Author Archives: Susan

ASPPB Uses Carrot & Stick for New EPPP2

Members of the Louisiana State Board of Examiners, at their November 30 meeting in Baton Rouge, discussed how the Association of State and Provincial Psychology Boards (ASPPB) has adopted a reward and punishment program for those state boards still resisting adopting the controversial second examination a psychology license, the EPPP2.

Complaints about the new exam had been growing and escalated when officials at ASPPB decided in August 2017 that the new test was to be mandatory. Following that move and resulting controversy, ASPPB backpedaled somewhat and on October 24 notified its members that they would have an option to use the EPPP but without the EPPP2.

However, there are penalties associated. Some members said they view this as an attempt to coerce states into compliance.

According to the October 24 announcement from Dr. Sharon Lightfoot, President of the ASPPB Board of Directors, if Louisiana chooses to decline the use of EPPP2, individuals here will not be allowed to take EPPP2 even if they wish to do so. Also, those test-takers from compliant states will pay $300 as a reward for early adoption of the additional exam, while those from late adopters will pay $450.

“Only applicants who are registered through a jurisdiction that has adopted the Enhanced Exam, and who have passed the knowledge portion of the exam, will be allowed to take the skills portion of the exam,” said Lightfoot.

“January 1, 2020 through December 31, 2021 is designated as an early adoption period. All jurisdictions who decide to adopt the Enhanced EPPP at any point during this time frame will be offered reduced fees for their applicants,” wrote Lightfoot.

In October, LSBEP members Drs. Amy Henke and Greg Gormanous, and Executive Director, Jaime Monic, attended the annual meeting of ASPPB in Salt Lake City, Utah. The EPPP-2 was discussed in depth.

Henke has been critical of the move since she lead opposition and the passage of a Resolution in the Louisiana Psychological Association. Sources say that some consider the ASPPB to be more in the mode of a “sales” organization and that there was little opportunity given for the ASPPB member jurisdictions to voice concerns.

One source said that ASPPB appears to be going around its board members and marketing the new test to internship programs and state legislatures. It was reported that they have also said that student groups support the new test when that is not the case.

Through 2016 and 2017 objections to the EPPP2 mounted, mostly from student and early career psychologist organizations.

In 2016, Dr. Henke, then a Director on the Executive Council of the Louisiana Psychological Association (LPA) and Co-Chair of the LPA Early Career Psychologists Committee in LPA, put forth a Resolution to oppose the EPPP2 for Louisiana, which passed unanimously. Dr. Henke is now serving on the state psychology board.

Objections, from Henke and others, involve technical and scientific issues, but also the criticism that there is no problem that the new test needs to solve. “There is no evidence that the public is facing some sort of previously unheard of crisis in terms of safety from currently practicing psychologists,” said Dr. Henke in 2016.

The Examination for Practice of Professional Psychology (EPPP) is privately owned by the ASPPB, which claims to serve its 64 members, regulatory boards of psychology. In a plan that appears to have been in place for a number of years, the ASPPB has decided to double the content and the price of its main product, the EPPP, from $600 to $1200, plus administration fees.

LSU’s Dr. Frick and Dr. Matson Named World Class Scholars

In two separate reports, Louisiana State University Psychology Professors, Dr. Paul Frick and Dr. Johnny Matson, have been designated as top scholars in comparison to all others worldwide.

In an October report from LSU News, Dr. Paul Frick was noted to be one of only four researchers from LSU who achieved an h-index over 100, based on the Google Scholar Citations database. Only 3,160 scholars worldwide reach this level of significance.

Dr. Johnny Matson, professor of psychology and Distinguished Research Master, was noted for his interdisciplinary achievements, as one of only three LSU researchers who were among the top cited scholars by Clarivate Analytics this year, based on a review of journals indexed in the Web of Science Core Collection 2006-2016. According to LSU News, this measure takes into account the top 1% within each of 21 broad fields, over a specific period of time.

Dr. Paul Frick holds the Roy Crumpler Memorial Chair and is professor of psychology at LSU. His research investigates the many interacting factors that can lead children and adolescents to have serious emotional and behavioral problems, such as aggressive and antisocial behavior.

The h-index measures both productivity and impact of published papers. The score measures the researcher’s total number of papers as well as how many times each paper is cited by other scholars. An h-index over 100 amounts to 100 research papers each cited over 100 times.

“It’s quite an honor to be on this list,” Frick told LSU. “In my research, we have looked at kids with behavioral problems and developed ways of identifying them and treating them. Once your scale or system of how a disease or problem is classified and diagnosed is picked up by entities such as the World Health Organization and the American Psychiatric Association, you tend to get a lot of citations because everyone who uses your measure and has to cite you to justify theirs.”

Dr. Matson was included in the Clarivate Analytics 2018 list of only 6,078 scholars worldwide and one of only 2,020 in the new, interdisciplinary category.

This is the first year that Clarivate Analytics has looked specifically at cross-field citations, “…as frontier areas of research are frequently interdisciplinary, it is even more important to identify scientists and social scientists working and contributing substantially at the CrossField leading edge.”

Dr. Paul Frick is the inaugural recipient of the Roy Crumpler Memorial Chair in Psychology at Louisiana State University, Baton Rouge campus. Frick most recently served as the Department Chair in Psychology at the University of New Orleans.

In 2017, he was named the Editor-in-Chief for the prestigious Journal of Abnormal Child Psychology, the official journal of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP), a multidisciplinary scientific society.

Frick is a leading international authority in child and adolescent diagnosis and behavior and his work focuses on the pathways by which youth develop severe antisocial behavior and aggressiveness. He has published over 180 manuscripts in either edited books or peer-reviewed publications and he is the author of 6 additional books and test manuals. He has been Distinguished Professor and Chair of the Department of Psychology at the University of New Orleans, and was named the recipient of the Robert D. Hare Lifetime Achievement Award by the Society for the Scientific Study of Psychopathy.

Dr. Frick’s research has been funded by the National Institute of Mental Health, Office of Juvenile Justice and Delinquency Prevention, and the John T. and Catherine D. MacArthur Foundation. In 2008, he received the MacArthur Foundation’s Champion for Change in Juvenile Justice Award for the state of Louisiana. He has been the editor of the Journal of Clinical Child and Adolescent Psychology, is past president of the Society for the Scientific Study of Psychopathy. He has an Honorary Doctorate from Orebro University in Orebro, Sweden in recognition of his research contributions in psychology. He is also Professor in the Learning Sciences Institute of Australia at Australian Catholic University.

Dr. Matson is expert in autism, mental disabilities, and severe emotional disorders in children and adolescents, and has produced more than 700 publications and 38 books. Just a few of his titles are the International Handbook of Autism and Pervasive Developmental Disorders, Practitioner’s Guide to Applied Behavior Analysis for Children with Autism Spectrum Disorders, Practitioner’s Guide to Social Behavior and Social Skills in Children, and Assessing Childhood Psychopathology and Developmental Disabilities, and Treating Childhood Psychopathology and Developmental Disabilities.

