Medicare’s Physician Definition: What’s Happening and Why It’s Important

Representative Tim Griffin has agreed to co-sponsor the physical definition bill (HR 794) thanks to outreach advocacy efforts by ArPA president Courtney Ghormley Ph.D.  and ArPA treasurer and legislative committee chair Tisha Deen, Ph.D. Drs. Ghormley and Deen visited with Rep. Griffin at his Little Rock office in an effort to explain the bill and ask for his co-sponsorship. The bill would allow psychologists to be under the physician definition in Medicare. We are now the only doctoral profession that is not listed under this definition. This definition allows for use of certain evaluation and management codes as well as participation in incentive programs for electronic health records.  If you know Rep. Griffin please thank him for his co-sponsorship.  Thanks to Drs. Deen and Ghormley for taking time out of their busy schedules to do this important advocacy work.

On May 23, 2013 Senator Sherrod Brown, D-Ohio, introduced a bill to include psychologists in the Medicare physician definition. S. 1064 would amend title XVIII of the Social Security Act to treat clinical psychologists as physicians for the purposes of furnishing clinical psychologist services under the Medicare program. Sen. Brown’s bill has been referred to the Senate Committee on Finance, where it awaits further review and approval.

Sen. Brown’s bill is the companion bill to HR 794, introduced in the House by Rep. Janice Schakowsky, D-Ill., on Feb. 15, 2013. The APA Practice Organization (APAPO) has worked to gain 23 bipartisan cosponsors since Rep. Schakowsky’s bill was reintroduced in this legislative session. HR 794 has been referred to the Subcommittee on Health of both the House Energy and Commerce Committee and the House Ways and Means Committee, where it also awaits further review and approval before being sent back to the full committees.

Psychologists already deliver nearly half of all psychotherapy services to Medicare beneficiaries in hospital outpatient settings and more than 70 percent of psychotherapy services in hospital inpatient, partial hospital and residential care settings. And the Medicare program and patient need for mental health substance use and behavioral health services will only continue to grow in the coming years. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates individuals age 65 and older will comprise 20 percent of the country’s population by 2030.

The Brown and Schakowsky bills will allow psychologists to be treated like all other non-physician providers already included in the Medicare physician definition, thereby ending unnecessary physician supervision without increasing Medicare costs.

In inpatient hospital and psychiatric hospital settings, this bill would enhance psychologists’ ability to direct appropriate care for their patients. Psychologists are licensed to assess, diagnose and treat mental and substance use disorders and are already key providers in these settings, but they are often hindered by inappropriate physician supervision of services provided within their licensure. This overdue change would help clarify clinical oversight for hospital patients under the care of psychologists and reduce the administrative burden on hospital staff.

In outpatient hospital and community mental health center settings, Medicare patients who would otherwise need inpatient psychiatric care are provided partial hospital services. Psychologists can and do run partial hospital programs in the private health system today — overseeing, supervising and providing treatment — yet Medicare requires that such services must be prescribed by a physician, provided under a written treatment plan established and periodically reviewed by a physician, and furnished while under the care of a physician. If these physician barriers are removed, beneficiaries will have better access to needed partial hospital services.

 

Written By Paddy Walz, PhD