Provider profiling: What works for medicine works for mental health?

Provider profiling is a growing practice in organizations that supply or pay for health care, and escalating health care costs are likely to accelerate this trend. First developed for general medical settings, profiling systems now challenge practicing psychologists to meet ostensibly objective, scientific standards of care. The most advanced approaches compare providers on a "level playing field" statistically adjusted for variations in the "illness burden" of their patients. Profiling psychological practice, however, requires specialized new tools and more sophisticated analytical methods than have typically been used. This article provides a practical overview of provider profiling, emphasizing related developments in health care policy that are perhaps less familiar to practicing psychologists. Potential pitfalls confronting professional psychology are discussed, and points for advocacy are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The commerce of professional psychology and the new ethics code.

The 1992 version of the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct brings some changes in requirements and new specificity to the practice of psychology. The impact of the new code on therapeutic contracts, informed consent to psychological services, advertising, financial aspects of psychological practice, and other topics related to the commerce of professional psychology are discussed. The genesis of many new thrusts in the code is reviewed from the perspective of the psychological service provider. Specific recommendations for improved attention to ethical matters in professional practice are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Record Keeping Guidelines.

These guidelines are designed to educate psychologists and provide a framework for making decisions regarding professional record keeping. State and federal laws, as well as the American Psychological Association's "Ethical Principles of Psychologists and Code of Conduct," generally require maintenance of appropriate records of psychological services. The nature and extent of the record will vary depending upon the purpose, setting, and context of the psychological services. Within these guidelines, more directive language has been used when a particular guideline is based specifically on mandatory provisions of the Ethics Code or law. However, some areas are not addressed in those enforceable standards and regulations. In these areas, more aspirational language has been used. This document aims to elaborate and provide assistance to psychologists as they attempt to establish their own record keeping policies and procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer review in California: Summary findings in 40 cases.

Describes 40 requests for review of psychological services and fees processed by the California State Psychological Association Professional Standards Review Committee between January 1979 and August 1981. Nearly half of the reviews required a formal hearing by an ad hoc committee (2 psychologists and 1 public member) that met with the provider. Less complex cases were handled by a committee member who acted as ombudsman. The most frequent questions involved fees for specific services, utilization of services, reimbursement by the carrier for psychological treatment of psychological assistants and employees, and overutilization and duplication of services with hospitalized patients. Deficiencies in quality of care were found in one-third of the cases. The relative newness of peer review, the problems of using volunteers to perform the reviews, the increasing utilization of peer review by carriers, the lack of visibility to consumers, and the necessity of peer review to counter sunset legislation are discussed. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Third party recognition of psychological services.

Investigated reimbursement guidelines for psychological services among 26 insurance companies in Missouri. The most frequently covered services were individual inpatient and outpatient therapy. Group and family therapy were inconsistently covered, biofeedback was reimbursed by fewer insurers, marriage counseling was recognized by only one company, and vocational guidance by none. All companies specified benefit limits for nervous and mental conditions and had selection procedures to determine which providers were eligible for reimbursement. Issues of concern to state and national insurance committees are delineated. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Standards for providers of psychological services.

Presents revised Standards for Providers of Psychological Services that differ from the original Standards in 2 respects: (1) Minimally acceptable levels of quality assurance and performance are defined and (2) a more limited range of services is covered. The Standards illuminate weaknesses in the delivery of psychological services and point to their correction. These Standards establish a more effective and consistent basis for evaluating the performance of individual service providers and guide the organizing of psychological service units in human service settings. The 4 standards concern providers, programs, accountability, and environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis in training pediatric psychologists.

Examines the shortage in the US of personnel who are trained in child mental health care that results in underservice to children, youth, and families. Doctoral programs offering specialty training are in short supply, as are pediatric psychology training programs. In addition, many clinical psychology programs are ill-equipped to offer curriculae for the development of skills and knowledge bases required by child psychologists. It is concluded that a training conference is needed to communicate the issues involved in this mental health provider crisis if children are to have access to psychological services. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicaid: Direct provider recognition.