Matson has served as Editor-in-Chief for Research in Autism Spectrum Disorders (Oxford England), Editor-in- Chief for Research in Developmental Disabilities (Oxford, England), and Associate Editor for Journal of Mental Health Research in Intellectual Disabilities (London).

Through the years he has served on 80 editorial boards, both US and International, including as Editor-in-Chief for Applied Research in Mental Retardation and the Official Journal of the American Association for University Affiliated Programs. He has also served as guest reviewer for over 50 journals, both US and International. And, he has visited as a professor around the world, including Canada, Sweden, and India.

Among his many professional activities, Matson has been a guest expert on ABC’s 20/20, consulted with the Alabama, California, Georgia, Illinois, Iowa, Louisiana, Missouri, Virginia, and the US Departments of Mental Health. He has been a guess expert on CBS Eye-to-Eye and consulted for the DSM III-R Educational Testing Service. He has served on the President’s Committee on Mental Retardation, and consulted to the US States Department of Justice, and the US Department of Education.

“This is really about having a few decent ideas but mostly about having a goal and working and working to reach it,” Dr. Matson said to the Times.

“Maintaining that level of focus over that period of time is not easy,” he said, “at least it wasn’t for me. In my case, largely it has been about getting researchers and clinicians to be made aware of and to have the tools to identify co-morbid challenging behaviors and psychopathology in persons with autism and/or intellectual disabilities,” he said.

“If I have been able to do that, in some small way, then it will mean better care for many persons with developmental disabilities.”

CDC Data Points to Higher Psychological Distress in America

The CDC reported new numbers last month in both deaths by suicide and drug overdoses that point to the worsening psychological well-being of America’s citizens. The CDC Director said the sobering statistics should be a wake up call.

Robert Redfield, M.D., CDC Director, said, “The latest CDC data show that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.”

In its newest report, the CDC notes that the age-adjusted suicide rate increased 33% from 10.5 per 100,000 in 1999 to 14.0 in 2017.

The rate of suicide among females increased from 4.0 per 100,000 in 1999 to 6.1 in 2017, while the rate for males increased from 17.8 to 22.4. Compared with rates in 1999, suicide rates in 2017 were higher for males and females in all age groups from 10 to 74 years, said the CDC.

For 2017, the age-adjusted suicide rate for the most rural counties (20.0) was 1.8 times the rate for the most urban counties (11.1).

The rate for the most rural counties in 2017 (20.0) was 53% higher than the rate in 1999 (13.1).

The age-adjusted suicide rate for the most urban counties in 2017 (11.1 per 100,000) was 16% higher than the rate in 1999 (9.6).

Since 2008, suicide has ranked as the 10th leading cause of death for all ages in the United States. In 2016, suicide became the second leading cause of death for ages 10–34 and the fourth leading cause for ages 35–54.

Another report for 2017 figures from the CDC indicated that there were 70,237 drug overdose deaths in the United States, 9.6% higher than the rate in 2016.

The age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 21.7 in 2017. For each year, rates were significantly higher for males than females.

Rates of drug overdose continued to increase. In 2017, the age-adjusted rate of drug overdose deaths was 9.6% higher than the rate in 2016 (21.7 vs 19.8 per 100,000), although the percentage increase was lower than that seen from 2015 to 2016, when the rate rose by 21% (from 16.3 to 19.8 per 100,000).

The rate of drug overdose deaths in 2017 was 3.6 times higher than the rate in 1999. Rates increased for both men (from 8.2 in 1999 to 29.1 in 2017) and women (from 3.9 in 1999 to 14.4 in 2017). In 2017, the highest rates of drug overdose deaths occurred among adults aged 25 to 54 years.

From 1999 to 2017, the greatest increase in drug overdose death rates occurred among adults aged 55 to 64, from 4.2 to 28.0 per 100,000, a more than six-fold increase.

LSBEP to Begin Complaints Processing Procedure Updates

The Louisiana State Board of Examiners of Psychologists (LSBEP) will make changes to their disciplinary policies and procedures, including promulgating new rules and regulations if needed, the Board members announced at their recent Long-Range Planning meeting. The meeting was held November 30 at the Board’s new offices located at 4334 S. Sherwood Forest Blvd., in Baton Rouge.

The new disciplinary procedures are the result of study by a task team, which has been meeting over the past months in confidential discussions to craft these new procedures. Members of the task team are LSBEP Chair, Dr. Jesse Lambert, current LSBEP Executive Director, Ms. Jaime Monic, board attorney for complaints issues, Ms. Courtney Newton, and Louisiana Psychological Association Chair of Professional Affairs, Dr. Kim Van Geffen.

At the November 30 public meeting, Ms. Newton explained to members and attendees about the changes. She said that it was essential for a bifurcated and completely separate process to exist between the investigative element and the hearing element of a disciplinary action, and that the task team worked to create a two-pronged process with a firewall between the two elements.

One of the changes that is being proposed is that whenever a complaint is received and needs to be investigated, a Complaints Committee will be formed. This committee will include the LSBEP attorney, the Board Investigator, who is a private investigator, and a Complaints Coordinator.

In July this year the Board added contracts so that there would be three psychologists available as Complaints Coordinators. The contracts were for Sasha Lambert, PhD (Complaints Coordinator I), Erin Skaff Vandenweghe, PsyD (Complaints Coordinator II), and Mark Vigen, PhD (Complaints Coordinator III). The Board also confirmed Statewide Surveillance as the source for services for Licensed Investigators, in July.

The new complaints process will also include a board member, who is to be part of the investigation process. If the complaint goes to a hearing, the Board member who sits on the Complaints Committee will recuse themselves from the hearing panel.

Previously, the Board had held that no board member could be involved because of the fact that a vote of four of five board members was required for disciplinary actions.

Another of the elements included in the renewed approach is the “Letter of Education.” This has been used before and addresses actions that do not rise to the level of a violation and so are not subject to open records or reporting. This allows the board to recommend further education and avoid a licensee being reported.

The new procedures also allow for confidential process when those with substance abuse problems may be referred for colleague assistance programs, also without always being reported.

The psychology Board is currently involved in litigation involving its complaints procedures and this required closed meetings of the task team during the past year, according to sources.

In February 2017 a psychologist appealed a decision made by the LSBEP. The Judge in the 19th Judicial District Court, Judge Michael Caldwell, vacated the board’s decision, saying that the process “reeked” with due process violations, according to sources.

Next, the LSBEP appealed Caldwell’s decision on two of the issues: 1) That the board’s attorneys were law partners; and 2) the Board’s prosecuting attorney had previously been involved in the psychologist’s child custody case.

The LSBEP won the appeal and now the remaining issues are back in Judge Caldwell’s court.

