The National Psychologist May/June 2014, Vol 23, 3, p 10.
National health care trends highlighted at Ohio conference
By Paula E. Hartman-Stein, Ph.D.
Columbus, Ohio – A representative from the private payer insurance industry, the director of the Ohio Medicaid system and the APA representative to the committee that creates codes used by the insurance industry all agree that health care delivery in the near future will require increased efficiency by providers, greater integration and performance-based reimbursement.
During a two-and-a-half hour panel discussion on health care trends at the Ohio Psychological Association conference, Tom Albert, a representative from Wellpoint insurance, said third party payers are dropping requirements for pre-authorizations for services involving psychology out-patient visits and neuropsychological testing.
According to Antonio Puente, Ph.D., professor of psychology at the University of North Carolina Wilmington and APA representative to the American Medical Association’s CPT panel, “Post payment audits are going to be a thing that all of us will have to live with.”
He said medical necessity is a key concept that requires justification that what the provider does at each patient encounter is of value. Puente also said that pay-for-performance is a trend that cannot be ignored. Wellpoint representative Albert agreed: “Pay for performance is where management is going.”
A psychologist in the audience, Thomas Swales, Ph.D., of Beachwood, Ohio, asked the crowd of about 50 people how many were using metrics with their patients to show change. Only a small minority raised their hands.
John McCarthy, director of Ohio’s Medicaid program, said much of his work has been with facility-based care. “I see the return of the diagnostic-related group payment structure that results in less haggling because the amount that is reimbursed is related to the diagnosis.” He said that increases motivation to use effective treatments quickly and tends to reduce the adversarial relationship between providers and health care plans.
Albert predicted that residential care will likely be a benefit in the future as well as reimbursement for telemedicine in rural communities. All three agreed that greater integration of behavioral and medical services is the future of health care.
In a private interview following the panel, Puente said he recently conducted a survey of over 400 psychologists to determine how they rank priorities of 10 key initiatives of recent APA presidents. “Integrated care is the number one initiative psychologists think is important,” he said. Puente said there are barriers to making this happen, such as the lack of appropriate reimbursement in the current CPT system for health care professionals to interact with each other.
“The CPT system is a highly developed and polished one for silo-based health care. As a consequence, it becomes next to impossible to incentivize practitioners to do anything beyond providing their services in isolated fashion, resulting in a fragmented and inefficient system of care. “
He said that electronic health records (EHR) may be a step toward better integration. “But there is nothing like human communication. In EHR there is no exchange,” he said, adding that new codes would have to be written for communication between providers to be incentivized.
“Medicine does not seem to be on the verge of understanding and leading the charge on integrated care. This is a unique opportunity for psychology to be in a pivotal position to assist health care in integrating all aspects. Psychology could propose to the AMA, Medicare and/or the state Medicaid programs that silo-based assessments and interventions produce expensive and less useful results.”
Paula Hartman-Stein, Ph.D., is a consultant in private practice and teaches integrated behavioral geriatrics for Arizona State University and the University of Massachusetts Medical School’s primary care certificate program. She is a member of technical expert panels for three measures in the Medicare pay-for-reporting system and offers webinars to make it easy for psychologists to implement. She can be reached through her website, www.centerforhealthyaging.com
Hartman-Stein, P. (2014). National health care trends highlighted at Ohio conference, The National Psychologist 23, p 10.