Half of the states of the US recognize psychologists as service providers under Medicaid, although there is great variation in the services covered and methods of reimbursement. The present author describes the administrative and legislative avenues taken by Virginia psychologists to obtain independent provider status. A model bill is presented that would give consumers of any Medicaid program direct and unobstructed access to all psychological services provided within the scope of the clinician's license. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Report by the… ; purposes, standards, and procedures.

"The American Board for Psychological Services was incorporated to accomplish one fundamental purpose: to serve the public interests by providing a directory of agencies judged to be capable of providing competent psychological services to the public." Means by which ABPS intends to achieve its functions, the definition of "psychological service," criteria for evaluation of psychological services, evaluation procedures, means of appeal from ABPS judgments, reevaluations, and current fees and charges of ABPS, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leiomyosarcoma of the buccal mucosa: a case report

In 1987, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) initiated the Agenda for Change, a major revision in the evaluation process for hospitals. An essential component of that change was to shift the emphasis away from standards for individual departments to standards for hospital-wide functions. In recent years, hospital librarians have focused their energy and attention on complying with the standards for the "Management of Information" chapter, specifically the IM.9 section on knowledge-based information. However, the JCAHO has listed the health sciences librarian and library services as having responsibilities in six other chapters within the Comprehensive Accreditation Manual for Hospitals. These chapters can have a major impact on the services of the hospital library for two reasons: (1) they are being read by hospital leaders and other professionals in the organization, and (2) they articulate specific ways to apply knowledge-based information services to the major functions within the hospital. These chapters are "Education"; "Improving Organizational Performance"; "Leadership"; "Management of Human Resources"; "Management of the Environment of Care"; and "Surveillance, Prevention, and Control of Infection." The standards that these chapters promote present specific opportunities for hospital librarians to apply knowledge-based information resources and service to hospital-wide functions. This article reviews these chapters and discusses the standards that relate to knowledge-based information.     

Formalized psychological services in state education programs.

In recent years "state regulations have played a major part in determining the nature of local school requirements" for psychologists. States having formally legislated provisions for school psychologists, states formally recognizing qualifications of school psychologists, professional training requirements for different levels of persons rendering psychological service in schools, and required supervised practicum or internship experience are discussed. The certification of school psychologists as teachers, the renewal of certification of school psychologists, the kinds of psychological services provided or used, the apparent absence of a sensitivity to a need for school psychological services, and the various titles by which psychologists are designated in school law or official statements are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public attitudes about psychologists and mental health care: Research to guide the American Psychological Association public education campaign.

Focus groups and a random telephone survey were conducted to examine the public's attitudes toward mental health providers. The research showed that the public has very little understanding of the qualifications and credentials of psychologists and cannot tell one mental health provider from another. Respondents believed that their emotional health affects their physical health but were typically not willing to pay more for mental health insurance coverage. An information gap was also evident: A majority of respondents agreed that psychological health is important, but almost half said they wish they had more information about how and when to access psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and health care.

Recent advances in health care psychology are noted, especially those involving the conceptualization and treatment of lifestyle and chronic health problems. The contributions to health care psychology of community psychology, brief psychological treatments, behavioral medicine, and health psychology are outlined. The central task of both organized psychology and individual psychologists is to create an underlying structure of clear boundaries and standards for clinical practice and training in health care psychology. Initially, this task should involve an inventory of Canadian psychologists currently providing health care services and the nature and amount of those services. Subsequently, a need exists for the profession to examine and create guidelines in psychological service delivery, professional role models, training, and scientific methods pertaining to general health care. (French abstract) (27 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An audit-evaluation of a school psychological services unit utilizing professional standards: An example.