In another issue, this one regarding time-limits, the Board appears to have confused different requirements during hearings in 2015. One case appears to still be on appeal due to this issue.

State boards have come under the notice of the Louisiana Legislature for process issues and several laws have been passed to address citizens’ complaints. In particular, the state medical board has been in front of the Legislature with citizen’s associations’ complaining about heavy-handed treatments at the board. Louisiana’s board actions increased over the last ten years without a similar increase in lawsuits. (See graph).

Senator Fred Mills advanced several measures and this year passed Act 515, moving boards under the Department of Health, because of what he termed, “…virtually no oversight” at the boards. Act 655 allows citizens to make complaints to the the Legislature committees.

[Editor’s Note: For additional information, see: “The Secret Life of Board Complaints,” in Psychology Times, Vol 6, Nos 10 and 12; “Board May Have Botched Time Limits,” Vol 6 No 10; “Judge Says Psych Board Procedures Unconstitutional,” in Vol.8, No 6; and Appeals Court Reverses Judge Caldwell’s “Reeks” Decision in Cerwonka– LSBEP Dispute,” in Vol 9, No 5.]

New Study Shows EPPP Can Discriminate Against African-Americans, Hispanics

A new study demonstrates that the Examination for Professional Practice in Psychology, known as the EPPP, has differing fail and pass rates for different races, and that the difference is large enough for AfricanAmericans and Hispanics to fall into “disparate impact” discrimination, as described in Title VII of the Civil Rights Act of 1964.

The study, “Are demographic Variables Associated with Performance on the Examination for Professional Practice in Psychology (EPPP)?” is published in The Journal of Psychology: Interdisciplinary and Applied, October 22, 2018. The author, Brian Sharpless, PhD, is associate professor at the American School of Professional Psychology. To collect data, he used a Freedom of Information Act (FOIA) to request test results and demographics from the New York state board of psychology for its candidates.

Dr. Sharpless gathered data on 4892 applicants and first-time EPPP takers. He obtained “Records of all doctoral-level psychology licensure applicants from the previous 25 years with EPPP scores, gender, ethnicity, and degree type were requested.”

He found that Blacks had a failure rate of 38.50% and Hispanics had a failure rate of 35.60%. Whereas, Whites had a failure rate of 14.07% and Asians had a failure rate of 24%.

New York uses converted scores for the EPPP, from 0 to 100, with 75 as the passing score.

The differences in minority candidates’ selection rate violates what is known as the “four-fifths rule.” This means that the pass rate for minority groups fails to reach at least 80% of the pass rate for the majority group.

Typically, when a test has this impact, industrialorganizational psychologists exercise very careful methods to set cut scores, seek additional validity or research, and investigate possible replacements with less disparate impact.

Dr. Sharpless wrote, “… given the ethnic performance discrepancies and limited validity evidence, additional psychometric investigation of the EPPP appears warranted (e.g., in terms of criterion and predictive validity testing),” Sharpless also wrote. “Further, it is recommended that the EPPP Step-2 should undergo similar assessments prior to implementation.”

“Additional empirical attention should be devoted to the cut score (i.e., a scaled score of 500, roughly corresponding to 70% correct).” He noted that “…the determination of the ‘passing’ score is one of the most important, yet difficult, psychometric tasks in testing …”

And he noted that “… passage of the EPPP carries serious professional ramifications for applicants. There appears to have been limited discussion of the theoretical and/or empirical justifications for the current cut off score in the publicly available EPPP literatures…”

While regulatory boards aren’t employers, the principles of employee selection may apply. Employers using tests often fall under Title VII of the Civil Rights Act of 1964 which prohibits employers from using neutral tests or selection procedures that have the effect of disproportionately excluding persons based on race, or other protected characteristics. Test
New Study Shows That EPPP Can Discriminate,developers and users must demonstrate that the use is necessary and related to relevant characteristics.

Industrial-organizational psychologists, who help companies show business necessity when a company is paying for employee performance, with a legitimate business goals of seeking top performing employees, may point out that regulatory boards do not have this same business necessity.

Regulatory boards concern themselves with the lower end of the distribution of performers, those likely to exhibit gross negligence or in some way endanger the public. Denying a license to a candidate because they perform at the average range, or even below average, might conceivably violate that candidate’s property rights and have no impact on safety.

Dr. Sharpless noted similar issues. “… if the EPPP is found to lack acceptable validity evidence (or if a decision is made to not submit the measure to further empirical testing), then it will remain open to charges of being a potentially arbitrary barrier in an already protracted path to professional independence…” Sharpless wrote.

He notes the lack of Blacks and Hispanic psychologists and suggests that these issues could be related.

And, he said, “… psychologists have always been at the forefront of developing tests of individual differences with valid and reliable scores…” And he wrote, “A case could be made that psychology gained recognition, as well as a more coherent professional identity, through such testing efforts. Therefore, it only makes sense that we submit our own licensing exam to these same high levels of scientific scrutiny.”

Brian A. Sharpless is an associate professor at the American School of Professional Psychology at Argosy University, Northern Virginia. He received his PhD in clinical psychology and MA in philosophy from Penn State University and completed post-doctoral fellowships at the University of Pennsylvania.

To link to the article go to: https://doi.org/10.1080/00223 980.2018.1504739

Stress Solutions

by Susan Andrews, PhD

Improved Sleep Reduces Stress, Improves Health

A recent article in the Healthcare Journal of New Orleans on The Art & Science of Sleep caught my eye this month. So many of us are burning the midnight oil trying to finish up reports and work for 2018. This article contained good “evidence-based tips for improving sleep quality.” Since everyone’s time is short these days, it is sometimes helpful to read a summary of key points instead of having to read a longer piece.

Have you noticed how many adults and kids go to bed with their phones. Kids are playing games up until parents force light out. Adults are reading email and new stories until their eyes force them to put it down. It is actually harder for most people to fall asleep if they are still pumping excess cortisol through their systems. It is harder to empty your mind and stop thinking under those circumstances. An important tip is to try to stop all games and reading at least 30 minutes before you hope to fall asleep.

Sleep is so important for losing weight, keeping your immune system healthy, and keeping your energy level up to the challenges of the new day. I was surprised at some of the “evidence-based” tips to improve sleep quality. The author of the article is Erin Baldwin and a good reference list from peer-reviewed journals is offered at the end of the article. These tips are derived from the 11 referenced journal articles.

Tip 1: Reduce exposure to blue light before bed and increase exposure to natural light during the day. This tip has to do with the effects of light exposure on the secretion of melatonin. Melatonin levels need to rise at night and drop in the morning. Exposure to light before bed suppresses melatonin secretion. Red light does not interfere with melatonin as much as blue light (sunlight and smart phone light) does. So, refrain from using electronics at least 30 minutes prior to bed. (Figuero & Rea, J. of Endocrinology, 2010)

Tip 2: Allow your core temperature to drop before bed. Warming your feet with socks can help. The National Sleep Foundation recommends a bedroom temperature of 65 degrees. Keep your head cool to help alleviate insomnia. (Nature 1999; Nofzinger et al, J. Clin Sleep Med 2006)

Tip 3: Make your bedroom a sacred place. Think of the classical conditioning work of Pavlov and his dogs.

