CMS Comment time

[WisNeuro]

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About that time again. Time to submit comments to CMS to help avoid reimbursement cuts. I believe telehealth and some other issues are also still on the table. Please take a couple minutes to submit. You do not have to be an APA member, and it literally takes like 2 minutes with the template that APA provides, but feel free to personalize it for more impact.

Action Center

 

[Sanman]

Is "this process is entirely stupid" a valid comment? Already sent official comments, but that is the one that I wanted to send.

 

[WisNeuro]

Is "this process is entirely stupid" a valid comment? Already sent official comments, but that is the one that I wanted to send.

Valid? Almost certainly. Effective?

 

[WisNeuro]

But yes, it sucks that we have to rinse and repeat this every year or every other year at this point. Though, it does look like we have some momentum coming out of the pandemic when MH has been emphasized, we just need to keep that momentum going and put the work in.

 

[Sanman]

But yes, it sucks that we have to rinse and repeat this every year or every other year at this point. Though, it does look like we have some momentum coming out of the pandemic when MH has been emphasized, we just need to keep that momentum going and put the work in.

The proposed cuts to tele-health services are very frustrating given that the new legislation and development of PSYPACT has really helped to breathe a new life into the possibilities for PP.

 

[WisNeuro]

The proposed cuts to tele-health services are very frustrating given that the new legislation and development of PSYPACT has really helped to breathe a new life into the possibilities for PP.

Yeah, I am all for telehealth, but am ambivalent with PSYPACT. I don't think we've though through the unintended consequences on that one.

 

[AbnormalPsych]

Yeah, I am all for telehealth, but am ambivalent with PSYPACT. I don't think we've though through the unintended consequences on that one.

I forsee psychs in less populated geographical regions with lower rates getting licensed in the saturated and HCOL states and doing telehealth at their own regular rates into HCOL states, undercutting psychs actually living in the HCOL areas. Its going to get messy. That's just private practice. Who knows how this might be with bigger systems playing ball one day.

 

[WisNeuro]

I forsee psychs in less populated geographical regions with lower rates getting licensed in the saturated and HCOL states and doing telehealth at their own regular rates into HCOL states, undercutting psychs actually living in the HCOL areas. Its going to get messy. That's just private practice. Who knows how this might be with bigger systems playing ball one day.

That will be the start. And then insurers will make sure that a good portion of their network is midlevels and telehealth psychs who are working n low reimbursement states. So, either wait forever to see someone local, or see someone who lives in Alabama next week!

 

[Justanothergrad]

About that time again. Time to submit comments to CMS to help avoid reimbursement cuts. I believe telehealth and some other issues are also still on the table. Please take a couple minutes to submit. You do not have to be an APA member, and it literally takes like 2 minutes with the template that APA provides, but feel free to personalize it for more impact.

Action Center

thanks for posting. this is super important for folks to do.

 

[WisNeuro]

thanks for posting. this is super important for folks to do.

Definitely important, just wish more people would take the time. Like last year, how many psychologists are there in the state of NY? More than 12,000? And only 400 took the time to comment?

 

[Justanothergrad]

Definitely important, just wish more people would take the time. Like last year, how many psychologists are there in the state of NY? More than 12,000? And only 400 took the time to comment?

Seriously? I didn't realize the numbers were that bad.. I knew it was bad but damn.

 

[AcronymAllergy]

They need to create a CE on professional advocacy and then, instead of having a quiz at the end, require that all attendees send out one of these comments. I mean, I know it's not possible, but one can dream.

 

[WisNeuro]

Seriously? I didn't realize the numbers were that bad.. I knew it was bad but damn.

Yeah, if you wonder why we seem to lag behind in reimbursement fights, this is it. People just sitting on the sidelines.

 

[PsychPhDone]

Definitely important, just wish more people would take the time. Like last year, how many psychologists are there in the state of NY? More than 12,000? And only 400 took the time to comment?

I couldn't figure out how our home addresses get used - any idea?

 

[WisNeuro]

I couldn't figure out how our home addresses get used - any idea?

