A broad swath of organized medicine, including the Texas Medical Association, is asking congressional leadership to oppose a bill that legally would consider clinical psychologists to be physicians within Medicare, saying it “inappropriately” expands psychologists’ scope of practice.
TMA, almost every other state medical society, the American Medical Association, and many national specialty societies voiced their objections to the Medicare Mental Health Access Act in a letter to the chairs and ranking members of the U.S. House Energy, House Ways and Means, and Senate Finance Committees.
The bill would, in the words of its summary, expand “the definition of ‘physician,’ for purposes of the Medicare program, to include a clinical psychologist with respect to the furnishing of qualified psychologist services.”
Days after introducing the measure, Rep. Judy Chu (D-Calif.) said in a statement current Medicare standards are “antiquated” and restrict access to mental health care.
But TMA and its organized medicine partners said in their letter the measure “jeopardizes the safety of patients in the Medicare program and would create silos in the delivery of appropriate mental and physical health care,” also noting that Medicare defines physicians “as providers who medically diagnose patients, prescribe and manage medication, and supervise other medical staff.” The Medicare Mental Health Access Act, on the other hand, would allow clinical psychologists to treat patients “without supervision throughout in-patient settings, including partial hospitalization settings,” they wrote.
Expanding the term physician to include clinical psychologists under Medicare “would have far-reaching and negative impacts on patients seeking psychiatric care,” the letter also said.
“Physicians complete four years of medical school plus three to seven years of residency, including 10,000-16,000 hours of clinical training,” medicine noted. “Our colleague psychologists are an essential part of a physician-led patient care team, however, they lack the requisite medical education, medication management training, and clinical training that is critical in determining differential diagnosis and do not fit the definition of a physician.
“Medicare patients in partial hospital programs or in-patient settings with acute and serious mental illness often have multiple complex medical problems … Psychologists are not trained to treat acute mental illness requiring medication management or co-occurring physical illnesses. Given the complexity of this patient population, it is essential that we retain collaborative guardrails that require psychologists to consult physicians who have the education and training to effectively manage the entire treatment plan, including both physical and mental health services.”
The bill does nothing to expand access to mental health and substance use disorder services under Medicare, TMA and others argued.
“In-patient care, including partial hospitalization, requires physician supervision for a reason,” the letter said. “Treatment in these settings is for acute mental illness and the overall treatment of physical conditions that requires advanced medical training. Therefore, if psychologists were allowed to manage these patients, they would not receive the full array of medically necessary services they require from an in-patient setting and thus, access to the care that these patients truly need would be curtailed, not expanded.”
Recipients of TMA’s letter included House Energy Committee Chair Rep. Frank Pallone (D-N.J.) and ranking member Rep. Greg Walden (R-Ore.); House Ways and Means Committee chair Rep. Richie Neal (D-Mass.) and ranking member Rep. Kevin Brady (R-Texas); and Senate Finance Committee chair Sen. Chuck Grassley (R-Iowa) and ranking member Sen. Ron Wyden (D-Ore.)
The bill received a hearing on June 30 in the House Energy and Commerce Subcommittee on Health.