Tip 4: Stick to a Sleep Schedule.

Tip 5: Wind down before bed. Allow your mind to slow down. Stop worrying over problems that make it hard to shut down thinking about. Listen to soft music or do a meditation. The article suggests using a drop of Lavender essential oil on your pillow or rub some into your hands and inhale from cupped hands.

Tip 6: Rethink your sleeping position. Alight and elongate your body, no joint stress.

Tip 7: Cut back on nighttime use of alcohol and anti-anxiety medications. While both cause you to fall asleep faster, they also decrease your sleep quality later in the night. Benzos can disrupt the normal sleep cycle and suppress REM sleep. (Pagel & Parnes, J. Clin Psychiatry 2001)

Tip 8: Reduce Stress. This is almost redundant, but the article highlights the value of regular physical exercise a few hours before bedtime.

Have a restful and happy holiday.

Girl in the Spider’s Web

by Alvin G. Burstein

Almost 150 years ago, the philosopher John Stewart Mill published what was then a provocative essay, On the Subjection of Women. Mill, a former child prodigy and later, a noted public intellectual. He argued that women were not just disadvantaged, but as, half of humankind, the largest group of enslaved humans. He documented the peculiarly onerous abuse to which women could suffer because “…their masters require something more from them than actual service. Men do not want solely the obedience of women, they want their sentiments…not just a forced slave but a willing one….” For that reason, he predicted that our patriarchal society would stubbornly resist acknowledging women’s rights to liberty and equality. He would not be surprised by the circumstance that Americans would elect a black man as President before according that office to a woman. He would have taken pleasure in the reality of a recent Congressional election that saw record numbers of women candidates, and victors.

Despite his Victorian context, Mill is clearly a bellwether of the twentieth century #Me Too movement that gives voice to women’s experience of abuse, especially sexual abuse. Steig Larsson, author of the popular Millenium novel series that spawned the Swedish and American versions of The Girl With The Dragon Tattoo films is another such bellwether. The motivational focus of both the novels and the films is its protagonist’s, Lisbeth Salander’s hatred of men who hurt women.

The success of the three American films—The Girl With The Dragon Tattoo, The Girl Who Played With Fire, and The Girl Who Kicked The Hornets’ Nest
assured its sequel, The Girl In The Spider’s Web. The new film will satisfy fans of the first three, bringing back the main characters: Salander, journalist Blomquist, his editor and sometime lover, Erika Berger and the unorthodox computer genius, Plague. Continuity with its predecessors is underscored by the opening scene. Salander interrupts a sadistic abuser in flagrante delicto, exposing the perpetrator and hanging him by his heels.

As it unfolds, some backstory emerges. Salandar is provided with a sister, and the two are victims of their father’s sexual abuse. Another innovation is Salander’s involvement in an international struggle for control of a world-wide network of atomic weapons. She must now deal, not only with criminal gangs, like those trafficking in prostitution in the earlier films—though there is one of those here as well, Spider, but also with American and Swedish security forces.

There are some shortcomings. Salander’s use of tasers, satisfying in the original films, gets tediously familiar in this one. More central is the handling of the relationship between Salander and Blomquist. In the earlier films, her vulnerability to his casual sexual involvements, her hurt when she takes the risk of loving a man, only to discover his tomcat character is powerful and painful. In this sequel, she turns to him with caution and only out of situational need. And Bomquist’s decision as the film’s end to forego a scoop feels artificial. Finally, and most critical plot-wise, is a motivational switch. A key motivational element in this film is sibling rivalry between daughters, not hatred for men who hurt women.

Can Louisiana Fully Embrace Integrated Healthcare?

by J Nelson

For decades now, psychological scientists have demonstrated that savings from 30 to 60
percent in medical costs and much better health outcomes are possible if we give up the
biomedical model and embrace the psychological-social-biological framework instead, called
integrated care. But can Louisiana make this change? In this article we review where we are
and where we’re going, and some of the barriers to change that seem to persist.

If the famous axiom is right, and we have to hit bottom to get better, Louisiana should be due
for improvements in its health and healthcare system. Last year U.S. News & World Report
ranked 50th overall with a 45th in healthcare. The rank included a 43rd place in mortality, a
46th in infant mortality, a 50th in obesity, and a 43rd rank in smoking. At the same time,
Louisiana’s costs are high–the Report placing the state at 45th in health care affordability.

This pattern of poor health outcomes and high costs reflects the country as a whole. The
United States ranks 50th out of 55 industrialized countries in a measure of life expectancy
and medical care spending, according to Bloomberg, who concluded the U.S. is the “least efficient” health-care system in the world.

Yet, healthcare is the largest industry in the country, accounting for almost $3.5 trillion in sales in 2016,according to the National Health Expenditure Data from CMS. More recently, the  industry is now also the nation’s largest employer.

The sheer size and complexity of the healthcare industry would suggest that innovations would  be challenging, but change may be even more unlikely because of the political power yielded by the industry. Last year the pharmaceutical industry, Blue Cross/Blue Shield, the American Hospital Association, and the American Medical Association were the 4th, 5th, 6th, and 7th highest contributors to Congress, and the year before that pharmaceuticals and insurance was 1st and 2nd.

Given this, it is surprising that the American Psychological Association (APA) recently managed to grab a little territory for psychological assessment, now finally considered as a “thinking” valued activity, in the newest Rules. A feat which required behind closed-door negotiations.

Healthcare is a Closed System

The medical-pharmaceutical-hospital-insurance industrial complex has a firm hold on the prices and services in this country, through the “CPT Codes” and the “Relative Value Scale Update  Committee” or RUC. These groups decide what services are allowed and how much they are reimbursed.

Three hundred “Advisors and Experts,” primarily from the American Medical Association’s House of Delegates, representing 109 medical specialties, attempt to influence an “Editorial Panel,” composed of representatives from medical societies, insurance companies and the government.

This panel conducts closed meetings and decides on what healthcare services are paid for, and  which are not, by way of the complex set of codes known as CPT or “Current Procedural Terminology.” CPT is owned by the Center for Medicare and Medicaid Services (CMS), leased to the American Medical Association (AMA), who then copyrights it and strictly controls the development of new codes. The RUC assigns the value to the service, and somehow this is not considered price-fixing or restraint of trade.

The system includes the FDA, which receives 40 percent of its funding from the pharmaceutical companies, Dr. Irving Kirsch, Associate Director of the Program for Placebo Studies at Harvard Medical School, has explained. Kirsch has also laid out evidence that drug companies and the FDA skew research to approve drugs that have little actual value.

