMPs, PTT. Why is hyponatremia a big deal? How do you correct it? When do I call a consult? When is the presenting symptom organic? When do vitals start to get scary for an alcohol withdrawal? What am I looking at when I look at vitals?

These questions are all life and death questions and without proper training, they can spell death or severe injury for the patient. I don’t like to see things as “protecting my turf.” If you work hard and are good, you’re always going to get rewarded. But to push someone into a position that they aren’t ready for is just irresponsible to patient care.

Moreover, I’m noticing a trend where everyone wants to do exactly what physicians do without medical school and residency. It’s really disheartening. I didn’t spend years of life doing this and training correctly and adequately for someone to try and shortcut it and potentially kill a patient.

I don’t mean to sound harsh or bitter and I hope it’s not coming off that way, but without proper training and education, people don’t even know what they don’t know.

I think you might be misunderstanding me. I'm mentioning that the bar to be a "provider" has gotten so unbelievably low so quickly that all the allied health professional fields are taking notice. I would not be surprised if governing body's for speech, OT/PT are not looking on and figuring out how to get their prescribing privileges. Medicine took a real left turn many years ago and with how much more power business has then physicians, I'm personally very concerned.

 

[MisterKitty]

Is it really worth it to continue pursuing psychiatry as a trainee? I feel that eventually the job of a general psychiatrist is going to be squeezed out. Need therapy? Social worker. Need meds? NP/PCP. Like why should I continue this training modality if every part of the job is being contracted out to the lowest bid. Seriously regretting not going the surgery route at this point in time.

 

[Shufflin]

Don't be disheartened. Psych is still a winner in many respects. Hours, pay, stress, impact, risk, and demand, when taken as a whole, wins out over most everything else. And don't think encroachment means replacement. I'm in a location where encroachment is happening, but not a single MD has been replaced because of it. Just the opposite, it's opened up more leadership opportunities because of it.

 

[Merovinge]

Is it really worth it to continue pursuing psychiatry as a trainee? I feel that eventually the job of a general psychiatrist is going to be squeezed out. Need therapy? Social worker. Need meds? NP/PCP. Like why should I continue this training modality if every part of the job is being contracted out to the lowest bid. Seriously regretting not going the surgery route at this point in time.

If it makes you feel any better the exact same things are happening to the surgical fields. Many procedures are now starting to get done by midlevels and there are midlevel training programs specifically for surgical intervention (that is not just rounding on surgery patients for the attending).

 

[Mad Jack]

I fully respect psychologists, but this proposal is horrifically dangerous. With no training in general anatomy, physiology, and pathophysiogy, how are they going to monitor blood levels or even know what results they are looking at with regard to medications? How are they going to know what medications react with other medications? How are tbey going to understand the many side effect profiles and the ways in which these affect prescribing? This is so misguided, understanding mental illness in no way prepares one to prescribe medication for those same illnesses any more than a physical therapust is qualified to perform orthopedic surgery

 

[scoopdaboop]

If it makes you feel any better the exact same things are happening to the surgical fields. Many procedures are now starting to get done by midlevels and there are midlevel training programs specifically for surgical intervention (that is not just rounding on surgery patients for the attending).

Point me to an article that says NP's are doing surgeries other than lac repairs.

 

[scoopdaboop]

Also, this bill will be hilarious because psych NP's that prescribe will also oppose this, because clearly the NPs are going to be the more replaceable "provider" by this than MDs. And they will use the same argument MDs use against midlevel encroachment. The irony.

 

[TexasPhysician]

Point me to an article that says NP's are doing surgeries other than lac repairs.

Chipping away every year-

Pediatric penile surgery by a nurse practitioner in the operating room - PubMed

It was demonstrated that a well-trained APP can safely perform minor penile procedures independently in the OR with indirect supervision.

pubmed.ncbi.nlm.nih.gov

 

[scoopdaboop]

Chipping away every year-

Pediatric penile surgery by a nurse practitioner in the operating room - PubMed

It was demonstrated that a well-trained APP can safely perform minor penile procedures independently in the OR with indirect supervision.

pubmed.ncbi.nlm.nih.gov

Shame.

 

[SourceOfDenial]

I fully respect psychologists, but this proposal is horrifically dangerous. With no training in general anatomy, physiology, and pathophysiogy, how are they going to monitor blood levels or even know what results they are looking at with regard to medications? How are they going to know what medications react with other medications? How are tbey going to understand the many side effect profiles and the ways in which these affect prescribing? This is so misguided, understanding mental illness in no way prepares one to prescribe medication for those same illnesses any more than a physical therapust is qualified to perform orthopedic surgery

You don’t need to go to med school to teach yourself to interpret a CMP or CBC. You can look up interactions in a drug/drug interaction checker. You can read up to date to gauge likely side effects.

