I attended a seminar on the incoming effects of Obamacare on: notes, utilization review, treatment plans, and how each are tied with reimbursement decisions from private insurance companies under the newer reforms. Here are the major take aways: 1. As there are more mandates for coverage and parity, there will be more aggressive utilization reviews. So when you have an audit from an ins co. they will more and more be interested in whether you can account for the type of tx pursuant to sx, length, tx plan, and whether there is improvement. One problem is that many of the reviewers, similar to now, will be non-psychologists. 2. This is a biggie. There will probably be ACO (Accountable Care Orgs) that become the dominant service providers under Obamacare. Private practices will be under increased pressure to shut down. Here's how it may work. The new fleet of "health clerks" that will be hired by ins co's cos and by the govnt will have access to the federal electronic data-base. They will be able to track whether someone has missed their appnt with a private practice doctor-not affiliated with an ACO. They are then able to call the patient and essentially say "hey, we noticed you missed your appt. with doctor so and so. Did you know that you could also go down to "Insert Name" ACO where the following services are provided?" They will be ushering people into these new care facilities. For psychologists I see the effects as following: 1. Potential positives: The ACO may be a stabilizing employment opportunity. However, this will not be true if the requirements for the ACO are "mental health" driven and not "clinical psychology" driven. So if they operate like HMOs and employ mid-level providers in our stead then this will absolutely screw us. However, if they have some reason to employ psychologists rather than mide level providers then there is an opportunity for: 1. elevated requirements in standards of training in order to be hired (like the VA) and 2. A better quality of life for a shrink...no billing, scheduling, etc. Shrinks wld also take a profit share from the ACO in addition to therapy fees. 2. Absolute negatives: treatment standards will be more granulated and standardized. Longer term txs will likely be met with more resistance. Some illnesses will be excluded from coverage to meet the more concentrated and elevated demand that will arise in these ACOs. Our wages will likely have a cap. Remember, in Canada the highest a psychologist makes is appx $50/hr. So if this ends private practice, our earnings could take a serious plunge. Our methods of tx will also be more subject to bureaucratic demands and regulations.