Publication of the Florida Psychological Association Winter 2013 • Vol. 64, No. 3

F l o r i d a

Psychologist

Collaborating with Providers Across Disciplines in a Child and Family PracticeSee page 18

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TABLE OF CONTENTS

Feature Articles

8 A FEW TIPS FOR NAVIGATING MEDICARE W. Steven Saunders, PsyD, Member

Editor

12 FROM THE DIRECTOR OF PROFESSIONAL AFFAIRS Carolyn Stimel, PhD, ABPP

17 2014 FPA CONVENTION Steve Bloomfield, EdD

18 COLLABORATING WITH PROVIDERS ACROSS DISCIPLINES IN A CHILD AND FAMILY PRACTICE

Jessica Garcia, PhD

22 2014 CALL FOR PHWA NOMINATIONS

25 LEGISLATIVE UPDATE Liz Campbell, PhD, LAPPB Co-Chair

In Every Issue

3 FROM THE EXECUTIVE DIRECTOR Connie Galietti, JD

5 THE PRESIDENT’S CORNER Robert J. Porter, PhD

13 APA COUNCIL REPORT David Kazar, PhD, ABPP

14 PAC CONTRIBUTORS

16 SUSTAINING MEMBERS

20 PSYCHOLEGAL NOTEBOOK Robert Henley Woody, PhD, ScD, JD,

ABPP

24 CPE QUIZ - Winter 2013

From the executive Director

By Connie Galietti, JD

The past year for FPA has been particularly challenging, not unlike what our members have too been experiencing. With revenues declining but expenses on the rise, we are all working harder to do more with less without failing to deliver the highest level of qual-ity we expect of ourselves and each other. As you may already know, our communications coordinator left us in November and we made the painstaking decision to freeze her position. Dwindling membership numbers and diminishing revenue from other sources is making the bottom line harder to balance; but we are not going to sacrifice the services you deserve. FPA is doing what we all have had to do recently – tighten the belt, dig in our heels and make things happen! With the support of our wonderful volunteer base and Central Office Staff, we are committed to ensuring that our service to you will continue to be what you have come to expect from us.

To help FPA succeed in 2014, we have built a great team of paid staff and volunteers who are already working to plan events and provide services to our members. I am confident that 2014 will be a year of growth. Our incoming president, Steve Bloomfield, is pulling our teams together to conduct a series of strategic planning exercises. We have planned an excellent summer convention to include many opportunities for networking and mentoring. We are also beefing up our communications initiatives with a larger presence on Twitter and LinkedIn. This will complement our recently updated website and new www.mentalhealthflorida.com website.

Our Chapters are also becoming even more active than before. All members of FPA should attend at least one, if not all, of these valu-able programs. Most events provide continuing education. All events promise the chance to meet colleagues, learn from mentors and receive referrals for your practice.

We are also excited at the renewed energy of FPAGS. FPAGS has included a regular member of FPA on its board to act as an advisor. Under the leadership of current FPAGS Chair, Sarah Goldstein, and advisor, Dr. Josh Gross, we have seen a wonderful increase in student participation in FPA governance. Most chapters, all divisions and FPA committees now include student representatives on their boards. With the input of our future practitioners, FPA is sure to grow as these young leaders bring innovative and new ideas to the table.

My opening statement was, “this is a challenging time;” but it is not a discouraging one. FPA is blessed to have a robust volunteer net-work, committed staff members and a great membership base. We are dedicated to making 2014 one of the best years for our organization. Thank you for being part of this journey.

Florida Psychologist • 3

Publications Chair: David J. Romano, PhD

Member Editor: W. Steven Saunders, PsyD

Editorial Board: Robert J. Porter, PhDW. Steven Saunders, PsyDZoe Proctor-Weber, PhDLiz Campbell, PhDConnie Galietti, JD

The Florida PsychologistThe Florida Psychologist is the official

publication for the Florida Psychological As-sociation, a professional membership associa-tion for psychologists in Florida. The Florida Psychologist is published three times per year: Spring, Summer and Winter.

DisclaimerThe thoughts, opinions, and positions ex-

pressed in this publication are solely those of the individual authors and are not necessarily endorsed by the officers, Board of Directors or general membership of FPA. Publication of an advertisement does not imply endorsement or approval of the advertiser or their service/product being advertised.

SubmissionsWe invite authors to submit work to the

Florida Psychologist. As Florida’s leading source of news on the latest psychological opinions, theories and research, legislative updates, and membership information, we count on experts like you to maintain the high standards of the Florida Psychologist. Priority is given to articles about: legislative, politi-cal, advocacy, regulatory news or informa-tion, practice issues, FPA news and business, columns and articles by FPA committee chairs and members on issues not covered above, and other information.

The Florida Psychological Association408 Office Plaza Drive, Tallahassee, FL 32301

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Psychologist Mark Your Calendars!!