Details the planning and implementation stages of an internally generated audit-evaluation review of a school psychological services unit. The review was conducted by a team of professional peers and consumers, and utilized professional standards and guidelines for services delivered. The review is seen as having general application to the evaluation expectations facing these units. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of Psychological Services to Clients With Disabilities: The Need for Awareness.

Objective: To identify barriers to, strategies for, and supports for psychological services for clients with disabilities. Design: Mail survey. Participants: Four hundred eighty-one psychologists who were American Psychological Association members. Measure: A survey that ascertained psychologists' perceptions of access barriers, success factors, and support needs in providing services to clients with disabilities, as well as experiences with bias or sensitivity. Results: Barriers to service provision include funding, accessibility, lack of provider knowledge, limited training in disability issues and services, and lack of sensitivity. Conclusions: Additional training for psychologists in disability issues, legal requirements regarding public accommodations, and disability resources is needed. Psychologists with disabilities may be an important resource. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional training in psychology: Quest for international standards.

Describes features of the professional training of psychologists in Western Europe, Latin America, Australia and New Zealand, Israel, and the US. The issue of why the teaching of professional psychology varies markedly from place to place despite relative agreement on the components of the scientific bases of psychology is addressed. International standards for training and the recognition of accredited training programs are discussed. Rigorous education is needed in the scientific content and intellectual history of psychology as a prerequisite for professional training to help individuals who establish themselves in countries other than those in which they were educated. Suggestions are offered for achieving minimum training standards for psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The CHAMPUS Reform Initiative in Hawaii: Reestablishing a medical monopoly.

Examined the effect of the Civilian Health and Medical Plan of the Uniformed Services (CHAMPUS) Reform Initiative (CRI) in Hawaii. Data are presented from 1986–1991 on the professions involved, outpatient and inpatient services rendered, and psychotherapy fees by profession. This "medical gatekeeper" model of managed care, based on a system of referral to specialist services by primary care physicians and developed by a Hawaii medical group, yielded predictable results. Whereas psychologists had been the dominant providers of outpatient mental health services since 1980 and had a minor presence in inpatient services, the implementation of CRI resulted in psychiatrists becoming the dominant outpatient provider and psychologists essentially being eliminated from hospital practice. These results should alert psychologists to the danger of extinction from medical monopolies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rapid urease test for presumptive identification of Cryptococcus neoformans

Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat services were over-represented. Questionnaire results were validated by comparison with an interview study of all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient "early warning system' to alert purchasing authorities to changes in demand or perceived problems with local provider units. ECR data must be interpreted in the context of further local background information from sources such as GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services and contracts.     

Policy on insurance.

Comments on the position adopted by APA in negotiating with insurance companies on the subject of reimbursement to psychologists for services rendered under health insurance plans. When outpatient psychotherapy is covered by insurance, a psychologist making an independent determination of the need for psychotherapeutic treatment is, according to the APA resolution, being a "judge of illness in the medical sense" and that the "appropriate inter-professional collaborative relationships" between medicine and psychology is for the medical person to make the determination of psychotherapeutic illness and to decide upon the need for psychological services. We are officially concurring that medicine is within its rights in determining the need for and supervising psychological services, when these services are covered by insurance. The APA position on this insurance issue contravenes previously accepted APA policy which states that, within the scope of ethical practice, a psychologist may function autonomously as a psychotherapist. This has been done without sufficient justification, and certainly without sufficient notice to and discussion by the membership. It behooves APA to defer any further negotiation on this issue until it provides for a full reconsideration of the issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

College students' perceptions of the value of psychological services: A comparison with APA's public education research.

The American Psychological Association's (APA) public education campaign, "Talk to Someone Who Can Help," was professionally researched and developed to educate the public about the availability and value of psychological services. What about its application to the 12 million college students poised to become the future consumers of our health and mental health services? By sampling this population, the authors sought to extend the application of APA's public opinion research to college communities and their providers of psychological services. Results and comparisons are presented in this article, along with implications for educating and serving this specialized client population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)