At a 2015 meeting of the Louisiana Psychological Association, Dr. Tony Puente, now a past-president of APA, was one of the two outsiders allowed to participate in the CPT process. “Essentially,” he said, “the CPT tries to divvy it up in a way that is theoretically and empirically, and diplomatically and politically,  correct.” Participants must sign a strict AMA confidentiality
agreement and declare, “I will not disclose, distribute or publish confidential Information to any party in any manner whatsoever.”

To decide on reimbursement, 28 voting members on RUC, representing medicine specialties  such as anesthesiology, cardiology, neurology, neurosurgery, obstetrics, oncology, psychiatry, and so on, meet and decide how much each service is worth, and how much is to be paid.

An underrepresentation of primary care in this system and an undervaluing of their contribution, has lead to high-cost specialists and a shortage of primary care physicians, according to the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. This has been shown to negatively impact outcomes. In a special issue of the American Psychologist on Primary Care and Psychology, Dr. Susan McDaniel and primary care leader Dr. Frank deGruy reviewed evidence that for each primary care physician added to a social system, “all-cause mortality decreases by 5.3 percent.” Conversely, for every specialist added the mortality rate goes up 2 percent.

Healthcare is a Misnomer

“Health is a misnomer, because most activity involves illness. Health care and medical care are not synonymous,” said Hamilton Moses and co-authors in, “The Anatomy of Health Care in the United States,” in a 2013 article of the Journal of the American Medical Association (JAMA).

Prevention requires tools that are often unfamiliar because educational, behavioral, and social interventions, not usually considered to be part of medicine, may be most effective for many diseases,” Moses wrote.

While medical costs are driven by chronic disease, it is not due to an aging population, even though age is often cited as the cause. The JAMA authors show that about 80 percent of the total health care cost is accounted for by those under 65, and relate to psychological, social and behavioral elements. The CDC estimates that lifestyle factors account for 80 percent of heart disease and stroke, 80 percent of type 2 diabetes, and 40 percent of cancer.

“Behavioral intervention is the foundation for lifestyle medicine,” writes Dr. John Caccavale, author of Medical Psychology Practice and Policy Perspectives. “Of the top four classes of medical problems in America – metabolic disorders, respiratory disease, cardiovascular disease, and mental disorders – physicians will have great difficulty demonstrating that they are improving patient health by utilizing medications as a first-line treatment for these classes of disorders,” writes Caccavale.

For decades now, psychological scientists have known that behavior is the key to costs. In an interview with primary care psychologist, Dr. Michele Larzelere, she explained that psychological scientists have agreed that those using an integrated care model can expect a 30 to 60 percent reduction in medical use costs.

And, unlike medical care which carries a large risk, behavioral treatments have few side effects. The author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Martin Makary, MD, found that medical error, unrelated to the illness or injury, is the third cause of death nationwide, following only heart disease and cancer deaths.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said in a report by The Washington Post. Health is woven into a complex set of social and psychological behaviors, not a single cause. “Socioeconomic status is one of the most powerful predictors of all cause mortality,” says Dr. Chris Leonhard, health psychologist and Professor at the Chicago Professional School at Xavier.

“New Orleans is a startling example of this,” Leonhard said. “Life expectancy at birth in the Tremé where the average household income in 2010 was about $26,000 is 55 years, while in Lakeview, the average 2010 household income $75,000, and life expectancy at birth is 80 years.”

Outdated Treatment Models: The Opioid Crisis Example

A dramatic example of flawed decisions in the medical/pharma industrial complex is the opioid  crisis. Twenty years after a marketing blitz aimed at convincing physicians that opioids were safe and effective, the over-prescribing of this heroine-type drug has catapulted overdose deaths to a rate higher than auto fatalities, HIV or gun deaths.

Louisiana is in the middle of the crisis, with some of the highest opioid prescribing rates in the nation and an escalating death rate from overdose. Last year in a Louisiana House Health and
Welfare Committee hearing, Representative Helena Moreno told members that there are “… more opioids prescribed in Louisiana than are people in this state.”

Despite the flood of legal opioids into the society, the CDC reported no change in pain that would meaningfully drive the prescribing: “…there had not been an overall change in the amount of pain that Americans reported.” The CDC found that there was no long-term benefit for opioids compared to no opioids. However, they did find ample evidence for harm.

In contrast, the CDC did find that psychological and physical treatments for pain were beneficial (“CDC Guideline for Prescribing Opioids for Chronic Pain”). This despite the fact that these non-medical approaches are rarely integrated into treatment programs.

“It is now widely accepted that pain is a biopsychosocial phenomenon,” clinical health psychologist and Past-President of the Southern Pain Society, Dr. Geralyn Datz, told the Times. “For many years the biomedical model of treatment has prevailed as a way to treat pain patients,” Datz said. “This model is based on some very early research about acute pain,” she said. Things are very different now. “We know that chronic pain is a complex and dynamic process, and it involves a person’s thoughts, beliefs, experiences and these all can influence pain for better or worse. In addition, conditions such as depression and anxiety can arise from the presence of pain, and these also can worsen pain through interactions of the brain with the body.”

Louisiana’s Challenges

The intentions to blend psychological factors with traditional healthcare seem sincere in Louisiana. In the Medicaid Annual Report for 2017, the Medicaid Director Jen Steele wrote of her mission to improve quality, patient experience, outcomes and lower costs. And, some progress with Patient Centered Medical Homes has come about.

However, making significant changes may be challenging. Using data from both Medicare and Medicaid use, Louisiana’s costs are above expected in a number of areas. The Kaiser Family Foundation looked at data from 2014 and Medicare spending per enrollee, and found that Louisiana ranked 10th in Medicare spending compared to other states, with New Jersey, Florida, New York, Maryland and Connecticut at the top five.

Data from Dartmouth Atlas of Health Care found that Louisiana has a high average number of inpatient days per beneficiary. In a detailed breakdown from 2012, Dartmouth found that  Louisiana had the highest number of inpatient days per person compared to all other states.
Louisiana averaged 6.0 days per beneficiary while the average across the nation was 4.6 days.

In a group for comparison of multiple chronic conditions Louisiana fell above the 90th percentile again with an average of 20.8 days, while the average was 17 days. For dementia the average number of inpatient days was 30.5, and national average was 22.5.

The Alexandria, Monroe and Shreveport regions are some of the highest areas of hospital usage, based on Medicare data collected by Dartmouth.

Dartmouth found that in 2015, the national average of hospital usage was 254 per 1,000 Medicare enrollees. Louisiana averaged 279.8, and some regions were the highest in the country Alexandria was 335.4, Monroe 325.0, Slidell 320.5, and Shreveport was 294.

Dartmouth researchers note that, “Regional variation in hospital and physician capacity reveals the  irrational distribution of valuable and expensive health care resources. Capacity strongly influences both the quantity and per capita cost of care provided to patients.”