2014 Annual Summer ConventionJuly 17-20

Coconut Pointe Hyatt RegencyBonita Springs

4 • Winter 2013 / Vol. 64, No. 3

2013 FPA BOARD OF DIRECTORS

Executive Committee:President ..........................................................Robert J. Porter, PhDPresident Elect ......................................... Stephen I. Bloomfield, EdDImmediate Past President .................................Diane A. McKay, PsyDSecretary ..............................................Camellia Ann Westwell, PsyDTreasurer ...................................................... Zoe Proctor-Weber, PhDLAPPB Co-Chairs .................................................. Lori Butts, JD, PhD

Elizabeth Campbell, PhDAPA Council Representative ..................... I. Bruce Frumkin, PhD, ABFPFPAGS ...............................................................Sarah Goldstein, MS

Chapter Representatives:Bay ..............................................................Felix J. Subervi III, PhD

Nekeshia Hammond, PsyDBrevard/ Indian River ........................................ Jessica G. Karle, PhDBroward ........................................................Jacqueline Valdes, PhD

Laura A. Cohen, PhDCalusa ................................................................. Mabel Lopez, PhDCapital .......................................................................Jill Ricke, PhDCentral ...........................................................David J. Romano, PhDDade-Monroe .....................................................Franklin Foote, PhD

Regina Mendoza, PsyDLower West Coast .......................................Donald A. McMurray, PhDNorth Central ....................................................... Tim Ketterson, PhDNorth East ........................................................ Darah Granger, PsyDPalm .......................................................... Cynthia Silverman, PsyD

Lawrence Levy, PsyDPinellas .........................................................Harold Shinitzky, PsyDWest ................................................................. Ron Yarbrough, PhD

COMMITTEE CHAIRS & APA LIASONSBylaws & Policy Review ..........................................Larry Kubiak, PhDDisaster Response Network ..............................David J. Romano, PhDDiversity ........................................................... Karmon Sears, PsyDContinuing Education ....................Robert Woody, PhD, ScD, JD, ABPPEarly Career Psychologist ......................................David Chesire, PhDElections & Awards ..........................................Diane A. McKay, PsyDEthics Advisory ....................................Stephen Ragusea, PsyD, ABPPFederal Advocacy .......................................... Janet Hibel, PhD, ABPP

Kristi Van Sickle, PsyDFinance ....................................................... Zoe Proctor-Weber, PhDGovernance ...................................................Ronald Yarbrough, PhDHealth Care Policy .................................... David B. Kazar, PhD, ABPPMembership ................................................... Anthony Tanona, PsyDProf. and Public Information ..................................... Alan Keck, PsyDPsychology in the Workplace .................................. Jim Atsaides, PhDPublic Education Coordinator .......................... Regina Mendoza, PsyDPublications ...................................................David J. Romano, PhD

DIVISION PRESIDENTSChild, Adolescent and Family ........... Samantha Carella PsyD, ABPP-CCForensic Psychology ............................................. Lori Butts, JD, PhDMedical Psychology .............................Regina Melchor-Beaupre, PsyDNeuropsychology .......................................... Zoe Proctor-Weber, PhDWomen’s Issues ...................................................Lori Kleinman, PhD

presiDent’s corner

By Robert J. Porter, PhDPsychology Services Associates, LLCTampa, Florida

President’s Corner

Florida Psychologist - Spring 2013 5

2013 FPA BOARD OF DIRECTORS

Executive Committee:President Robert J. Porter, PhD President Elect Stephen I. Bloomfield, EdDImmediate Past President Diane A. McKay, PsyDSecretary Camellia Ann Westwell, PsyD Treasurer Zoe Proctor-Weber, PhDLAPPB Co-Chairs Lori Butts, JD, PhD Elizabeth Campbell, PhD

APA Council Representative I. Bruce Frumkin, PhD, ABFP

Chapter Representatives:Bay Felix J. Subervi III, PhD Nekeshia Hammond, PsyD Brevard/ Indian River Jessica G. Karle, PhDBroward Jacqueline Valdes, PhD Laura A. Cohen, PhDCalusa Mabel Lopez, PhDCapital Jill Ricke, PhD Central David J. Romano, PhDDade-Monroe Franklin Foote, PhD Regina Mendoza, PsyD Lower West Coast Donald A. McMurray, PhD North Central Tim Ketterson, PhDNorth East Darah Granger, PsyDPalm Cynthia Silverman, PsyD Lawrence Levy, PsyDPinellas Harold Shinitzky, PsyD West Ron Yarbrough, PhD

COMMITTEE CHAIRS & APA LIASONS

Bylaws & Policy Review Larry Kubiak, PhD Disaster Response Network David J. Romano, PhD Diversity Karmon Sears, PsyD Continuing Education Robert Woody, PhD, ScD, JD, ABPP Early Career Psychologist David Chesire, PhD Elections & Awards Diane A. McKay, PsyD Ethics Advisory Stephen Ragusea, PsyD, ABPPFederal Advocacy Janet Hibel, PhD, ABPP Kristi Van Sickle, PsyD Finance Zoe Proctor-Weber, PhDGovernance Ronald Yarbrough, PhDHealth Care Policy David B. Kazar, PhD, ABPPMembership Anthony Tanona, PsyD Prescriptive Authority Perry Buffington, PhDProf. and Public Information Alan Keck, PsyD Psychology in the Workplace Jim Atsaides, PhDPublic Education Coordinator Regina Mendoza, PsyD Publications David J. Romano, PhD

DIVISION PRESIDENTS

Child, Adolescent and Family Samantha Carella PsyD, ABPP-CCForensic Psychology Lori Butts, JD, PhD Medical Psychology Regina Melchor-Beaupre, PsyD Neuropsychology Zoe Proctor-Weber, PhD Women’s Issues Lori Kleinman, PhDFPAGS Emily Claus, MS

Robert J. Porter, PhD

New CPT Codes – Lots of Darkness, a Little Light

I attended a briefing on the new psychology codes at the APA State Leadership Conference in Washing-ton, DC last month. I will attempt to provide a condensed summary and some recommen-dations I gleaned from that meeting. These are my own observations and suggestions, they are not official APA, FPA or CMS policy (Note: The following applies to therapy codes, not assessment. Those are another story).

