One year later, Katherine Nordal, Ph.D. discusses work

One year later, Katherine Nordal, Ph.D.
discusses work
(June 2009 Issue)

One year ago, Katherine Nordal, Ph.D., took over as executive director for professional practice for the American Psychological Association (APA). Her 30 years of practice experience, including neuropsychological assessment, adult, youth and family therapy, forensic evaluations and consultation, substance abuse consultation among other areas, gave her a hands-on understanding of the issues that practicing psychologists face.

Nordal has worked closely with state associations and other leaders in the industry to create opportunities for psychologists and to defend the scope of practice.

She took a break from her busy schedule to talk with New England Psychologist's Catherine Robertson Souter about the organization and its future plans.

Q: What does the practice organization do?
A: There are two sides. The Practice Directorate is part of the APA, and its companion organization, the APA Practice Organization, is funded by dues that licensed practitioners pay. The Practice Organization is concerned with advancing, protecting and defending the professional practice of psychology. We would be doing things like preserving the doctoral degree as a standard for entry into the profession, seeking appropriate levels of compensation for psychological services for practitioners, working with state associations to monitor insurance company and managed care company practices, working to expand prescriptive authority for psychologists. Basically, protecting and expanding scope of practice.

Q: And the Practice Directorate covers all of psychology including those who are not required to be licensed, like researchers? What does that side do?
A: All of our public education; our consumer survey about stress, mind/body materials, and a new public education program around childhood obesity in conjunction with the YMCA. We also provide colleague assistance, a task force on the seriously mentally ill, our governance groups, and work we do around guidelines and professional practice and standards. Plus, a lot of the legal regulatory work we do that has to do with protecting access to care for folks.

Q: What are the main day-to-day issues?
A: Health care reform is a huge issue for us. One thing that is a big part of our legislative agenda this year is to ensure that psychologists are included as a named profession in the physician definition under Medicare. Doing that will open up more things to psychologists and provide for a delivery system and reimbursement mechanics that will allow psychologists to work in integrated health care settings and get reimbursed for their services.

It may also expand the ability for us to participate in graduate medical education programs.

Q: You also talk about helping state associations work with their local payers.
A: We have launched a survey about managed care and insurance company practices that has been piloted in New York and in Georgia. That survey is being refined and we are going to launch it nationally this summer in an effort to get information about the practices of specific insurers and managed care companies. We can then use that information like a consumer report card for state associations to work with, negotiate or simply talk with these companies about their reimbursement practices that might limit access for patients to the kind of care that they need.

We are also looking to develop other advocacy materials like treatment guidelines or practice parameters.

Q: This would help psychologists demonstrate the need for services?
A: Well, we don't have anything currently at APA that says, for instance, "a patient with this kind of disorder needs this kind of evaluation. If someone has a brain injury following a motor vehicle accident, they should have this kind of assessment. If someone has a depression, they need this kind of treatment." So there is serious discussion at APA about developing some parameters that we can use with insurance companies.

For example, in Massachusetts they have had some problems with one insurer cutting back on the amount of psychological and neuropsychological assessment they are willing to pay for. The Massachusetts Psychological Association in conjunction with the Massachusetts Neuropsychological Society have developed strategies for that dealing with that insurer at the state level. That's an area where we can help.

Q: So that a psychologist can show that this is standard care, not something outrageous?
A: If someone has depression, these are the treatments that we know work. Currently the guidelines that insurance and managed care companies use to dictate treatment are based on guidelines that have been promulgated primarily by medicine.

Q: How does the economy factor in to what the organization does?
A: It certainly helps to dry up the public sources of funding for training and treatment. The challenge is always there to try to forestall rate cuts. The sustainable growth rate formula right now calls for a 21 percent cut in Medicare fees for providers. That's not going to happen, but we need major payment reform because we have an unsustainable system in terms of health care costs.

The economic viability of practice is always at the top of our radar screen - particularly for those people who own their own business and are solely dependent on fee for service. We spend a lot of time and energy being vigilant and looking for opportunities to impact in a positive way.

At APA, we want to ensure that psychologists will have vibrant, healthy practices and our goal is to help provide them with information and resources so that they are able to do that.

That can mean showing them how to do things differently, giving them new tools, or pointing out areas in which there is a future. For instance, there is a wide range of opportunity in health care. We spend three-fourths of our health care dollars on chronic illness and that is an area where there is opportunity for psychologists to grow or expand their practice, to diversify into specializing. Whether it's working with patients with physical disorders or specializing in a particular area, with diabetics, or cardiac patients, there are some health care practice issues that are ripe for folks to pursue.