Health psychology and public policy: The political process.

During the past 20 years, psychologists have successfully modified federal statutes, resulting in recognition of the profession's clinical and research expertise. Despite these successes, professional psychology's training institutions have largely failed to address basic issues in health policy and the implications of national health policy for psychology. The importance of public health programs under Title VII of the Public Health Act and the significance of full inclusion of psychology in all federal health programs, including Titles XVIII (Medicare) and XIX (Medicaid), are poorly understood by most health psychologists. Federal health policy decisions, including management of excessive federal health spending, will dictate the growth and opportunities for health psychologists. Understanding federal health spending and recent federal initiatives such as Resource Based Relative Value Scale, Diagnostic Related Groups, and practice guidelines will be of benefit to health psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy research on Medicaid in Hawaii.

Describes the complex organizational and social conditions for conducting psychotherapy research in a state Medicaid program. Comparative data are offered on service delivery and utilization in Medicaid, the Civilian Health and Medical Program of the Uniformed Services, and the dominant employee health plan in Hawaii. It is suggested that the reporting of these data has led to extended coverage of psychologists under Hawaii Medicaid laws. The major overlap in types of procedures used by psychologists and psychiatrists and some indications of the impact of the extended coverage of psychologists on Medicaid health care costs are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation: Psychology's greatest opportunity?

Rehabilitation (RHB) is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in RHB. Although psychologists have benefited from legislated membership in RHB, most individual psychologists and the psychological associations have not recognized the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy are necessary to secure the scope of professional practice most psychologists expect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases

BACKGROUND: Significant changes are restructurng the U.S. health care delivery system. National health reform is now extending itself into the public sector. Increased health and medical costs by federal and state governments are forcing a reevaluation of major entitlement programs, especially Medicaid. METHODS/RESULTS: Because Medicaid is the single largest item in many state budgets, states are now enrolling Medicaid patients into managed and coordinated care arrangements as a means to control costs and increase access to care. HMOs are not only competing for private patients but also actively seeking the Medicaid population. Nationally, almost one-fourth of all Medicaid patients are now enrolled in managed care plans. Various models and approaches have been developed by individual states. CONCLUSIONS: Because managed care enrollment in the Medicaid program has increased substantially in recent years, selected services including vision care are no longer rendered by any practitioner willing to accept Medicaid fees. Freedom of choice is now restricted to pre-selected and panel practitioners participating with the managed care program. The rules, regulations, billing procedures, fees, and program requisites will differ under managed care programs. Private optometric practitioners must consider entering economic and organizational relationships and linkages that make them attractive to managed care organizations.     

Psychology and HMOs: New partnership or new adversary?

Discusses the provision of psychological services in health maintenance organizations (HMOs) with regard to the level of the legal recognition of the autonomous functioning of psychologists. Professional concerns over the role of psychologists in HMOs and over incentives to provide quality mental health care in such organizations are also discussed. The need is stressed for psychologists to be recognized as autonomous providers under the basic federal health programs. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The APA and Deafness.

Until the 1960s, people who were Deaf and mentally ill lacked access to psychological treatment. Few mental hospitals and clinics had interpreters available, and few psychologists and mental health professionals had knowledge of sign language. Major court decisions and federal laws have effected change, culminating with the Americans With Disabilities Act of 1990. This legislation gave people who are Deaf the right to equal access to mental health care as well as a host of other opportunities they had been previously denied. New access laws allowed Deaf students to become educated as psychologists, and a number of hearing psychologists who knew sign language entered the field of deafness. These two groups assumed vital roles within the American Psychological Association in addressing the issue of mental health access for people who are Deaf. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sanity examiner certification: An evolving national agenda.

A national survey of the states and territories revealed that the vast majority of state courts allow psychologists (and other nonphysician health care providers) to serve as forensic experts. Over the past decade organized psychology has been similarly successful in removing all known legislative and administrative barriers to its participation in the federal judicial system. The American Bar Association's criminal justice mental health standards provide for parity with medicine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Equality, public policy, and professional psychology.

Views psychologists as having substantial roles to play in the advocacy, development, and implementation of federal, state, and local policies that promote equality. Research, evaluation, education, and consultation are considered important components of strategies that professional psychologists can use to effect change. Specifically, the roles of psychologists in formulating public health care practices and in understanding the impact of child care services are discussed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care reform in the states.

Challenged by relentless increases in health care spending, state governments have been forced to experiment with health care system reform. Medicaid has been expanded by Congress, forcing states to provide a broader array of health benefits to more recipients. As states consider reform, federal limitations mandated by Medicaid and by the Employee Retirement Income Security Act (ERISA) of 1974 on state activity pose significant obstacles. ERISA sharply limits a state's ability to raise revenue to fund these health programs. Several states have responded to these limitations by seeking waivers. Despite these obstacles, 8 states already have enacted comprehensive health reform measures, and virtually every state is considering legislative reform. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CHAMPUS ten-state claim experience for mental disorder: Fiscal year 1975.

Describes in detail the utilization of mental health services by beneficiaries under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) for fiscal 1975, including tabular presentation by treatment procedure, diagnosis, profession, state, and average fees. Some interpretative comments are offered, as well as trend comparisons with utilization in the prior 2 yrs. Since qualified psychologists are now recognized by federal law as independent providers in this program, the data are of special significance to the profession of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicare/medicaid billing fraud and abuse by psychologists.