Preliminaries (general knowledge)All codes represent a certain amount of work, a certain • degree of effort and skill, and a certain amount of overhead, delivered in a specified geographical loca-tion. Psychology work amount is measured in time.• Psychology work effort and skill are considered rela-• tively uniform across time. Time and effort and skill overlap to some degree, so time is the primary distin-guishing feature of the complexity of a service.Psychology work effort and skill are also considered, • however, to differ somewhat with type of service to some degree. For example, group vs. individual and in-take vs. treatment, and assessment vs. treatment, etc.Psychology overhead is generally very small compared • to a physical medicine practice.Psychology geographical overhead varies with the • same multiplier that applies for all disciplines.The determination of the work amount, effort, and • skill, as well as the other items, is calculated using empirical procedures based in observations and sur-veys of actual practices plus a professional oversight committee’s assessment. These values are generated without regard to cost. The cost is determined by multiplying the values times the RATE representing a particular profession which, in turn, may be influenced by the market, by Congress, etc. The important point is that the work element is the basic measure for psychology, not so much overhead, and not so much variation in skill.AMA is responsible for calculations, setting amount of • time for timed-codes, etc. in the context of the empiri-cal work and in accord with the advisory committee. The committee, by the way, has psychology represen-tation at several levels, along with surgery, physical therapy, nursing, etc.

Continued on page 20

(continued on next page)

Basic Steps of HIPAA Compliance for the Small Psychology PracticeDisclaimer: The material presented here is intended as a summary of the steps and objectives of HIPAA compliance for a typical psychology practice. It is not intended as legal advice, nor is it a substitute for the authoritative government guidelines themselves. The summary is illustrative and explanatory only, and is not intended as a comprehensive or definitive guide to compliance. The reader is encouraged to use this summary as a basis for exploring guidelines in greater detail, perhaps starting with an examination of the reference materials included below. This material includes information presented in workshops on this topic presented by the author.

HIPAA compliance is a process of developing and documenting policies and procedures for HIPAA compliance implementation in an organization. The actual polices and procedures, and the documented course of their development, may be quite straightfor-ward for a small practice, but can get rather complex for practices with several providers, support staff, and independent contractor-vendors. Compliance is an ongoing process, so periodic review is essential. If you have not completed Compliance Documents yet, or if you want to update what you have, perhaps this short overview of the process can be of help.

There are, basically, eight interrelated steps in the process: 1. Risk Assessment; 2. Business Associate Agreements; 3. Policies and Procedures; 4. Training; 5. Breach Plan; 6. Contingency Plan; 7. Documentation; 8. Prepare of OCR Audit

Risk Assessment: The first step in HIPAA compliance is to assess the risks of PHI (Patient Health Information) release or inappropriate use in your practice. This step is tailored to the size and type of orga-nization, and may be rather simple. However, it must be done. Your assessment of risk includes identifying where and how PHI is collected and stored, who has access to it, and what is being done to protect the data from inappropriate access.

Risk assessment is the beginning of the compliance process and will provide the basis for guiding the development of the practices, poli-cies, and procedures, needed to maintain HIPAA security. That is, the results of a risk assessment contribute directly to the development of compliance in the other steps. A Risk Assessment Document is part of the compliance document set.

Business Associate Agreements: The second step in HIPAA compliance is to determine the entities with which the practice shares PHI either formally or incidentally, and to determine what sort of Business Associate Agreement (BAA) is needed to make sure that the information is sufficiently protected. If the entity is, in fact, either a sub-part of the practice or, alternatively that the practice is a sub-part of a larger entity, then a BAA applies to those components is as “agents” of the practice. On the other hand, if the entity is an indepen-dent contractor or other separate business, then that entity is referred to as“Independent Contractor”. Both types of entities require BAA.

For example, your in-house bookkeeper that reviews billing and

Florida Psychologist • 5

may send bills to patients and process payments from insurance companies would usually be an “agent” whereas the company that provides your internet fax service would be an independent contractor.

In all cases, the entities must sign a BAA which outlines their responsibilities to protect the PHI and spells out the consequences of failure to protect the info. In the case of agents, the consequences for the agent can include dismissal etc, but for the practice itself the conse-quences of agent failure may involve reporting the breach to the government (for example: My bookkeeper left his file of all my pts billing records in his car and it was stolen and then recovered but with no sign of the records.) The government has specified, however, that, in the case of an Independent Contractor, the Independent Contractor is responsible for the security of the information, NOT the practice. This condition must, however, be spelled out in the BAA. So, for example, you should ask your internet fax provider if they can provide a BAA. If they cannot, get a provider that can.

Policies and Procedures is the third step; it involves the development of written guidelines which describe the ways in which PHI is handled, and how HIPAA requirements are met. These can be relatively simple for a smaller practice and more complex for larger and more complex practices. The P&P must address three Safeguards: Administrative, Physical, and Technical.

Administrative Safeguards address procedures that prevent unauthorized access to PHI; the plans for training of staff in PHI protection; backup and recovery plans; a plan for periodic evaluations of procedures; sanctions for non-compliance; guidelines for sharing information with external entities and the BAAs with those entities; and the designation of a security officer who is responsible for monitoring implementation of safeguards (that person can be the practice principle or owner).