While I don’t understand why psychologists want prescribing practices(more burden for a marginally effective armament of drugs? Doesn’t seem worth it to me) I think opposing it outright is failed from the start. Hasn’t worked for MDs wanting to limit NP abilities, not sure why a similar approach would work here.

Psychiatry as a field needs to find other ways to stay relevant.

 

[Mad Jack]

You don’t need to go to med school to teach yourself to interpret a CMP or CBC. You can look up interactions in a drug/drug interaction checker. You can read up to date to gauge likely side effects.

While I don’t understand why psychologists want prescribing practices(more burden for a marginally effective armament of drugs? Doesn’t seem worth it to me) I think opposing it outright is failed from the start. Hasn’t worked for MDs wanting to limit NP abilities, not sure why a similar approach would work here.

Psychiatry as a field needs to find other ways to stay relevant.

You can see that something is off, but you'll have absolutely no clue why. A differential diagnosis requires understanding more than just a number range. I'm fine with NPs prescribing because they actually get some training in A&P, pathophys, and general pharmacology. Their skills and foundation may be lacking but they are at least resistant. A psychologist is no more qualified to prescribe psychiatric medications than an auto mechanic is, it's completely outside of their training.

And interaction checkers don't give you a barebones overview of things, they're not good enough to make sound clinical decisions.

 

[Merovinge]

You can see that something is off, but you'll have absolutely no clue why. A differential diagnosis requires understanding more than just a number range. I'm fine with NPs prescribing because they actually get some training in A&P, pathophys, and general pharmacology. Their skills and foundation may be lacking but they are at least resistant. A psychologist is no more qualified to prescribe psychiatric medications than an auto mechanic is, it's completely outside of their training.

And interaction checkers don't give you a barebones overview of things, they're not good enough to make sound clinical decisions.

I can't believe I'm partially defending RxP (because I actually strongly oppose it), but their proposals to date often require at least as much classroom and clinical time as PA's and NPs on top of their existing PhD requirements. The state level proposals are not simply that anyone with a PhD in psychology can prescribe. When we drop the bar to all online night class NP degrees with clinical hours that can be measured in months, not years, and taught by other NPs instead of actual experts, its very easy to have other fields also meet these requirements if they perceive gain from doing so.

 

[nexus73]

I can't believe I'm partially defending RxP (because I actually strongly oppose it), but their proposals to date often require at least as much classroom and clinical time as PA's and NPs on top of their existing PhD requirements. The state level proposals are not simply that anyone with a PhD in psychology can prescribe. When we drop the bar to all online night class NP degrees with clinical hours that can be measured in months, not years, and taught by other NPs instead of actual experts, its very easy to have other fields also meet these requirements if they perceive gain from doing so.

I don’t know how a psychologist gets equivalent training doing nights and weekend classes for 2 years. Even a PA is 26 months full time. And the part time psych NP programs are 4+ years for nights and weekends.

 

[Armadillos]

Scrolled through chunk of thread, but are these practice scope discussions somewhat morally conflicting to anyone else?

On one hand we (psychiatrists) are benefiting from essentially a cartel MD/DOs have setup (state medical boards) and in general cartels seem bad for society, so have to wonder if ours is too.

But on the other hand patients are just incredibly bad at evaluating (or even caring to evaluate) a providers competence that there seems to be no other viable option than having someone else vet the providers for them.

Maybe we just need to develop some super accurate board exam that actually measures competence to practice, is like 2 weeks long and 5,000 questions and whoever can pass it gets a prescription pad whether they are a plumber or a chairman of a psychiatry program.

 

[kopftonmd]

Maybe we just need to develop some super accurate board exam that actually measures competence to practice, is like 2 weeks long and 5,000 questions and whoever can pass it gets a prescription pad whether they are a plumber or a chairman of a psychiatry program.

But would the plumber still charge to show up in addition to fees for medical services?

 

[nexus73]

Scrolled through chunk of thread, but are these practice scope discussions somewhat morally conflicting to anyone else?

On one hand we (psychiatrists) are benefiting from essentially a cartel MD/DOs have setup (state medical boards) and in general cartels seem bad for society, so have to wonder if ours is too.

But on the other hand patients are just incredibly bad at evaluating (or even caring to evaluate) a providers competence that there seems to be no other viable option than having someone else vet the providers for them.

Maybe we just need to develop some super accurate board exam that actually measures competence to practice, is like 2 weeks long and 5,000 questions and whoever can pass it gets a prescription pad whether they are a plumber or a chairman of a psychiatry program.

