LETTER BY R. MALLORY STARR, PHD
Can it be said that it is the best of times and the worst of times for psychology practitioners — especially those in the clinical psychology and counseling psychology field who work mainly in healthcare and are engaged in insurance and other third party payment schemes? I believe there is reason for optimism regarding being a psychology practitioner. It may not be the best of times, but it is not terrible either. Psychologists have many assets — a range of capabilities which come from their educational and experience history. Their assets are generic skills, the developmental status of the field, and, the future prospects even with some downsides.
The recent past regarding clinical practice especially in the healthcare arena — there was a two party arrangement in which agreements, practice details and major decisions were between practitioner and patient. Practitioners of psychotherapy and psychological testing next gained status as a result of certifications and licensing in the states where they practiced. The field of psychotherapy also expanded beyond psychiatrists, psychologists and social workers to include psychiatric nurses and now mental health counselors from varied backgrounds. This expansion was the start of formal regulations. A bit later the third party payment systems were implemented. The implementation of third party payment systems such as insurance and managed care programs came with more regulations resulting in problems for practitioners especially related to regularity complexities and third party payment systems which can mean often delayed receivables due to complexity of compliance -- such as forms being filled out and reporting on progress. Receivables at times became delayed well beyond 30 days and this further made problems for practitioners who are scheduled to pay their rent and administrative assistants on a 30 day basis. The result has been a new field coming in — that of factoring in which a practitioner would turn receivables for collection over to an organization and thus collect about 70% of what they were owed.
Third party payment systems also resulted in other problems for practitioners — the loss of autonomy for key decisions for their practices due to third party payment organizations going on averages rather than focusing on the individual circumstances of patients. The goals of a third party payor became those treatments that are less expensive meaning short term therapies. To be a practitioner also in today’s world one goal can be to be independent of third party payment systems or be part of third party payment systems and assume the risks which include needing staff to assist with back office systems for compliance as well as the expenses of computerized reporting and billing. Despite these factors the field is still growing, and psychologists are coping despite the threat of even more changes coming such as value billing, outcome- based payment systems, balanced score cards, CEU creep. Psychologists are also seeing more and more the value of diversification of their practices from pathology focus to use of their same technology for performance enhancement orientations such as in executive and manager development programs in organizations, stress management programs, wellness-oriented programs with spa and retreat settings, more application to what is called human factors engineering — much of this work being independent of insurance and healthcare practice restrictions.
A noticeable trend is that of psychologists making an impact and shaping the environment they practice in rather than being mainly reactive — this is more and more going on management by plan rather than reactive. It involves getting involved in the mainstream and collaboration with other fields to increase the scope of their practices. This involves licensing mobility systems. Even the parent organization of the field is moving in a different direction — from focus on benefiting society to both benefiting society and the guild issues in the profession. It is in general a movement from System One Management to System Four Management Style.
A trend that is of much benefit to psychologists and the field is that of behavioral economics which has as key underpinnings the process of perception, projection, affect, thinking and behavior associated with economic activity such as supply, demand, buy and sell decisions, as well as about bias which is reference to unconscious factors in decision making. Major underpinnings psychologists have are related to describe, predict and control factors regarding behaviors. Specifically, implementation of these aspects of practice are interviewing skills, testing, research -- all of which go into implementation of therapeutic programming. The generic skills and underpinnings of healthcare setting psychologists can be translated to the language of the corporate settings.
As overview of some important trends the following is noteworthy: increase in scope of services from healthcare to corporate settings — from interventions targeted to pathology to interventions based on strengths and performance enhancements; integration to the mainstream — to visibility — from psychotherapy to coaching, management and executive development, increased assertion and attention to guild issues and the development of scope of practice, licensing mobility, development of systems to manage compliance and regulatory issues and a move in the parent organizations (such as APA) to not only benefit of society but guild issues and enhancement of opportunities for members.
Another way to express what is going on is a look at what the practice of psychology can be given the current environment — it can be made up of psychologists and others in practices who may fit into three categories of functioning — Finders who are really marketeers (they find clients), Minders who provide the services, and Grinders who do administrative functions. Members of DCPA are moving in these directions and DCPA Board members are being influential. Washington, DC has about 1400 Licensed Psychologists and only about 10% of that group are members of DCPA. To fulfill DCPA’s vision and mission in timely fashion increase in number of members is needed and it is expected that will occur.