Resolution on Psychologists in Integrated Primary Care and Specialty Health Care Settings



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on Psychologists in Integrated Primary Care and Specialty Health Care Settings
ADOPTED BY THE APA SERVICES, INC. BOARD OF DIRECTORS
SEPTEMBER 2018
APA SERVICES, INC.
RESOLUTION



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APA SERVICES, INC.
This policy was originally developed under the APA Practice Organization and
is now under APA Services, Incas of January 1, 2019.
INTRODUCTION
This policy was established as a companion to the 2016 APA Council Resolution,
Psychologists in Integrated Primary Care and
Specialty Health Settings.

The goals of this companion policy are to support and expand the aforementioned Council resolution, specifically addressing practice issues related to the promotion of psychologists in integrated care settings through initiatives related to employment, workforce development, reimbursement through commercial and public insurance, billing, legal corporate partnerships between psychologists and physicians, education and training psychologists in integrated care, patient and health systems outcomes research, organizational collaborations supporting evidence-based, interdisciplinary approaches to healthcare across the lifespan (older adults, adults, children and youth) and across general and specialty care, as well as products supporting psychology practice in integrated care. For the purposes of this document, the term integrated care will be used to refer to various models or approaches of incorporating behavioral health services with adult and pediatric medical care ranging from co-lo- cation to fully integrated inter-professional team-based services. Psychologists across the United States increasingly serve in leadership roles in academic health systems, community hospitals, and health systems in the public and private sectors. Examples of administrative roles include Deans of Medical Schools or Allied Health Schools, Vice or Associate Chairs of Family Medicine, Section Chiefs in Pediatrics, Directors of Integrated Behavioral Health, Chief Psychologists or Chiefs of Psychology Services, Directors of Behavioral Medicine, and Directors of Research Centers. In these leadership positions, a psychologist demonstrates the value of psychological services and advocates for appropriate scope of services and reimbursement, increased psychology workforce, and staff privileges at departmental and organizational levels. Nonetheless, psychologists working at academic health centers, hospitals, and health systems continue to face barriers to hospital staff appointments and clinical privileges (Coons, Psychologists are currently functioning well in various levels of integrated care models in fact, 29% of behavioral health providers co-located in primary care are psychologists. (Miller, Petter- son, Burke, Phillips, & Green, 2014). These models are supported by the science of psychology, which has shown integrated care to be valuable in terms of both health outcomes and costs. For example, research has shown that integrating mental healthcare into primary care helps to lower costs, decrease emergency department visits and increase quality of care (Nielsen, Langner,

Zema, Hacker, & Grundy, 2012). In addition to primary care, psychologists are also essential multidisciplinary team members in
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APA gratefully acknowledges the work of the APA Council of Representatives Integrated Policy Workgroup/Helen L. Coons, PhD, ABPP, in their contribution of this background on practice issues included here.
specialty areas such as pain management, weight management/
bariatric surgery, oncology, cardiology, sleep medicine, neurological disorders, and rehabilitation medicine. Nonetheless, reimbursement of psychological services in health and other practice settings by Medicare and commercial insurance companies has steadily declined over the last three decades. Routine health behavior interventions such as effective obesity treatment, specified by the USPTF includes Behavior- al-based clinical interventions optimally will combine information on safe physical activity and healthy eating for weight loss with cognitive and behavioral management techniques to help participants make and maintain lifestyle changes which are not reimbursed by Medicare when provided by a psychologist.

(LeBlanc, O’Connor, Whitlock, Patnode, & Kapka, 2011). In addition, healthcare finance reform in the Federal, State, and private sectors is expanding the use of bundled and global payments, although it is unclear if psychological consultation, psychological and neurocognitive assessment, as well as prevention and treatment interventions, will be included in these payment models. Current regulations in many states prevent billing for psychological assessment and treatment services on the same day that psychiatric services are delivered, thus compromising inter-pro- fessional approaches to mental health and substance abuse conditions and contributing to fragmented care and disparities in care. In addition, psychological services billed with the Health and Behavior CPT codes are not uniformly reimbursed by CMS or commercial insurance companies in each state. Moreover, even when reimbursed, these services are paid at significantly lower rates than those of comparable mental health services.

State Corporate Doctrine of Medicine Laws which govern in- ter-professional contractual relationships among healthcare professionals prevent psychologists from partnering with physicians to create business entities in almost half of the states. These laws compromise psychologists ability to partner in Accountable Care Organizations and other professional groups who contract with insurance payers for medical services. Additional barriers to integrated care include accreditation requirements that are difficult to accomplish in brief and population based integrated care treatment models.
Psychologists across the career trajectory are requesting information and training on competencies, models, and contractual options for individual and group practice in and outside of primary care and specialty healthcare settings (Coons, The health system marketplace is increasingly hiring behavioral health professionals who maybe doctoral level psychologists, social workers, licensed counselors, health coaches, and other masters prepared professionals. Unlicensed interns and postdoctoral fellows, and early career psychologists are not



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RESOLUTION ON PSYCHOLOGISTS IN INTEGRATED PRIMARY CARE AND SPECIALTY HEALTHCARE SETTINGS
always eligible to bill insurance companies for psychological or neuropsychological testing or treatment or prevention services, and consequently are less employable in the healthcare market place.
The APASI supports the following actions to promote psychologists in integrated care through professional identity development, marketplace tools, legislative advocacy, and legal/
regulatory advocacy:




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