Medicare/Medicaid billing fraud and abuse can be prosecuted under a wider array of laws than apply within the private sector. Cases are typically initiated by whistleblowers or through detection of unusual billing patterns. Few psychologists in independent practice have ever been convicted of Medicare/Medicaid billing fraud or abuse, but government antifraud efforts against psychologists appear to be on the rise. These efforts are pursued under the auspices of containing spiraling health care costs, but they can uncover unintentional billing abuse by psychologists, arising from general ignorance of claim-processing procedures, lack of uniformity across insurance programs, constantly changing guidelines, and ambiguous interpretations. Recent investigations in south Texas have especially targeted the use of extenders for psychological and neuropsychological testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The critical importance of personal involvement.

Suggests that the deliberations surrounding Medicare may once again become the key to the enactment of national health care reform legislation and argues that if psychologists want to directly influence public policy, more of them must become personally involved in full-time advocacy and public policy work. Examples of federal policies that affect psychologists are discussed as well as the importance of joint psychology-law programs and the efforts of a psychologist and associate commissioner in Maine to shape a unified, outcome-driven mental health and mental retardation system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Federal involvement in mental health care for the aged: Past and future directions.

Reviews federal legislative trends in mental health services for the elderly under the Reagan administration. The consolidation of 21 health programs into 4 block grants is considered for its impact on elderly mental health care, and Congress's support of important programs such as clinical training, social research, and research on Alzheimer's disease is discussed. Severe limitations for reimbursement of mental health care under Medicare are considered. It is concluded that Community Mental Health Centers under the Reagan administration will further limit non-revenue-producing services such as prevention, consultation, and education as they exhaust their 8-yr federal funding support, and it is unlikely that Medicaid will increase its coverage of services for the mentally ill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician domination in the health care industry: The pursuit of antitrust redress.

Argues that the exclusion of qualified practitioners from the medical staffs of hospitals and the exclusion of psychological services from federal and commercial health care programs threaten the independent and autonomous practice of psychology in any national health insurance program. If psychological services are to be made available to consumers through such a program, psychologists must act now to preserve their status as independent professionals. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The new child health insurance expansions: how will school-based health centers fit in?

In June 1998, the Making the Grade National Program Office and the National Assembly on School-Based Health Care sponsored a workshop on the relationship between the State Child Health Insurance Program (SCHIP) and school-based health centers. Workshop participants used the health centers' experience with Medicaid managed care as a window for understanding their prospects for negotiating contracts with health plans under SCHIP. Speakers representing the federal perspective, state agencies, health plans, and local school-based health centers offered their views on the challenges of developing contracts, incentives, and disincentives that health plans have to contract with school-based health centers, and what has accounted for success where relationships are moving forward. Experiences in Colorado and Connecticut were presented as case studies on these evolving issues.     

Psychologists' reactions to Medicaid managed care: Opinion and practice change after 1 year.

How do psychologists adapt over time to a new managed care program? Reactions of Iowan psychologists to a managed mental health care program for Medicaid recipients were examined. The program was generally perceived negatively, although perceptions improved over time. Psychologists in private practice decreased the proportion of Medicaid patients they treated. Psychologists who continued to treat Medicaid patients reported decreased levels of job autonomy and satisfaction. A new managed care program presents psychologists with difficult ethical decisions, in which the quality of care provided to clients must be weighed against the negative aspects of participating in a managed care program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hidden problems in current health-care financing and potential changes.

Health-care costs in the US have risen significantly in the past 10 yrs, markedly affecting access to quality medical and mental health care. Deficit financing of our federal health-care expenditures adds billions of dollars annually to our national debt. Health-care reform is being hindered by both the inability of the government to pay for the uninsured and the unremitting spiral of the Medicare and Medicaid entitlement programs. The reasons for the total health-care cost increases include higher provider charges, overutilization of services, and the burgeoning technology; problems of malpractice, overspecialization, and consumer demands have also fueled the higher costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactions of bupranolol with the polymorphic debrisoquine/sparteine monooxygenase (CYP2D6)

Health-care costs in the United States have risen significantly in the past 10 years, markedly affecting access to quality medical and mental health care. Deficit financing of our federal health-care expenditures adds billions of dollars annually to our national debt. Health-care reform is being hindered by both the inability of the government to pay for the uninsured and the unremitting spiral of the Medicare and Medicaid entitlement programs. The reasons for the total health-care cost increases include higher provider charges, overutilization of services, and the burgeoning technology; problems of malpractice, overspecialization, and consumer demands have also fueled the higher costs.     

Psychologists and Governmental Affairs.

Discusses the problem of why economists and political scientists are frequently called to high-level administrative posts in government while psychologists are not. Several suggestions are made, including the following: (1) An APA Central Office sponsored research program consisting of personal interviews with major and key personnel in various federal departments, beginning with the President, with the goal of preparing a program for the federal government on the employment of psychologists as consultants and advisers or as full-time employees. (2) A communication from the APA Central Office to all members of the APA or to a selected group of prominent psychologists indicating to them the desirability of establishing and maintaining liaison with local and state political party organizations for promoting psychology and psychologists. (3) The inclusion of federal nonpsychologist major party officials in convention programs as invited speakers on appropriate topics that link psychology with national affairs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)