Physical Safeguards address the physical structures of the entity, including access to offices, filing cabinets, use of security systems, guidelines for the safeguarding of paper records, and the physical security of electronic systems and their access (including computer, fax, copying machines, phones, answering machines, and other such items.)

Technical Safeguards address the policies and proce-dures related to the use of software systems, including “cloud” systems, email, voice-mail, and so forth. Some of these safeguards overlap with physical ones (locks on computers, for example). Most, however, relate to , for example, the need to have passwords and, prefer-ably, two-factor authentication (logon password has to be

confirmed with code sent to your cellphone, for example). Other technical safeguards include emergency access procedures, maintaining activity logs, procedures guard-ing against alteration of PHI, and the manner of elec-tronic storage of data. In regard to storage, encryption is, increasingly, a practical necessity.

Keep in mind that all the safeguards apply to all aspects of the practice that has anything to do with PHI. This includes phone systems, voicemail, fax, email, tex-ting, copymachines, USB “thumb-drives”, external storage, networks, “cloud” systems, smartphones, tablets, and so forth.

Training, Breach Plan, Contingency Plan: These fourth and fifth, and sixth steps address the issues of training of staff, the specification of the plan of action

should a breach occur, and con-tingency plans for data recovery should breach and corruption occur.

Training can be specified in any number of ways, but work-shops, online certification pro-grams,.are possible choices. It is also useful to include formal and documented (signed) review of

Policies and Procedures with staff on a yearly basis and for all new staff.

A Breach Plan summarizes the plan of action should a breach occur. The Contingency Plan explains how PHI information will be available if, some reason, the data stor-age is breached or changed. The Contingency Plan usually includes information about backups and their scheduled updates and security information regarding the backups. The magnitude of the breach, the nature of the informa-tion breached, the potential distribution of the material, mitigating actions or circumstances, are all to be taken into account when listing the plan of action and the use of contingency plans.

The reader is advised to review the breach and contingency portions and reporting portions of the HIPAA guidelines with a knowledgeable person to make sure that the plan is appropriate for your practice. (See second government link, below.) Remember, in some cases, the analysis of the breach may require a forensic analysis, which is why consultation with an appropriate entity is recommended when creating a breach plan.

There are, however, some important general points to consider regarding potential breaches and contingencies. First, remember that Independent Contractors and Agents are considered differently (see above). Second, if there is a “low probability of compromise” after a risk review of the breach, the breach may not be reportable. Factors to be considered during the risk review for “probability” include:

President’s Corner continued

The creation of HIPAA compliant practice can be a daunting task. General guidelines tend to target

the largest and most complex practices.

6 • Winter 2013 / Vol. 64, No. 3

The type and extent of PHI involved; the sensitivity of the information involved; the likelihood that the informa-tion can be linked to specific persons; the nature of the person(s) who received the information and whether they have HIPAA obligations; whether information that may have been exposed to release was, in fact, actually re-leased; the extent to which the risk has been mitigated by, for example, an action such as obtaining a BAA from the person(s) to which the information was exposed. Finally, backup of information and alternative ways to access it is a usual part of any practice, and is very straightforward in the digital age. Just make sure the backup service can give you a BAA!

The last two steps, Documentation and Prepara-tion for Audit, are inter-related and speak to the issue of the necessity of creating an accessible documented record of the compliance development process, the plan for periodic review of compliance, and an accessible, audit-able, record of the development of the process and the resulting documentation as preparation for OCR (Office of Civil Rights) audit. Documentation of compliance activities must not only be updated periodically, but must be main-tained for six years.

SummaryThe creation of HIPAA compliant practice can be a

daunting task. General guidelines tend to target the larg-est and most complex practices. However, close reading of the guidelines reveals that, for the smaller practice,

most of the work is fairly straightforward and that many of the goals are easy to achieve with some guidance from a knowledgeable source. For example, a small practice can create policies and procedures using publicly avail-able sources, practice support staff can review and sign BAA compliance documents, and vendors can be asked to provide HIPAA BAA documents. The hardest part in these cases is the close look one must give to one’s existing practice processes and procedures, and the evaluation of risk and a consideration of ways to reduce it. I hope this short article will encourage the reader to begin the process if they have not already done so.

General ResourcesGOV: http://www.healthit.gov/sites/default/files/pdf/pri-vacy/privacy-and-security-guide-chapter-2.pdf andhttp://www.hhs.gov/ocr/privacy/hipaa/understanding/cov-eredentities/smallbusiness.html

Private Company: http://www.hipaasurvivalguide.com/hipaa-regulations/hipaa-regulations.php AMA: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act.page APA-PD: http://www.apapracticecentral.org/business/hipaa/hippa-privacy-primer.pdf

Feature

A few Tips for Navigating MedicareBy W. Steven Saunders, PsyD, Member Editor

If you are a Medicare provider you have already found that navigating the system can be a daunting task. Working as a provider and even surviving an audit, I’ve learned a few things and hope to pass some of these helpful hints on to my colleagues. This article is not intended to be a guide to becoming a Medicare provider or for billing insurance. Rather, this article will focus a few main areas that may be of help to psycholo-gists who are current Medicare providers based upon my own research and experience. You are encouraged to research the laws and rules governing Medicare participation on your own.

