President’s Message: January 2014

Health Care Reform: Top 10 Things Ohio Psychologists Should Know

AshtonBy: Kathleen Ashton, PhD, OPA President

This January, the Affordable Care Act (ACA), also known by some as Obamacare (lovingly or not so lovingly) takes full effect. This piece of legislation is likely to be the most impactful piece of health care legislation since the establishment of Medicare. Here are just a few of things that you ought to know as an Ohio psychologist:

  1. The individual mandate. Health insurance exchanges have started operating in Ohio, run by the federal government. Starting in 2014, individuals without health care insurance will have to pay a fine. In addition, many Ohioans will qualify for subsidies to insurance bought through the health care exchanges. This means that more Ohioans will have access to insurance, meaning you may potentially have a larger patient pool.
  2. Medicaid expansion. Ohio has approved Medicaid expansion, enabling more Ohioans to receive health care insurance through Medicaid.
  3. Mental health parity. The ACA requires mental health parity and abolishes pre-existing conditions as a reason to deny coverage. This means that all medical health insurance coverage will have mental health coverage included.
  4. Good bye fee for service. The ACA encourages the development of Accountable Care Organizations (ACO) to provide integrated care to Medicare patients. ACOs will collect outcome data and be paid by efficacy rather than procedures or visits.
  5. Hello integrated care! Helping ACOs manage chronic conditions like pain, obesity, diabetes, hypertension and smoking cessation is a potential opportunity for psychologists trained in behavioral medicine.
  6. Measuring outcomes. As stated above, psychologists will need to participate in outcome measurement (i.e., PQRS) with Medicare patients. Until now, there were bonuses for participating, but starting in 2014, there will be penalties for not participating. This is all part of the push for payment to be based on treatment outcomes rather than providing a visit or specific service.
  7. Integrated primary care. There is a push to integrate mental health and substance abuse services into primary care settings. This might mean co-location, but more importantly means real communication between providers in a multidisciplinary team.
  8. Electronic medical records. Using electronic medical records (EMR) can be a key part of providing integrated care. EMR can help mental health providers be aware of issues arising in a patient’s medical care and facilitate timely communication between psychologists and other medical providers. Although confidentiality concerns are important, EMR will be essential to future practice. APA Practice Organization has resources available to help psychologists learn about EMRs.
  9. Traditional 50 minute therapy hours. Practice is more likely to look more like the medical model to Ohio psychologists. Psychologists may move toward using briefer visits, curbside consultations, group treatment models and briefer interventions to increase access to care.
  10. Retraining? Psychologists in traditional private practice settings may benefit from retraining in skills that might serve them in primary care settings. Areas such as behavioral medicine, evidenced based treatment, brief intervention, brief report writing, multidisciplinary team participation, consultation, and electronic medical records utilization could help strengthen your potential to acclimate to health care reform. All Ohio psychologists need to keep abreast of the ongoing changes affected by health care reform such as HIPPA, ICD-10 use, PQRS, etc.

Overwhelmed? There are many resources through OPA and APA to help you adjust to health care reform. In fact, we recently appointed a Health Care Reform Task Force, headed by Gary Sipps and Patrick Palmieri to help Ohio psychologists stay informed about the upcoming changes and develop practical tools for adjusting to health care reform.

Remember to use OPA and APA advocacy tools to help influence health care reform on behalf of psychology. For example, the Behavioral Health Information Technology Act of 2013 (S. 1517/H.R. 2957), sponsored by Senator Sheldon Whitehouse (D-RI) and Representatives Tim Murphy (R-PA) and Ron Barber (D-AZ) would make psychologists eligible for existing HITECH Act incentive payments that would make pricey EMRs more affordable.

The ACA represents an exciting shift in health care with many opportunities for psychology, it’s time we embrace the possibilities in spite of our anxieties!

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