I'm already an APA member, so I just enter my email and zip, so they can track which state numbers. I suspect APA may send you some marketing stuff with home address, but even as an APA member, it's pretty minimal. PESI sends me about 20x teh junk mail that APA does.

 

[WisNeuro]

Bumping this to keep it up top. Just updated the numbers today and they are dismal. Please share with your local/divisional/listserv/office psychologist colleagues.

 

[thebalmofhurtminds]

It's frustrating to be one of the few constantly submitting comments and pushing it to my department when I know so many just ignore it. Our reimbursement just keeps getting chipped away.

 

[WisNeuro]

It's frustrating to be one of the few constantly submitting comments and pushing it to my department when I know so many just ignore it. Our reimbursement just keeps getting chipped away.

Psychologists can be an apathetic bunch. They like to complain about things, but when you ask someone to pony up or put in the work, very few do.

 

[thebalmofhurtminds]

Psychologists can be an apathetic bunch. They like to complain about things, but when you ask someone to pony up or put in the work, very few do.

Yeah, see that. I try to emphasize that APA literally writes the comment for them.

 

[WisNeuro]

Yeah, see that. I try to emphasize that APA literally writes the comment for them.

Yeah, it's pretty astounding to see psychologists who don't think they can spare the 90 seconds to do this.

 

[R. Matey]

Yeah, it's pretty astounding to see psychologists who don't think they can spare the 90 seconds to do this.

I think it might be also be ignorance. Had it not been for you posting this here, I may not have known it was happening. I'm an APA member, but I don't read everything they send me.

 

[WisNeuro]

I think it might be also be ignorance. Had it not been for you posting this here, I may not have known it was happening. I'm an APA member, but I don't read everything they send me.

Yeah, that is definitely an issue on the organizational level. How do we effectively communicate important information between a wide range of members from a generational standpoint. We deal with the same issue at the state association level.

 

[Sanman]

We've talked about the issues before. The biggest one I am seeing is apathy towards insurance work. Many of the early career folks not interested in VA/Hospital work seem to want to do cash only psychotherapy in higher income areas. Few seem to want to focus on insurance reimbursement issues. I am one of the few VA folks at my facility with an interest in this stuff. I still get people who do not understand why I am concerned. The attitude seems to be that because it is not going to affect me today or tomorrow, I should be fine with lower reimbursements and fewer career options. Physicians would be screaming bloody murder if faced with our reimbursement issues.

 

[R. Matey]

We've talked about the issues before. The biggest one I am seeing is apathy towards insurance work. Many of the early career folks not interested in VA/Hospital work seem to want to do cash only psychotherapy in higher income areas. Few seem to want to focus on insurance reimbursement issues. I am one of the few VA folks at my facility with an interest in this stuff. I still get people who do not understand why I am concerned. The attitude seems to be that because it is not going to affect me today or tomorrow, I should be fine with lower reimbursements and fewer career options. Physicians would be screaming bloody murder if faced with our reimbursement issues.

 

[Justanothergrad]

Psychologists can be an apathetic bunch. They like to complain about things, but when you ask someone to pony up or put in the work, very few do.

I'm resistant to call 2 minutes and a copy paste to be 'work', but I get your point

 

[WisNeuro]

We've talked about the issues before. The biggest one I am seeing is apathy towards insurance work. Many of the early career folks not interested in VA/Hospital work seem to want to do cash only psychotherapy in higher income areas. Few seem to want to focus on insurance reimbursement issues. I am one of the few VA folks at my facility with an interest in this stuff. I still get people who do not understand why I am concerned. The attitude seems to be that because it is not going to affect me today or tomorrow, I should be fine with lower reimbursements and fewer career options. Physicians would be screaming bloody murder if faced with our reimbursement issues.

Well, physicians are the ones who call most of the rules regarding changes in CPT coding and some other CMS issues, as well as blatantly lying in front of Congress during testimony, so they don't need to scream as much.