In the Louisiana Medicaid 2017 Annual Report, the top 10 provider types, ranked by payment, were first, hospitals, at $1.3 billion, and second, pharmacy, at $726 million. Dentists were third at $162  million, then mental health rehabilitation at $140 million, nurse practitioners at $115 million, and behavioral health rehabilitation agencies at $114 million. Distinct psychiatric hospitals were next at $76 million and freestanding mental health hospitals at $69.7 million.

In comparison, other providers, which include audiology, chiropractic, personal care attendant, physical and occupational therapy, psychology, social work and other services not covered  otherwise, totaled $917,000.

The need may not be being met, even in this picture. In a 2018-2019 Combined Behavioral
Health Block Grant Plan, published in late 2017, the state noted that the number of persons being served was 3.29% of the estimated prevalence. The estimated number of children/youth with serious emotional disorders was said to be 38,803 and only 1,370 had been served. The prevalence estimate for adults with serious mental illness was 192,019 and only 7,590 had been served.

In the grant report, the state confirmed that it was building its workforce and ability to function in an integrated care environment. The state has indicated progress in developing  integrated care in some ways, looking for its managed care companies to advance the plans.

However, in a list of “Specialized Behavioral Health Services CPT Code” and reimbursements, effective July 2018, the fee structures provide little in the way of reimbursement for health and behavior, or any clear mechanism for integrated services. The “health and behavior” services pay between $12 and $15 and are only listed for a psychiatrist, nurse/physician’s assistant, medical psychologist, and a psychologist. There are none listed for clinical social workers or counselors.

Some codes and fees are listed for psychotherapy. Individual psychotherapy is reimbursed at  69.76 for psychiatrists for 45 minutes, $55.81 for nurse practitioners and physician assistants,
$55.81 for psychologists, and $48.83 for social workers, counselors, and marriage and family
therapists. But this may not translate to integrated care. And group therapy, a valuable therapy mode for many issues, is paid at only $23.23 to $18.58 and there is no reimbursement for the social worker or counselor listed on the current fee schedule.

These arrangements may explain why there are few providers who  chose to participate. Access to care and rates have been a problem nationally, with nearly half of all providers not offering Services to Medicaid patients. Nationwide, Medicaid fees are about 72 percent of Medicare, which is about 80 percent of private pay. Only about 130 psychologists were listed as providers on the 2014 Medicaid rolls, according to a report at that time.

One Representative’s Efforts

During the Louisiana 2016 Regular Legislative Session Representative Barbara Norton from Shreveport put forth a measure, House Bill 1164, to create a task force to study the delivery of
integrated physical and behavioral health services for Medicaid enrollees who suffer with serious mental illness.

Norton brought together an array of associations and state agencies from across disciplines and from across the state to look at ways to improve the care offered by Medicaid.
She told the Times, “This was an opportunity to pull so many people together, at no cost. I met with many of these people who felt as I did, that this would be a great piece of legislation, that they want to help the state of Louisiana and health, and make a real difference.”

The bill passed committee with a 10 to 0 favorable vote. But then, on the House floor, it failed with 51 nays and 33 yeas. Five of those who had supported it in committee switched their votes on the floor and twenty did not vote. Why? Representative Norton thinks it might have been political. “We still feel the Medicaid belongs to President Obama but it belongs to all of us and we’ve not started to understand the significance of these issues.”

Representative Norton tried again in 2017, this time passing a measure as a Concurrent Resolution, asking again for the study of the issue by a comprehensive task force, HCR 55. The
measure passed easily and task force was formed. However, she said that the task force met only twice. The Representative will be calling another meeting in December in Baton Rouge, she said. “It has not been given a fair shake.”

“My goal is to go back with whomever and find out what we can really do for the people because the problems in this area are so serious,” she said. “We’ve not even started to understand the significance of what this should be about and the more we look––the shootings the mental health issues––the more it’s necessary that we reach out to all the people and look at all the facts that there are, and continue to work. Because we’re talking about peoples lives.”

“I understand that sometimes people don’t know the type of leadership it takes but if people want to be on the committee, and care to discuss these real issues, then it’s not the type of thing where a person can call in or send information. We need to discuss ideas and plans,” Norton said.

“I do believe that at the end of the day, with the help of leadership, we may turn some thinking around, and clearly understand why it is so important to look at all these things. I promise you I’m going to work with this until we see some differences, and people see some hope.”

 

Gov. Edwards and First Lady Travel to Israel, Meet with Prime Minister

JERUSALEM, Israel — On October 31, Gov. John Bel Edwards met with Israeli Prime Minister Benjamin Netanyahu as part of a weeklong Louisiana economic development mission in Israel, according to the press release on the same day. Following a photo session, the two discussed Louisiana’s strong relationship with Israel, as well as trade and economic development issues of mutual importance to Israel, the United States and Louisiana.

“This long-awaited meeting is the result of many years of friendship and partnership. On behalf of the people of Louisiana, I was proud to share with Prime Minister Netanyahu that Louisiana stands with Israel, and we will always remain faithful to our staunch ally in the Middle East,” Gov. Edwards said. “Over the years and during this mission, I have come to appreciate how alike our two lands are – similar in industrial strength and similar in economic priorities. But beyond that, Israel and Louisiana are inhabited by warm and welcoming people with a strong desire to succeed and innovate, to leave the legacy of a better way of life to their children and grandchildren. I’m sure this is a source of tremendous pride for Prime Minister Netanyahu, as it is for me. Our delegation has enjoyed learning everything we can about this great nation, and I hope the unique Louisiana culture of innovation that we are sharing in Israel has been equally enjoyed by our hosts.”

Prime Minister Netanyahu has an extensive history of service in the Israeli government and the private sector. He first served as prime minister from 1996 to 1999, and then again from 2009 to the present. He has also held the positions of Minister of Finance, Minister of Foreign Affairs, and Ambassador of Israel to the United Nations. His private sector works includes service with the Boston Consulting Group, and he holds degrees in architecture and business management from MIT. Netanyahu and Edwards are both Army veterans of their nation’s military: Netanyahu served in the Yom Kippur War of 1973. A 1988 graduate of the U.S. Military Academy at West Point, Gov. Edwards commanded a rifle company in the 82nd Airborne Division at Fort Bragg, North Carolina, before completing his military service, graduating from the LSU Law Center and setting up a civil law practice.

Of key interest to Israel and Louisiana on the trip are exploring ways to expand trade and  foreign direct investment activity between the two partners, according to the press release. While substantial, trade between Louisiana and Israel is small in scope compared to overall trade volume with other nations. For instance, Louisiana ranks as the No. 9 exporter to Israel
among U.S. states, with approximately $200 million in exports; that’s a small portion of the over $57 billion in total Louisiana exports. Israel’s more than $60 billion in annual exports includes nearly $22 billion in shipments to the U.S., though Louisiana’s share of Israeli imports is less than $150 million, with fertilizers, mineral and metals among the leading categories.