First, get to know the Current Procedural Terminology or CPT codes. These are neces-sary for billing. Your billing agent can help you understand the codes that you can and cannot bill. You can do billing yourself if you

have a small practice and the Florida Medicare administrator, First Coast Options, report that they can help you with this process. I use a billing company so I can’t speak about that process personally. APA has developed a helpful guide to CPT codes found here: http://www.apapracticecentral.org/reimbursement/billing/index.aspx

Another helpful guide can be found at Psych.org, http://www.ntst.com/compliance/CPT-Code-Changes-For-2013.pdf.

Medicare.gov has a helpful page for questions and answers for physicians that include helpful information for psychologists: http://www.cms.gov/Center/Provider-Type/Physician-Center.html?redirect=/center/physi-cian.asp

The next important thing for you to familiarize yourself with is the Local coverage

(continued on page 10)

8 • Winter 2013 / Vol. 64, No. 3

determination (LCD) / national coverage determination (NCD) policies. You can find these by using an internet search engine to search “Mental Health Services and First Coast Options” or go here http://medicare.fcso.com/Land-ing/223024.asp. LCD’s are state specific (hence they are local policies). Each state has its own Medicare adminis-trator that actually manages the program, sometimes (as with Florida) those are private companies and other States have separate state government agencies that adminis-ter the program. LCD’s govern the manner in which you should see your patients, how your notes should be writ-ten, what must be included in the note and what qualifies a patient to be seen. According to Medicare.gov, Clinical Psychologists may see Medicare enrollees but

”The following coverage criteria apply: He or she (the Psychologist) is legally authorized to furnish the services in the State where they are performed; Services are not otherwise precluded due to a statu-tory exclusion, and the services must be reasonable and necessary; Upon the patient’s consent, he or she must attempt to consult with the patient’s attending or primary care physician about the services being furnished and: Document the date of consent or declination of consent to consultations and the date of consultations in the patient’s medical record; or If consultations do not succeed, document the date and manner of notification to the physician in the patient’s medical record (does not ap-ply if the physician referred the patient to the CP); He or she may perform the gen-eral supervision assigned to diagnostic psychological and neuropsychological tests; and Services and supplies may be furnished incident to his or her professional services, with the exception of services fur-nished to hospital patients…” (See: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/down-loads/Mental_Health_Ser-vices_ICN903195.pdf).

If you are an “Independent Practicing Psychologist” (i.e. in private practice) and Practice inde-pendently of an institution, agency, or physician’s office and is licensed or certified to practice psychology in the State or jurisdiction where the services are performed”, then you can see Medicare enrollees as well. Further, Medicare.gov states, that

“The individuals treated are his or her own patients; When he or she practices in an office that is located in an institution: The office is confined to a separately-identified part of the facility that he or she uses solely as an office and cannot be construed as extending throughout the entire institution; and He or she con-ducts a private practice (services are furnished to pa-tients outside the institution as well as to institutional patients); He or she may perform diagnostic psycho-logical and neuropsychological tests when a physician orders such tests; and He or she has the right to bill directly and collect and retain the fee for his or her services.” (See: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProd-ucts/downloads/Mental_Health_Services_ICN903195.pdf).To avoid an audit, follow the LCD’s and other Medi-

care Policies. Read carefully the LCD’s on documentation. First Coast Options offers educational conferences and seminars that are available to the general public and to practitioners. I’ve lobbied them for a couple of years to provide a “Mental health Practitioners” educational events only and they have responded that they have “taken it under advisement.” They have spoken at FPA events in the past with mixed reviews. Medicare allows you to audit yourself and pull reports that show how you compare with your peers (other psychologists billing Medicare). These

reports are called, The Compara-tive Billing Report (CBR) for Part B providers and it furnishes a detailed examination of the comparative data that Medicare considers when determining how the provider’s billing patterns contrast with those of other providers of the same specialty. That report is very im-portant and I can’t understate why you should pull one for yourself 1 or 2 times a year. You can do that by creating a profile on First Coast’s website (mentioned previously in this article) and logging into your account. All your data is available for your review. Audits are primar-ily based on computer algorithms that Medicare uses to find unusual billing patterns. When an unusual pattern arises, it is sent to a hu-man auditor that then investigates further. When you pull your CBR, review it carefully. Ensure you aren’t seeing the same patient for more sessions than are “reason-able and necessary” (take your best guess on what that means but a conservative approach will likely

Tips for Navigating Medicare continued

In short remember these final tips when dealing with Medicare:

1) Familiarize yourself with the CPT’s you can bill for your patients and follow the LCD and NCD policies.

2) Log-on to First Coast Options website (http://medicare.fcso.com) and find out when their next educational event will be located and the date. Consider attending. You can earn CEU’s.

3) If you are audited, consult an attorney (start with FPA’s attorney service) but use common sense. Shop around and find someone both experienced in working with Medicare and whom you can afford. If they ask for a large ($5000 or more) retainer, ask why and ask to pay “as you go.” You may not need it.

4) Realize that the auditor is a human too and is there to help you. First Coast Services considers providers their clients and they want to give you good service. Patience and courtesy will go a long way in navigating a complex bureaucracy.

10 • Winter 2013 / Vol. 64, No. 3

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be prudent). In addition, make sure you aren’t seeing multiple patients too often for the same CPT code. For ex-ample, I bill neuropsychological testing (CPT code 96118) above what the average psychologist bills. However, when Medicare contacted me regarding this, I directed them to the fact that I work 1-2 days a week at an acute rehabili-tation hospital where I primarily see head injury, stroke, and other brain disordered patients. They were satisfied with that reason and no further action was taken.

