Tag Archives: Washington

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


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.






Highlights on the Hill

Rain Soaked but Dedicated

Rain Soaked but Dedicated

Despite being soaked to the skin by pouring rain while waiting in security line, the visit to the hill in Washington D.C. was very exciting! We met with staffers in the following congressional offices: Reid Ribble, Gwen Moore, Paul Ryan, Ron Kind, James Sensenbrenner and Tom Petri. We also met with congressman Mark Pocan and his legislative aide. Unfortunately, we were unable to get appointments with our two senators, Ron Johnson and Tammy Baldwin and congressman Sean Duffy.

For the first time, it appears that there is some movement with regard to SGR. Every office was very aware of the SGR issue. Every office appeared to agreed that the SGR formula was a problem and should be permanently fixed. Paul Ryan is addressing Medicare issues at the “macro level” and typically has not voted in support of specific SGR bills in the past. Of the offices that we visited, Gwen Moore was the most supportive of our issues. Gwen is already a cosponsor of the bill including psychologists in the physician definition in Medicare and her aid advised her to become a cosponsor of the bill for including psychologists in the incentives for setting up electronic health records. We were told that there are a couple of bills circulating that pertain to making a permanent SGR fix so that we are not plagued with the SGR cuts every year.

There is so much information to share with you that I can’t possibly share it in one or two blogs. Over the next few weeks, I will be sharing information with regard to PQRS, psychotherapy codes and the agenda items we presented to our legislators.

At this point, I have a request for all of you. It is important for psychologists to develop relationships with our legislators. I am asking you to help me by being willing to talk with your particular legislators and advocating for the issues of interest to psychologists. Legislators appreciate hearing from their own constituents and all of them accept appointments with constituents in their home office. Gwen Moore’s office made it clear that Gwen likes to visit with agencies in her district. James Sensenbrenner’s office also made it clear that they enjoy visiting and touring in the community because it helps them have a better understanding of the issues pertinent to the community.

Please consider setting up an appointment with your representative/senator. I am happy to provide information to you, attend the appointment with you and/or provide any support or assistance you may need.

Much more information to come!

The Advocacy Cabinet

(post author: Dori Ann Bischmann, PhD)

(Psychologists in photo from left to right: John Weaver, PsyD, Greg jurenec, PhD and Dori Bischmann, PhD. Sarah Bowen, WPA executive director took the picture)

There is Hope: Psychtherapy Codes

It has been very exciting here at the APAPO State Leadership Conference in Washington D.C. We have lots of information to bring back home. There has been positive news despite the fact that we have many battles related to Medicare cuts. Let me share just a few of the positive things.

-the work values tied to our new psychotherapy codes are just interim values.
-since all new codes were not yet valued, Medicare chose to use the work values for the old codes while remaining codes went through valuation.
– the work values for the new codes are higher than the values for old codes. Thus after the interim period the work values of codes will be higher and thus rates may increase.
-three sets of codes are going through survey now and then will be valued for work rating: complexity add-on, crisis and 90 minute psychotherapy code
– yes there will be a 90 minute psychotherapy code.
-during this transition period we have the opportunity to shape our own world
-use the 60 minute psychotherapy code (90837) if you spent more than 53 minutes with your client. Don’t down code to 90834 because an insurance company might deny and you have to resubmit. Don’t let the insurance companies dictate the appropriate services to provide your client.
-Medicare says 90837 is a legal code, our provider association says its ethical to provide 60 minute sessions and with some types of client groups, it might be the most appropriate service to provide
-the system is in transition. The new norm is being established. Advocate for your profession, your livelihood and your clients by having conversations with insurance companies about the appropriateness of 60 minute sessions. We won’t win all the battles, but we will win some. Winning some is better than never trying at all.
-this is the time that we all have to speak up and advocate for what is right one case at a time
– our future is up to us. There is power in numbers. Join me and do your part in shaping your own future!

Tomorrow we go to the hill to advocate for change via our legislators. More than 300 psychologists representing every state and territory will descend upon the Capitol to tell our respective legislators that things need to change. We can’t continue to sustain these payment cuts, psychologists need to be allowed at the table for incentives to become part of the electronic healthcare records so that we don’t become obsolete by not having the required tools to participate in an integrated healthcare system, let us be included in the group that includes doctoral level, independently licensed professionals. Psychology is the only doctoral level profession to be left out of this group and this automatically leaves us out in the cold on many issues related to Medicare. As with all Governmental things, change doesn’t happen over night. But we will continue to advocate for what is right.

Much more to come.

Advocacy Cabinet
(Post author: Dori Bischmann, PhD)

Reference: 2013 APAPO State Leadership Conference. Washington D.C.