Talks between Gov. Edwards and Prime Minister Netanyahu are expected to open new avenues of trade and investment growth in commodities where Louisiana is a leader, such as oil and gas; along with applied research areas in which both Israel and Louisiana are emerging, such as water management; and defense and technology related fields where Israel is an innovation leader and Louisiana is an emerging force, such as cybersecurity.

Gov. Edwards also is meeting with key Israeli cabinet officials on the trip, including Deputy Minister Michael Oren in the prime minister’s office; Minster of Energy Yuval Steinitz; and Advisor to the Minister of Energy on International Developments and Foreign Affairs Benjamin Weil.

With Israel playing a central role in global cybersecurity, the delegation met with cybersecurity companies in Israel on Wednesday, with additional exchanges occurring on Monday at the nation’s CyberSpark Industry Initiative in Beersheba and a visit to Twistlock’s Tel Aviv operations planned on Thursday. In April 2018, Twistlock announced the opening of a global solutions engineering center at the LSU Innovation Park in Baton Rouge.

In Israel, cybersecurity exports generate an estimated $6.5 billion in economic activity annually, with Israel attracting $815 million or 16 percent of all global investment in cybersecurity ventures during 2017, second only to the U.S., according to the Israeli innovation partnership Start-Up Nation Central.

Psychologists and Students Present at National Assn of Neuropsychology in NO

The National Academy of Neuropsychology held its 38th Annual Conference in New Orleans at  the Sheraton Hotel, October 17-20, 2018. The theme of the conventional was “Becoming Agents of Change.”

Psychologists from the New Orleans area who presented at the conference included Dr. Kevin Bianchini who spoke on “Pain in the Medicolegal Context.

Dr. Lisa Settles and Dr. Margaret Hauck, along with colleague Dr. Mary Gleason, presented “Early Childhood Brain Development: A Clinical View of Exceptions to Typical Brain
Developmental Trajectories.”

Students presenting included Scott Roye, Alyssa De Vito, and Andrea Smith, all from Louisiana State University, and with co-author Matthew Calamia, PhD, Assistant Professor in Clinical
Psychology, Louisiana State University.

The National Academy of Neuropsychology (NAN) is a non-profit professional membership association for experts in the assessment and treatment of brain injuries and disorders. NAN members are at the forefront of cutting-edge research and rehabilitation in the field of brain behavior relationships.

For her presentation, Lisa D. Settles, PsyD, Assistant Professor of Psychiatry & Pediatrics at Tulane University School of Medicine, Tulane Center for Autism and Related Disorders, reviewed the diagnostic criteria of Autism Spectrum Disorders (ASD), basic neurobiological basis of ASD, specific symptoms of language impairment, social impairment, and RRBs and how the brain contributes to the deficits in youngsters.

Dr. Settles included reviews about issues of social communication delays and restricted, repetitive behaviors. She told the audience about how deficits in ASD are due to connections, activation, structures, and lack in these elements. She said there was difficulty studying young
children using imaging techniques that require stillness and following directions and noted that new information is forthcoming regularly and even weekly.

Margaret Hauck, PhD, neuropsychologist and Assistant Professor of Psychiatry at Tulane University School of Medicine, spoke on “Normal Development,” including cortical development, and explained that different regions follow different patterns. She reviewed how asymmetry appears early on, and how in the third trimester, the cortex is starting to learn. She told the audience how the newborn brain is prepared to experience, and is also prepared by experience. She also included how the greatest plasticity is in early years. She covered memory, encoding, retention, retrieval, autobiographical memory, attention, executive functioning, social and emotional development and other factors.

Dr. Gleason covered the prevalence of adversity in early childhood, the clinical correlates of  adversity and trauma-exposure in very young children, factors related to the presentation of
psychopathology in early childhood, and clinical implications of psychopharmacologic treatments.

She summarized that early childhood development is impacted by adversity and protective  actors in the caregiving environment. Mechanisms of these impacts is complex and includes direct and indirect influences, she explained. Therapy is safest and best supported treatments, while medications may play a role but large gaps in knowledge limit use.

Kevin Bianchini PhD, ABPN, FACPN, presented ” Pain Psychology for neuropsychologists: An Update.” He is a board certified Neuropsychologist and Clinical Psychologist, and is with Jefferson Neurobehavioral Group.

In his presentation, Dr. Bianchini covered the clinical circumstances of pain psychological evaluations, including predicting response to procedures or rehabilitation, understanding difficult-to-explain outcomes, and identifying treatment approaches, including treatment of comorbidities.

He noted that pain-related complaints are extremely common in the general population and  that the presence of pain influences recovery in neuropsychological conditions. He covered
psychosocial factors that influence recovery.

Dr. Bianchini also reviewed how psychometric testing is a valuable component of a consultation to assist the physician in making a more effective treatment plan and that it is useful in the assessment of mental conditions, pain conditions, cognitive functioning, treatment planning, vocational planning & evaluation of treatment effectiveness.

Psychosocial treatment is recommended as an important component in the total management of the patient with chronic pain, he told attendees, and treatments should be implemented as soon as the problem is identified, he explained. Psychosocial treatment may enhance the patient’s ability to participate in pain treatment rehabilitation, manage stress, and increase their problem-solving & self- management skills.

He described the scope of the problem and that pain complaints result in millions of
physician office visits per year and as many as 150 million lost work days. He noted that
the lifetime incidence of low back pain is 11 to 84% and lifetime incidence of neck pain
is 10 to 15%. Back pain is the most common reason for filing a workers compensation claim
and 30-50% of all Workers Compensation claims involve back pain. However, objective
physical findings do not fully explain the breadth and magnitude of disability seen in
many patients with back pain, he noted.

Scott Roye, MA, graduate student at Louisiana State University, presented a research poster, “Associations of Normative and Maladaptive Personality Traits with Self-Reported  Executive
Functioning.” Co-authors are Peter Castagna, MA, from Louisiana State University, and Matthew Calamia, PhD, Assistant Professor and also from Louisiana State University.

In his abstract, Rove noted, “Executive functioning (EF) is a collection of higher order processes designed to facilitate goal-oriented performance. Although commonly studied using performance-based tasks, self-report measures are also useful in assessment given their association with functional impairment. The relationship between self- reports of personality and EF is limited by the use of global EF scores and primarily measures of normative, rather than maladaptive, traits.”

In his study, Roye sought to better understand the relationships between
individual, self-reported EF domains and personality traits among a non-clinical
sample of young adults. Findings replicate prior work emphasizing the relationship of
neuroticism and conscientious/disinhibition to self-reported executive functioning and
extend previous research, Rove wrote.

Alyssa De Vito, MA, also a graduate student at Louisiana State University, presented “Apathy Symptom Severity and Progression Across Empirically-Derived Mild Cognitive Impairment Subtypes.” Her co-author is Matthew Calamia, PhD, Louisiana State University. De Vito examined apathy severity at baseline and its progression over time in empirically derived mild cognitive impairment (MCI) subtypes, she noted.

