Letter to the Editor: MPA responds to editorial on compensation

To the Editor,

We appreciate your raising the issue of compensation to Massachusetts psychologists and its direct impact on behavioral health and substance use services in your recent editorial (December, 2018).

Restricted access to mental health treatment for Massachusetts residents has been central to the advocacy efforts of the Massachusetts Psychological Association (MPA) for many years.

The stagnant third-party payor reimbursement to psychologists is a key contributor to this problem and in direct opposition to the surge of unmet behavioral health treatment needs.

This concern was highlighted by the Massachusetts Attorney General’s Office Examination of Health Care Cost Trends and Cost Drivers report in 2015, which cites “historically low reimbursement rates” as a significant barrier to accessing behavioral health services.

However, low reimbursement is only one of several important factors that result in decreasing psychologist enrollment with health plans.

MPA has been directly involved in efforts to increase mental health treatment for Massachusetts residents by working with health plans to improve the scope and quality of services.

Our approach includes quarterly meetings with health plan representatives where we directly address issues like gaps in coverage and administrative burdens on providers, as well as other forms of advocacy, such as participating on relevant state task forces and workgroups.

Through these efforts, MPA has secured significant results that directly impact clients and clinicians, such as wider coverage for 60-minute psychotherapy sessions.

MPA was also key in developing standardized authorization forms for assessments and other levels of care, which reduced administrative burden for clinicians. Increased administrative requirements by health insurances is a substantial impediment that factors into many psychologists’ decision to opt-out of insurance panels.

As a not-for-profit 501(c)6 professional organization, however, we are limited by antitrust laws and regulations to discuss reimbursement rates. The intent of these laws and regulations is to promote open and fair competition in all trades and professions. Since many MPA members are competitors, we are legally prohibited to engage in

activities that directly raise, lower, or stabilize fees or reimbursement rates, which are deemed “anticompetitive.”

Despite these restrictions, we are able to address other aspects of rate-setting practices. For example, we have successfully advocated for parity between medical and behavioral health rate determination processes, and improved access to longer therapy sessions by educating third party payors on evidence-based treatments that require longer than standard timed sessions.

Current areas of advocacy include supporting legislation limiting claw-backs by health plans, expansion of teletherapy coverage, and increasing transparency among health plans.

Other factors which influence reimbursements rates include the relative value of psychologists’ work. MPA continually educates health plans, legislators, and the public on the roles of psychologists, including their high-level doctoral training and numerous specializations.

The MPA has a public education campaign with dedicated psychologists who educate the public about the role of psychology in healthcare. By increasing appreciation for psychological services, we raise the value of our work, which ultimately affects reimbursement and other professional factors.

MPA is committed to improving both access to behavioral health services and the professional lives of Massachusetts psychologists. With the increased need for behavioral health services, market forces have intensified such that many psychologists are opting out of insurance panels to charge privately and the market is bearing it.

MPA remains dedicated to continuing to work with third party payors to decrease this disparity, but it is imperative that all psychologists join in our efforts. Our ability to advocate for improved behavioral health services and the profession is directly related to the resources at our disposal. We could be even more impactful if more psychologists rallied to support MPA.

Sincerely,

Margaret Lanca, Ph.D, President, Massachusetts Psychological Association

Jennifer B. Warkentin, Ph.D, Director of Professional Affairs, Massachusetts Psychological Association