 

[Sanman]

Well, physicians are the ones who call most of the rules regarding changes in CPT coding and some other CMS issues, as well as blatantly lying in front of Congress during testimony, so they don't need to scream as much.

Well, yeah. They still yell and scream to get their way. Meanwhile, psychology seems to be adopting the learned helplessness model of advocacy.

 

[thebalmofhurtminds]

Well, yeah. They still yell and scream to get their way. Meanwhile, psychology seems to be adopting the learned helplessness model of advocacy.

To be fair, I am finding it difficult not to succumb to learned helplessness every time I learn more about our institutional structure and the foundation for how psychologists are treated.

 

[Spydra]

We've talked about the issues before. The biggest one I am seeing is apathy towards insurance work. Many of the early career folks not interested in VA/Hospital work seem to want to do cash only psychotherapy in higher income areas. Few seem to want to focus on insurance reimbursement issues. I am one of the few VA folks at my facility with an interest in this stuff. I still get people who do not understand why I am concerned. The attitude seems to be that because it is not going to affect me today or tomorrow, I should be fine with lower reimbursements and fewer career options. Physicians would be screaming bloody murder if faced with our reimbursement issues.

I am wondering how much of this starts at the intern (or perhaps practicum in some cases) level when the mess of insurance work is presented in probably the worst possible manner. Then we see the more senior people in the field either swearing everything is great as is or learned-helpless complaining. Neither of those generate much in the way of believing that anything is fixable. I don't know how anyone exposed to this mess early on would leave the training years without the attitude of 'this is a waste of time' and not decide to take their time and talents (and perhaps student loan debt) elsewhere.

 

[PsyDr]

@WisNeuro

Submitted by me, all staff member (voluntary), multiple family members, and multiple friends. It takes no time at all to say, "If you agree with the contents, I would appreciate filling out this form."

@thebalmofhurtminds

It's really not that hard to change it on the individual level. Actually read the laws. Require institutions to put you on medical staff (e.g., "Oh, you made a mistake. I expect to be on medical staff"). Spend literally 45 seconds, and call your state and federal legislators, because calls count more than emails. Donate money to your state orgs. Give political candidates minor campaign contributions EARLY. Ask people, including staff, to at least email. Those are very minor things annually cost less than $500/yr and 1hr/yr.

Changing things on a national level isn't too hard either. You take the relevant information about the problem, create an actionable solution, and give it to the relevant person.

 

[WisNeuro]

@PsyDr awesome, thanks!

I wholeheartedly agree. I'm on a first name basis with my state reps, and I have personally talked to my federal level senators and my House Rep several times this year. I always advocate for trying to speak personally to people, even if you are talking to their staff. Unfortunately, only a very small number of people will go beyond simple form letter emails. Most people don't get how much advocacy matters. Here at the state level, my neighbor/state senator talks all the time about how he usually only gets a few phone calls about most bills, so when he gets 10+ calls about something, he really starts to take notice. That's all it takes sometimes, a couple handful of people who do just a little more.

 

[PikminOC]

Well, physicians are the ones who call most of the rules regarding changes in CPT coding and some other CMS issues, as well as blatantly lying in front of Congress during testimony, so they don't need to scream as much.

How do we lie to Congress? Very few of us are in the Ama as it's mainly academics and residents in it. I'm not paying 700 a year for them to continue to allow mid-level proliferation.

 

[WisNeuro]

How do we lie to Congress? Very few of us are in the Ama as it's mainly academics and residents in it. I'm not paying 700 a year for them to continue to allow mid-level proliferation.

Most recently it;s been fear mongering about CMS physician definition (which includes chiros and optometrists) for independent billing in certain contexts. AMA trots someone out there to fear monger with some strawman about prescribing status.

 

[Sanman]

Most recently it;s been fear mongering about CMS physician definition (which includes chiros and optometrists) for independent billing in certain contexts. AMA trots someone out there to fear monger with some strawman about prescribing status.

Needing a physician referral for psychotherapy is really a paperwork drag on both ends. The PCP needs to write it and we need to store the record. It is annoying and pointless. Every doc I ever worked with just did as I said anyway.