Using clinical and neuropsychological criteria, amnestic MCI individuals were identified as having more severe apathy symptoms than cognitively normal participants at baseline. However, only clinical criteria identified dysexecutive individuals as having more severe apathy symptoms compared to cognitively normal controls at baseline.

The study demonstrates that apathy severity and progression differ across MCI subtypes. Identification of individuals who may be at risk of developing more severe symptoms is important given apathy’s association with functional impairment, even after controlling for cognitive impairment.

Andrea Smith, an undergraduate senior at Louisiana State University, presented, “White Noise Effects on Cognitive Performance in Those with ADHD: The Moderating Role of Internalizing
Symptoms.” Co-authors are Scott Roye, MA, and Dr. Calamia.

According to her abstract, prior research suggests that white noise played concurrently with a cognitive task may facilitate cognitive performance in those with ADHD, for example, by reduced need to seek out other stimulation. However, much of this work has been done only with children. Additionally, studies of white noise and ADHD have not examined the role of comorbid depressive and anxiety symptoms, which are known to effect cognitive performance in those with ADHD. Smith aimed to address this gap in the literature.

The results indicate that the effects of white noise may uniquely influence cognition among individuals with ADHD, depending upon the presence and severity of their internalizing symptoms, Smith’s review said.

Psychologists to be Compensated for “Thinking” CMS Publishes New Psychological and Neuropsychological Testing Codes

The 2019 Medicare Physician Fee Schedule Final Rule was published at the Federal Register this week, and includes major changes in how psychological testing codes will be handled, changes
that Dr. Tony Puente, Past-President of the American Psychological Association, says are “…the biggest paradigm shift since the development of testing.” Puente presented at the annual  conference of the National Association of Neuropsychology last month held in New Orleans.

Dr. Kim Van Geffen, Director and Chair of Professional Affairs for the Louisiana Psychological
Association, explained that these changes are important for psychologists to understand.  “Beginning on January 1, 2019,” she said, “psychologists who bill insurance companies will be required to use a new set of CPT codes for billing psychological and neuropsychological testing,”
Van Geffen said.

“These codes, which were developed with input from the American Psychological Association,  ill greatly change the way assessments are billed,” Van Geffen said. “The new codes will include base codes and ‘add on’ codes and will distinguish technical work, such as administration and
scoring of tests, from professional work, such as integration and interpretation of evaluation data, clinical decision making and treatment planning. Both types of services will be billed with different codes.”

The CMS final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019, noted CMS. In addition to policies affecting the calculation of payment rates, this final rule finalizes a number of documentation, coding, and payment changes to reduce administrative burden and
improve payment accuracy for office/outpatient evaluation and management (E/M) visits over
several years, according to the announcement.

CMS officials also said that through an interim final rule with comment period, CMS is implementing a provision from the Substance Use-Disorder Prevention that Promotes Opioid
Recovery and Treatment (SUPPORT) for Patients and Communities Act that expands access to telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder for services furnished on or after July 1, 2019. CMS will accept comments on the interim final rule until December 31, 2018.

All releases about the Rule can be reviewed as CMS.gov.

In a series of recent announcements over the last months, Doug Walter, JD, Associate Executive Director for Government Relations, American Psychological Association Practice Organization, alerted psychologists that the Centers for Medicare and Medicaid Services (CMS) released its proposed changes on the 2019 Fee Schedule.

CMS had targeted the codes for revisions and asked the American Medical Association’s CTP® and RUC (Relative Value Update) Committees to restructure and revalue the testing codes. Doug
Walter, JD, Associate Executive Director for Government Relations, American Psychological Association Practice Organization, alerted psychologists to the proposed changes.

CMS had targeted the services because the claims had exceeded $10 million, up to $42 million in 2016, according to Puente. CMS considered the services to be overvalued and targeted them for revision and review.

Walter said APA’s Practice Organization staff had met repeatedly with CMS throughout the year to ask the agency not to make substantial cuts in testing service payments. “We are gratified that CMS listened, and rejected the significant reductions in payments that had been under consideration…” They prevented  4% cuts that would have come when psychologists collect their own test data, APA officials said.

Van Geffen will be conducting on-line training for LPA members and other psychologists in the next few weeks, she said. “These new testing codes represent significant changes in the way in
which psychologists code their testing services. Dr. Tony Puente, former APA President, refers to them as a ‘paradigm shift.'”

“Under the current Medicare regulations,” Van Geffen said, “psychologists are viewed as ‘technicians’ which means that our services are not financially valued for the cognitive work
which we do as a part of our assessments. The new codes represent a move toward
psychologists being paid for cognitive work.”

Although the codes will be somewhat complicated to learn initially, they will ultimately be a
valuable change in the reimbursement landscape,” Dr. Van Geffen explained.

In the most recent announcement, Walter wrote, “Based on a close examination of the proposal we project that the Medicare payment for a six-hour battery of psychological tests would increase 6.3%. The Medicare payment for a neuropsychological test conducted with the assistance of a technician would increase 6.8%, while the payment for a neuropsychological test
conducted by a neuropsychologist her/himself would decrease by just over 3%. The reimbursement rate for a one-hour neuropsychological status exam would increase almost 2%, with reimbursements for a two-hour exam declining 5.3%

Stress Solutions

by Susan Andrews, PhD

APA Study:
Discrimination Leads to Stress

APA has done a survey every year on stress in America. In recent years the Harris Poll survey has focused on discrimination because it is a growing cause of stress. The news has reported numerous clashes between police and black people and Hispanic people. Sadly, there has also been examples of violence based on racial and religious discrimination.

According to an APA study based on a survey of 3,361 adults, more than half of U.S. adults say they have experienced discrimination at the workplace, from police or in other situations. Discrimination was linked to high stress levels and to poor health in those who reported discrimination as compared to the people in the survey who reported not experiencing
discrimination.

The survey respondents reported that their discrimination induced stress has risen over last year. The discrimination has taken the form of poor service, threats, lack of courtesy, lack of
respect shown, among other examples. More than 75% of black people said they experience day-to-day discrimination. Almost one-third of both black and Hispanic adults told the survey that they have become hypervigilant about their appearance in the hope of being treated more fairly.

What the survey does not say is that this type of discrimination-induced stress is chronic stress. Stress that one has little relief from means that the negative effects on one’s health are stronger. Negative effects include excessive fatigue, higher blood pressure readings, reduced immune system protection, among others.

Discrimination-induced stress begs the question of how to reduce such stress. It is pervasive, and its reduction depends upon a major change in people’s beliefs and attitudes. Obviously changes in beliefs and attitudes cannot be legislated. Psychology failed to change even minor beliefs and attitudes about eating organ meat (such as liver) during WW2, such that the more desirable meat could be sent to our troops.

And, when we have no answers or ideas of how to change a situation, it is hard to figure out how to end a column on a more positive note.