If you are contacted by Medicare through First Coast Options requesting documentation for services, you can expect to likely get a letter that may concern and confuse you. Your initial reaction may be to run to an attorney, write a check and hope it all turns out ok. I certainly will not discourage you from seeking professional advice but I do encourage you to first use FPA’s attorney service first. It’s a service of your membership and they can help ease your mind. Many attorney’s that specialize in represent- ing healthcare professionals in audits with Medicare will likely charge you a retainer. That retainer may be very expensive. You should take a breath and realize that Medicare will give you 30-45 days to put your documenta-tion together. You can even request an extension that will almost always be granted. Secondly, you are required to either submit copies of your original notes OR a summary of the contact with that patient (see: http://medicare.fcso.com/Fee_lookup/LCDDisplay.asp?id=L33128). Medicare does not provide examples of notes that meet their crite-ria. They only provide text descriptions of what your notes should look like. So carefully review your notes to ensure they meet the criteria stated.

In 2011, I was contacted by First Coast Options re-questing documentation for a few psychotherapy sessions I did for some patients. The overall audit range was about 9 months. I did have what I considered excellent docu-mentation, including physician referrals, and original notes for each date of service. However, when I sent them in, most were disallowed by the auditor as being “inadequate documentation.” I did seek an attorney’s advice. Ulti-mately, the attorney I hired proved completely unhelpful to answering my questions and they received no answers from Medicare to their inquiries as to why my documenta-

If you are contacted by Medicare through First Coast Options requesting documen-

tation for services, you can expect to likely get a letter that may concern and

confuse you. Your initial reaction may be to run to an attorney, write a check and

hope it all turns out ok.

Florida Psychologist • 11

From the Director oF proFessionaL aFFairs

I believe there is one overarching reason that it is important that we belong to FPA, and that we encourage all other psycholo-gists to also belong. And that is that there is no other body or organization that speaks for our professional goals and interests. In the interests of self-disclosure, serving as FPA’s Director of Professional Affairs means that I receive a contracted amount to provide the services I do, so it may seem self-serving to urge membership. But, I have been involved at this point with the organization for about thirty years. On a volunteer basis I’ve been in various positions in my local chapter. On a volunteer basis on the state level, I’ve been

Insurance Chair, LAPPB representative and chair, and President over the years. The years of vol-unteer work vastly out-weigh the paid work and I anticipate continuing in the future. And one thing I have learned is that we

are small potatoes in a very large field. As part of the health care system, we are a part of the smaller mental health system, and then we have our own professional goals and inter-ests. Many of these coincide with the goals and interests of other professional groups. But there are also many that are specific to psychologists, and some that are specific only to psychologists in Florida.

The American Psychological Association is the professional association that advocates on national issues for us. You may not always agree with their positions (I certainly don’t), but they are the only national organization that actively works on all the issues that af-fect practicing psychologists although other specialty groups have emerged that do similar advocacy. The Practice Organization within APA is focused solely on practice issues and it

By Carolyn Stimel, PhD, ABPP

Why Membership in FPA is Important

is important that we support it. Back to FPA. We are always working to

identify barriers to full practice and to im-prove the profession. This means monitor-ing what the legislature is doing, what state agencies are doing, and what the regula-tory boards are doing. It means advocating for you when proposals will affect how you work. We don’t win all the time. We are often fighting competing interests, some of which are quite well funded and have more power than we do. But without members and their support, we can do none of this. Without the work of all of our volunteers, the Central Of-fice could not do much of anything. All of our officers, our committee chairs, our board of directors and many more are fellow psycholo-gists who are giving their time and energy to work to improve the lot of psychologists. Those who are not members ride on the coattails of those who do pay dues and work for the organization.

Over the years I’ve had the opportunity to meet so many colleagues who work in various areas of psychology, and who strug-gle with the same issues of how to balance ethical and legal demands with being the best they can be for their patients. We all try to do the right thing and it is always heartening to see us work through difficult issues. To return to the self-serving part, I have found that my contacts have enriched my practice through referrals and additional contacts. I have al-ways worried about my colleagues who prac-tice in self-imposed isolation as we all need to have our reality tested occasionally!

So, what is my point? I value my profes-sion and my work in it such that I am willing to work to maintain and improve it. I imagine most of you feel the same. So, volunteer your time and urge non-member psychologists to join so that we can be more.

...I have found that my

contacts have enriched my

practice through referrals and

additional contacts.

12 • Winter 2013 / Vol. 64, No. 3

APA Council Representative ReportBy David Kazar, PhD, ABPP

Welcome to my inaugural report as FPA’s represen-tative to the APA Council of Representatives and, of course, welcome to the New Year. As my first report in a position I have occupied for six days you may well suspect I have accomplished little on your behalf and in fact I know little about what is going on so this should be a short report.

I want to thank all of you who elected me. I know that this is a great honor and that it will be difficult to fol-low the accomplishments of my many predecessors most recently Drs. Frumkin and Woody before him. I hope that I can serve APA and FPA as well as they did.

As for what I do know and can report on. My first meeting will be soon, in late February in the temperate climate of Washington, D.C. I hope that I survive the snow since it has been years since I have seen snow except in pictures.