I feel the same way about airline pilots. Why do we need pilots licenses? The airline pilots are basically running a cartel. Only a trained pilot can fly a plane full of hundreds of people? Give me a break. I bet the flight attendant could probably learn to fly the plane in a fraction of the time and do just as good a job as long as there was an air traffic controller tracking their flight.

 

[wolfvgang22]

I feel the same way about airline pilots. Why do we need pilots licenses? The airline pilots are basically running a cartel. Only a trained pilot can fly a plane full of hundreds of people? Give me a break. I bet the flight attendant could probably learn to fly the plane in a fraction of the time and do just as good a job as long as there was an air traffic controller tracking their flight.

😱🤣

 

[tortuga87]

First NPs and now this. Getting worse every year.

Honestly the med students take care of psych patients better than the senior PMHNP students I am forced to teach in residency because the med students are just much smarter in general. I taught PMHNP students who have less than 2 months to graduate as an intern. So basically the *least qualified* psychiatrist *in training* is teaching people who can soon practice independently. Makes no sense.

We should just put everyone with anxiety on Xanax. Blast up that lamictal dose asap because I just memorized the side effects once for a test. Patients should be on baby doses of multiple antidepressants. Uncontrolled diabetes? Here’s some zyprexa because you say you hear voices sometimes. Bipolar = ssri monotherapy because they only come in when they are depressed. I’m about to go practice independently next month - whats the difference between thought process and thought content again? Face palm. I didn’t make up this stuff. But who cares about common sense right?

 

[Armadillos]

I feel the same way about airline pilots. Why do we need pilots licenses? The airline pilots are basically running a cartel. Only a trained pilot can fly a plane full of hundreds of people? Give me a break. I bet the flight attendant could probably learn to fly the plane in a fraction of the time and do just as good a job as long as there was an air traffic controller tracking their flight.

Probably not a good example as commercial flights will surely cease to have human pilots sometime in next 25-100 years, hopefully we will hold on longer than that

 

[Merovinge]

Probably not a good example as commercial flights will surely cease to have human pilots sometime in next 25-100 years, hopefully we will hold on longer than that

It's a fine example, because its simply a place in society where we expect licensing agencies to ensure a minimum standard and make our decisions based on that. No one expects their lawyer to not have passed law school/the bar, their dentist to not have passed dentistry school/whatever test they take, or their pilot to not have the minimum hours/be certified. This is absolutely not a "cartel" unless you are so far right that you think driver's licenses are an infringement of your personal rights.

 

[birchswing]

Shame.

As it stands are there *any* regulations on who can and cannot circumcise infants? It already exists outside the medical sphere. It long predates the medical sphere.

Also the mass "voluntary" circumcision US/WHO/Clinton Foundation campaign across Africa (over 25 million) are done with devices intended to used by lay persons or the patient themself. It's being called the next Tuskegee.

Edit: I may have quoted the wrong post. It was up above about NPs performing circumcisions.

 

[birchswing]

Probably not a good example as commercial flights will surely cease to have human pilots sometime in next 25-100 years, hopefully we will hold on longer than that

I doubt it. I think a few people like Elon Musk have put that out into the air. It's like an apocalyptic religion with the cars—always 1-2 years out.

That airplane Sully Sullenberg was piloting was overtaken by a goose. You'd need a really advanced computer to account for a goose—and we had one, a human brain.

Also doesn't seem like there's going to be much near-term investment in commercial aviation if it ever returns to normal.

 

[aim-agm]

I doubt it. I think a few people like Elon Musk have put that out into the air. It's like an apocalyptic religion with the cars—always 1-2 years out.

That airplane Sully Sullenberg was piloting was overtaken by a goose. You'd need a really advanced computer to account for a goose—and we had one, a human brain.

Also doesn't seem like there's going to be much near-term investment in commercial aviation if it ever returns to normal.

Also there is little benefit in automating pilots since they are a relatively small expense in operating a plane.

 

[Armadillos]

It's a fine example, because its simply a place in society where we expect licensing agencies to ensure a minimum standard and make our decisions based on that. No one expects their lawyer to not have passed law school/the bar, their dentist to not have passed dentistry school/whatever test they take, or their pilot to not have the minimum hours/be certified. This is absolutely not a "cartel" unless you are so far right that you think driver's licenses are an infringement of your personal rights.

My initial post may have come across more seriously than was intended, as I mentioned we need a way to vet people’s ability to safely prescribe meds and was just musing that would be more fair if we had some more objective way instead of whoever’s respective lobbies have the most swing in state/national politics as that cat is already long out of the bag.

