Tag Archives: Insurance

The Fee for Service Train is Leaving the Station: Next Stop ‘Value-based Payments’ –Why this Matters Now!

Health care costs reached $3.3 trillion in 2016 (Sahadi, 2018), and as much as 60% of all medical care visits involve some mental and behavioral health component (Rozensky, 2014). To address cost containment, the health care landscape is evolving toward new reimbursement mechanisms to replace fee-for-service payments (Nordal, 2012). Notably, payers and providers have hypothesized that payment with measures of value will eclipse fee-for-service by 2020 (McKesson Health Solutions, 2016).

This has implications for psychologists, such as increased use of electronic health records, evidence-based practices, telehealth, ehealth, integration into medical teams, quality metrics, and payment reforms (e.g., value-based payment models, bundled payments, and shared-savings models).

The US federal government is spearheading payment reforms through regulatory and legislative changes. It is important for psychologists to realize that value-based payment initiatives related to behavioral and mental health will impact their practice, as the federal government is often the driver of change that then trickles down to third-party payers. Medicare providers have experienced value-based payment models for at least 10 years. The payment models have become increasingly complex with larger potential cuts/bonuses.

For those providers required to participate, the newest Medicare program called MIPS varies payment from negative nine (-9) percent to positive nine (+9) percent of the posted rates for a given service. If a provider does not participate in the program, Medicare reimbursement is decreased by 9 percent, but if the provider successfully participates, a bonus of up to 9 percent is possible. The percentage (cut or bonus) is applied to all Medicare reimbursement received in an entire year. Thus, the consequences of not participating can be significant to your bottom line.

To help you prepare for value-based payment, WPA is hosting a workshop that will address the following: 1) overview of federal and regulatory trends driving value-based payment (i.e., CMS, MACRA, MIPS, etc.) 2) overview of the psychological research supporting measurement-based care (also referred to as routine outcome monitoring) 3) application of measurement-based care to one’s practice (including a practical demonstration of how to use the registry that APA is developing as a resource for psychologists) and 4) helpful guidelines from a provider with over 10 years of experience in value-based reporting and value-based payment.

Program Presenters: C. Vaile Wright , PhD is the Director of Research and Special Projects in the Practice Directorate at the American Psychological Association. She is involved in developing professional and clinical practice guidelines and increasing outcomes measurement and quality improvement efforts, including the development of a CMS-approved Outcomes Data Registry. She is widely published in peer-reviewed journals. Dori Bischmann, PhD has been participating in quality reporting since Medicare started the program in 2006. She was among the first psychologists to report via APA’s outcomes Data Registry, called MIPSPRO (formerly PQRSPRO). She is also the APA representative to the Physician’s Consortium of Provider Improvement, a group of medical professionals involved in creating and using quality measures.

Program Name: The Fee for Service Train is Leaving the Station: Next Stop ‘Value-based Payments” –Why this Matters Now!

Program Date: November 2, 2018 Program time: 9:00 to 4:00

Program Place: For more information contact: http://wipsychology.org

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The Structure of Advocacy in the Practice of Psychology

Advocacy is an important function in today’s society.  Those that speak the loudest and/or make the largest donations are able to affect important governmental changes.  Psychologists play an important role in advocacy because we not only advocate for our profession, but we advocate for the mental health needs of our patients and improvements in society at large. We are fortunate to have an advocacy structure set up for us.

APA has the Practice Organization (known as APAPO) which advocates for psychologists and the people we provide services to.  Among the many issues that APAPO might advocate is:  improved mental health care, increased funding for mental health care, improvements to insurance that facilitate access to mental health care, advocating the inclusion of psychologists (and good mental health care) into healthcare initiatives (Affordable care act), parity, changing Medicare law to facilitate psychological services/access and much more.

In order for advocacy to be effective, it is imperative that many psychologists, at the grass-roots level, be involved in sending messages to legislators.  APA has a system  in place that makes it easy for every psychologist to advocate.

Every state, territory and district of the United States has a psychologist designated as the Federal Advocacy Coordinator (FAC).  I am the Wisconsin FAC.  In the FAC role, I represent both APA and WPA and have a variety of responsibilities.  First, through a data base provided by APA, I send out action and information alerts to Wisconsin psychologists.  The alerts are written by APA and then sent out to the FACs for distribution.  You are in the data base if you are a member of APAPO or have previously used the APA (Capwiz) political action portal.

I encourage you to write to your legislators, at the very minimum, when you receive an action alert.  This is the cornerstone of grass-roots advocacy and it really does make a difference.  When a message avalanche hits the hill, legislators and their offices take notice. APA makes it easy by putting a clickable button in the action alert that will take you directly to the advocacy portal.  Enter your zip code to identify your specific federal legislators and then send emails.  APA provides a sample letter for you to use; you can edit the letter any way you wish or send it as written.  Even if you disagree with the APA stance on an issue, I encourage you to make your voice heard and write what you think the legislator should do to address the issue.

A second FAC responsibility is to attend the annual Practice Leadership Conference in March.  The conference provides several days of workshops on cutting edge issues related to the practice of psychology and health care in general. We also receive advocacy training.  On the last day of the conference, we go to Capitol hill in Washington D.C.  We meet with as many Wisconsin legislators as possible while the  other FAC’s meet with their respective legislators.  We essentially blanket the hill advocating the specific agenda delineated by APA.

This year we advocated to include psychologists in the “physician definition” under Medicare law.  We are the only doctoral level providers, licensed to work independently in our states, that are not included under this definition.  Chiropractors, dentists, podiatrists and optometrists are included under the physician definition.  This is important because many Medicare initiatives have been tied to providers that fall under “physician” such as funding to develop electronic health records, use of E & M codes and the ability to be independent in all places of service under all insurances.  Currently, it is required that psychologists have an MD sign off in some places of service for our work with Medicare fee for service beneficiaries. In contrast, MD sign off is not required when the patient has commercial insurance, Medicaid or Medicare advantage plans.  We also advocated to keep mental health services included in Medicaid and other health plans as congress continues to address the affordable care act and Medicaid.

A third responsibility for FAC’s is to meet with, write to or in other ways be active with legislators when they come to their Wisconsin districts.  I go to town hall meetings, listen to Facebook town hall meetings and write to the legislators and their aides.

Finally, the FAC brings this information back to you via education at annual conference, newsletter articles and this blog.  I also communicate with Wisconsin psychologists who have questions about action alerts.

At times, this is a huge responsibility (i.e. when major changes in health care bills are being voted on), but it is rewarding and important work.  I am proud of the role I play in affecting change at the governmental level.   Perseverance and patience are required because change does not occur quickly.  For many years in a row we go to the hill with virtually the same agenda items. Over time, you witness a slow, but important change occurring and then suddenly, or so it seems, the advocated change occurs!

If you have any questions or suggestions, please do not hesitate to contact me.  Thank you for all the help you have given me over the years by contacting your legislators!  Keep it up, we are making progress.

Dori Ann Bischmann, PhD

Federal Advocacy Coordinator

APA and WPA

Capwiz: an online advocacy program developed by Capitol Advantage that allows users to send advocacy messages and alerts to members.  APAPO is a member of Capwiz and utilizes this system to send alerts to psychologists.

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