Assuming I am not lost in a blizzard the most immedi-ate and largest issue before the Council is a reorganization. As I understand it APA is moving toward a reorganization of its system of governance. The move will be to have the Executive Board more responsible for the day to day responsibility of decision making and shift policy deci-sions primarily to the Council. The size of Council will be decreased slightly mostly as a cost savings goal. The size change will be achieved by reducing the total number of council members resulting in the each council member representing more members. This effectively will reduce the size representation of some constituents. For example, Florida has been on the cusp of having two representatives for the last few years but now the goal will be much harder to achieve. This will certainly effect the relative strength of the various interests within the Council. This decision is largely determined and Council will now be working on designing the implementation of the goal. Of course the larger issue is what is described as a power shift with the Executive Board having more influence and the Council less. The main argument in support of the change is that the world changes faster now than it did 5 years ago let alone 20 years ago. So the Council that is famous for tak-ing four years to change a rule or interpret a rule in ethics cannot meet the tempo of the daily demands for decisions. I am told this will continue to be a bloody battle (figura-tively I think).

As I understand it APA is moving

toward a reorganization of its system of

governance. The move will be to have

the Executive Board more responsible for

the day to day responsibility of decision

making and shift policy decisions primarily

to the Council.

A second pressing issue is that of the Principles for In-tegration of Behavioral Health with Patient Centered Medi-cal Homes. Not wishing to diminish the significance of the implementation the work of agreeing on how much of the proposal is accepted does not sound real exciting. Bear in mind that this document comes from health care planners and administrators and is weighted toward most (both cost and volume) services, which are medical services. At this point it is unclear to me how much influence Council can have over the document.

That is the lay of the land as far as I can see from the outside peeking in. I suspect that in 2 months I may have much more detail and understanding although the content of the report may be largely unchanged.

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Florida Psychologist • 13

PAC ContributorsThank you to all current members of the Florida Political Action Committee (PAC) that have given so generously! Through these monetary contributions, FPA has been able to support candidates who show a commitment to enhancing the mental health of Florida’s citizens. For more information about PAC, please contact Connie Galietti at connie@flapsych.com.Thank you PAC members!

Platinum Club ($1,000)

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Capital Club ($250)

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Florida 100 ($100)

Tom Bonner, PhDLarry C. Kubiak, PhD

Sylvia F. Carra, PhDDeborah O. Day, PsyDSharon F. Buchalter, PhDDebra A. Goldsmith-Peters, PhDKristi Sands Van Sickle, PsyDSandra S. Watson, PhD

Kathrin S. Brantley, PhDMarissa Marie Brattole, PhDAndrew P. Hicks, PhDWilliam Steven Saunders, PsyDJane Zarzecki, PhD

Deborah C. Silver, PsyDZoe Proctor-Weber, PsyD, PhDCheri G. Surloff, PhD, PsyDMark A. Masters, PhDEleanor Nelson-Wernick, PhDGary X. Lancelotta, PhDRobert L. Wernick, PhDCharles E. Folkers, PhDDavid A. Coe, PhDElizabeth H. Campbell, PhD

Diane R. Abdo, PsyDJudith Abramson, PhDRussell R. Addeo, PhD, ABPPWilliam D. Anton, PhDRobert D. Assael, PhDBeverly M. Atkeson, PhDWilliam W. Austin, PsyDEdmund S. Bartlett, PhD

William M. Beecham, PhDAdele Besner, PsyDHilda F. Besner, PhDMyron Bilak, PhDDeborah R. Bloome, PsyDSerena L. Bloomfield, EdDStephen I. Bloomfield, EdDLori P. Blum, PhDJames R. Boone PhD, ABPPRussell Bourne Jr., PhDArthur H. Brand, PhDAlan L. Braunstein, PhDSamantha E. Carella, PsyD, ABPP-CCDebra Kaye Carter, PhDLauren K. Cohn, PhDMyles L. Cooley, PhD, ABPPMaureen, Corbett, PhDAndrea S. Corn, PsyDChristopher Cortman, PsyDJoseph E. Crum, PhDSusan A. Danahy, PhDBrent David Decker, PhDRose M. DeMoor-Peal, PhDAndrea G. Deratany, PsyDRoxane H. Dinkin, PhDRalph J. Dolente, PsyDMary S. Driscoll, PhDJohn F. Duffy Jr., PhDTashawna K. Duncan, PhDDavid P. Dupere, PsyDMark S. Ellinger, PsyDRon M. Ellis, PsyDNorman K. Ellman, PhD, ABPPMichael G. Epstein, PhDCamille T. Fine, PhDDavid J. Fleischmann, PhDFranklin Foote, PhDPaul S. Foster, PsyDBlanche V. Freund, PhDJoan G. Gaines, PhDPurvi Gandhi, PsyDLazaro, Garcia, PhDMaria Garcia-Larrieu, PsyDJeffrey M. George, PsyDMiles E. Glazer, PsyDBarbara L. Goldman, PhDHector P. Gonzalez, PhDKetty Patino Gonzalez, PhDDarah, Granger, PsyDJoshua M. Gross, PhD, ABPPKaren A. Hagerott, PhD