 

[comp1]

Does anyone have a link to the actual bill? I can't find it.

 

[wolfvgang22]

Does anyone have a link to the actual bill? I can't find it.

It's H.R. 884 / S. 2772.

 

[PsyDr]

My esteemed psychiatric colleagues may wish to read the text of the bill, and the committee hearing dates.... Which is about how the Social Security Administration defines the term "psychologist"..... and last had a subcommittee meeting 3 months ago.... and never appeared before the VHA house committee

The more diligent colleagues may wish to look at the text of the actual bill that was in front of the VHA committee on the date of the original posting. Which has zero instances of the word "psychologist". Which is probably why prescription privileges for psychologists is wholly absent.

Hilarious.

 

[deleted343839]

It's H.R. 884 / S. 2772.

No, read the text. This is a very short bill, far too short to achieve what you're talking about.

This bill is one of many that have proposed a change to the Medicare "physician" definition to include psychologists. It is explicit about not changing scope of practice. This would allow psychologists to bill E&M codes in the same manner as other CMS-designated "physicians" such as chiropractors, optometrists, and podiatrists. The American Psychological Association has been pursuing this change for a long time and the bill always seems to die before reaching the floor. It has nothing to do with prescribing privileges.

But back to the original topic, this is the first time I've heard of such a proposal for the VA. Given the huge number of psychologists employed by the VA, perhaps we'd have heard more than a vague post without so much as a reference to a bill number. Also, I see nothing about VA prescribing privileges on the American Psychological Association's advocacy web page. So I'm wondering if this is... real?

 

[FatherPsychiatry]

Also, this bill will be hilarious because psych NP's that prescribe will also oppose this, because clearly the NPs are going to be the more replaceable "provider" by this than MDs. And they will use the same argument MDs use against midlevel encroachment. The irony.

 

[splik]

No, read the text. This is a very short bill, far too short to achieve what you're talking about.

This bill is one of many that have proposed a change to the Medicare "physician" definition to include psychologists. It is explicit about not changing scope of practice. This would allow psychologists to bill E&M codes in the same manner as other CMS-designated "physicians" such as chiropractors, optometrists, and podiatrists. The American Psychological Association has been pursuing this change for a long time and the bill always seems to die before reaching the floor. It has nothing to do with prescribing privileges.

But back to the original topic, this is the first time I've heard of such a proposal for the VA. Given the huge number of psychologists employed by the VA, perhaps we'd have heard more than a vague post without so much as a reference to a bill number. Also, I see nothing about VA prescribing privileges on the American Psychological Association's advocacy web page. So I'm wondering if this is... real?

This is spurious. E&M codes are medical codes. That means you are considering prescribing or looking at labs or imaging or medical data or you won’t be able to use them. How else would you use E&M codes if not for providing medical services?

I do support better reimbursement for psychology services but this is not the way and the claims made here are either naïve or deceptive

 

[ExecutiveDysfunction]

This is spurious. E&M codes are medical codes. That means you are considering prescribing or looking at labs or imaging or medical data or you won’t be able to use them. How else would you use E&M codes if not for providing medical services?

I do support better reimbursement for psychology services but this is not the way and the claims made here are either naïve or deceptive

Include Psychologists in Medicare's "Physician" Definition

2014 SLC fact sheet: Unnecessary physician supervision requirements in Medicare keep psychologists from providing a full range of services within state licensure.

www.apaservices.org

I’m not sure about the E&M codes issue, but one of the problems I’m aware of is that psychologists often cannot bill for services unless overseen by a physician. When it falls under our scope of practice, that does place an unnecessary limitation. Reclassification wouldnfix that

I’m talking things like psych assessment and treatment, not when there is a clear medical indication.

 

[splik]

Include Psychologists in Medicare's "Physician" Definition

2014 SLC fact sheet: Unnecessary physician supervision requirements in Medicare keep psychologists from providing a full range of services within state licensure.

www.apaservices.org

I’m not sure about the E&M codes issue, but one of the problems I’m aware of is that psychologists often cannot bill for services unless overseen by a physician. When it falls under our scope of practice, that does place an unnecessary limitation. Reclassification wouldnfix that

I’m talking things like psych assessment and treatment, not when there is a clear medical indication.

The bill is a wolf in sheep's clothing. Psychologists do not need physician oversight to provide 99% of services. The only thing that physician oversight is required for is admitting patients (even NPs and PAs can't admit patients), and partial hospital programs. Both of these should have physician involvement and oversight.

ETA: also if proponents of this didn't real want a backdoor to medicine they would request that the medicare laws be amended to including provisions for psychologists, not for psychologists to be defined as physicians.