Sandy's Position on Prescription Privileges for Psychologists
Question: What is your position on prescriptive authority for psychologists?
Sandy's Brief Answer:
I have been (since the initial DOD demonstration project), and continue to be, fully supportive of prescriptive authority as a specialty for psychologists with appropriate training and credentials. The evolution of treatment settings combined with the critical need, as exemplified by those in many rural settings, has long justified prescriptive authority psychology practice. We also know that the effective combination of psychological treatments with psychopharmacological medications is of great benefit to the public. All too often, historically, the optimal combination of these two modalities has been unavailable, disconnected, uncoordinated, or underemphasized in one modality or the other. My position on prescriptive authority fits well with my perspective on other recognized psychology specialties. Prescriptive authority, like other psychology recognized specialties, will lead the way for our field in healthcare.
We must secure funding for the science, education and support to states actively trying to pass RxP legislation. I supported such efforts while serving on the APA/APAPO Board and as the Board liaison to CAPP, which was responsible for RxP support efforts. I continue to support these efforts in my own state, as the Ohio Psychological Association moves HB 326 through the state legislative process. We must also gain physician definition under Medicare, maintain parity rules and regulations, and resist efforts to derail the Affordable Care Act, so that psychologists as a whole, and prescribing psychologists, in particular, can assume their full effective roles in an integrated, collaborative healthcare system.
Sandy's Long Answer:
I have been, and continue to be, fully supportive of prescriptive authority as a specialty for psychologists with appropriate training and credentials. The evolution of treatment settings combined with the critical need, as exemplified by those in rural settings, has long justified prescriptive authority psychology practice. We also know that the effective combination of psychological treatments with psychopharmacological medications is of great benefit to the public. All too often, historically, the optimal combination of these two modalities has been unavailable, disconnected, uncoordinated, or underemphasized in one modality or the other.
My position on prescriptive authority fits well with statements I have made about other recognized specialties. Such specialties will lead the way for our field in health care. In the current healthcare legislative climate, there are two major lingering challenges which significantly affect prescribing psychologists:
Funding and reimbursement.
We need to secure continuing funding for science, education and support to states which are actively trying to pass RxP legislation. I supported such efforts while serving on the APA/APAPO Board and as the Board liaison to CAPP, which was responsible for RxP support efforts. I also see the need clearly in my own state association, as the Ohio Psychological Association moves HB326 through the state legislative process. As President, I would also continue my support for APA’s broader initiative to vigorously pursue physician recognition under Medicare, to guarantee proper and ongoing reimbursement for psychologists’ services. We must also maintain our ongoing advocacy and regulatory emphasis on mental health parity, given the repeated threats to existing rules and laws. We can’t really achieve full parity when psychologists are not listed in the CMS physician definition. The problem created by this critical omission extends far beyond CMS and Medicare. The perception that psychologists are not equivalent, independent doctoral providers, due to lack of recognition as physicians under CMS/healthcare systems, migrated into commercial carriers and state rules.
Funding also needs to focus on reimbursement for services. We need psychological science to generate designs and data that can clearly demonstrate how dollars invested in psychological science bring about a stronger understanding of the human condition. This can then lead the way for psychologists to create and sustain effective psychological interventions in expanded areas of work, like prescriptive authority.
We also need to show that funding for advanced psychology training prepares a cadre of highly competent healthcare providers and scientists such as prescribing psychologists.
We must demonstrate that funding for our evidence-based healthcare services provide outcomes that are as strong as, or, in some cases, stronger than other healthcare professions. Then we must be prepared to function in a value-based payment system, functioning on flexibly meeting patient needs. Effective prescribing psychologists can certainly demonstrate such impact.
The Affordable Care Act
The Affordable Health Care Act put an emphasis on integrated care and patient-centered, family-centered collaborative care. The Affordable Care Act was empowering for psychologists to play a more integral role in healthcare, including greater leadership and opportunities, such as prescriptive authority. With continuing efforts to repeal and replace the ACA, I don’t want to see the positive movement made in integrated and collaborative care be diminished, leaving psychologists with lesser roles in healthcare delivery. In particular, the repeal of the ACA could have a detrimental impact on integrated and specialty care efforts with low-income, marginalized, hard-to-access individuals, given changes to Medicaid under consideration. This could also impact the acceleration of prescriptive authority for psychologists.
Psychologists, like other medical professionals and professions, are unified by our core knowledge, skills, attitudes and competencies. Our foundation in psychology is based on broad and general, accredited education and training—we have core competencies of scientific mindfulness, ethical standards for scientists and healthcare providers, and concerns for the welfare of all people. This provides us with a unified professional identity, while still recognizing that board certification, specialization and specialties can allow for more in-depth competence and experience. Current data suggest that, in today’s healthcare system, both consumers and healthcare settings alike understand that all health disciplines have a core foundation from which ranges of specialization emerge and evolve. The rest of the world may understand our commonalities better than we do. It is time to help specialty trained prescribing psychologists thrive in the evolving healthcare system.