Christina Marie Hansen, PsyDLawrence J. Harmon, PhDAlan J. Harris, PhDGina M. Harris, PhD, ABPNTracy L. Hartig, PsyDNancy M. Haynes, PhDMichael E. Hendrickson, PhDCibeles Hernandez, PhDJanet, Hibel, PhD, ABPPMurren S. Hill, PsyDRichard A. Hoffman, PhDGlee R. Hollander, PhDMatthew Hollimon, PhDJudith E. Horowitz, PhDJennifer Kristen Howell, PsyDJanet K. Humphreys, PhDDeborah, Huntley, PhDAlan Y. Ickowitz, PsyDPhyllis K. Jensen, PsyDSuzanne B. Johnson, PhD, ABPPStephen Jordan, PhDSheldon J. Kaplan, PhDDavid B. Kazar, PhDSuzanne L. Keeley, PhDBarbara E. Kelly, PhDAna Kelton-Brand, PhDTimothy Usher Ketterson Jr., PhDMichael L. Kieffer, PhDGrant A. Killian, PhDAli H. Kizilbash, PhD, ABPP-CNGary J. Kreisberg, PhDWilliam G. Kremper, PhDDamon LaBarbera, PhDLawrence J. Levy, PsyDHarold R. Linde, PsyDRobert P. Ludwig, PsyDThelma Ferrell Lynch, PhDJoan T. Magill, PsyDPriscilla V. Marotta, PhDScott A. Mathias, PsyD, ABN, ABPP-CLJudith S. McCleary, PhDAdam McCracken, PhDMary Ann McGrath, PsyDDiane A. McKay, PsyDElizabeth A. McMahon, PhDRegina, Mendoza, PsyDCatherine R. Michas, PhDTanya J. Mickler, PhDMelodie K. Moorehead, PhD, ABPPKaren L. Moorhead, PhD, ABPPTracey Morse, PhD

14 • Winter 2013 / Vol. 64, No. 3

William D. A. Musick, PhDRichard E. Nay, PhDGeorgann T. Norton, PsyDBecky J. Olson, PhDJacqueline Z. Orlando, PhDArthur S. Patterson, PhDSharon Jean Peachey Marshall, PsyDJeanne Peterson, PsyDLinda Petrilla, PhDCecilia A. Pinkerton-Yocum, PhDRobert J. Porter, PhDGregory A. Prichard, PsyDStephen Anthony Ragusea, PsyD, ABPPCatherine Bolling Ramey, PsyDSonya D. Rapee, PsyDElisabeth, Reading, PhDJaneane Adele Reagan, PhDJames R. Reed, PhDSusan C. Reeder, PhDMichelle Renee Reitman, PsyDCynthia L. Reynolds, PsyDWayne C. Richard, PhDAlice E. Richman, PsyDJill L. Ricke, PhDWilliam E. Riebsame, PhD, ABPPSherry V. Risch, PhDAna A. Rivas-Vazquez, PhD, ABPPDavid J. Romano, PhDSally J. Rowley, PsyDAndrew J. Ruffett, PhDPatricia Jo Ryan, PhDKaren Bailis Saef, PhDWilliam R. Samek, PhDJill D. Sanders, PhDAnita K. Sanz, PhDWendy Satin Rapaport, PsyDAlan L. Saunders, PhDPaul G. Schauble, PhDStacey Beth Scheckner, PhDStephen P. Schengber, PsyDSusan, Scholz-Rubin, PhDLisa M. Schulman, PhDMartha, Schwartz, PsyDMarnie G. Shanbhag, PhDDavid L. Shapiro, PhDHarold, Shinitzky, PsyDCeleste Nobles Shuler, PhDVictoria Jean Sikorski, PsyDPamela J. Silver, PsyDRobert B. Silver, PhD, ABPP, ABPNCynthia Silverman, PsyDRachael Elissa Silverman, PsyDWade Silverman, PhD, ABPPBarbara J. Simmonds, PhDJudith A. Siskind, PhDMichelle Janice Slapion-Foote, PhDMichael T. Smith, PhD

Jan M. Snyder, PhDMichael B. Spellman, PhDCarolyn A. Stimel, PhD, ABPPFelix J. Subervi III, PhDMichael L. Tallman, PsyDAndrew J. Theiss, PhDJacqueline C. Valdes, PhDAshley Vigil-Otero, PsyDNancy M. Vrechek, PhDLenore E. Walker, EdD, ABPPMarcy Weinberg, PhDArlene K. Weir, EdDAnastasia E. Wells, PhDAnne M. Wells, PhDLynne G. Westberry, PhDEllen Williams, PhDSusan M. Williams, PhDVirgil T. Wittmer, PhDGary L. Wood, PsyDRobert H. Woody, PhD, JD, ScD, ABPPTerilee Wunderman, PhDKarim Ziad Yamout, PsyDRose Zayco, PsyD

Florida 100 ($100)

Patrons

Michell Lyn Arnow, PhDShatha Atiya, PsyDAlexandra Maria Branagan, BSWilliam Tyler Branagan, MHCDavid James Chesire, PhDMartin D. Cohen, PhDRobert E. Cohen, PsyD, ABPPRobyn Jones Cohen, PhDCathleen Teresa Connolly, PhDJoanne H. Cornell-Ohlman, PhDGail F. Davis, PhDGregory S. DeClue, PhD, ABPPSteven P. Dingfelder, PhDCharles W. English, PhDNasrin Erfanian, PhDKatherine Falwell, PhDJennifer J. Ferrell-Hanington, PsyD

Daniel B. Goldman, PhDSanford L. Graves, PsyDJohn T. Grbac, PsyDSuzanne E. Green, PhDMartin J. Greengrass, PhDJulie F. Harper, PsyDMelissa Ann Harrison, PsyDMarcia S. Hausman, PhDJanet L. Helfand, PhDValerie Masten Hoese, PhDAmy L Hoffman, PsyDBruce David Houtler, PhDAlan D. Keck, PsyDKimberly Kirkpatrick Justice, PhDDonna La Flamme, PhDJudith A. La Marche, PhDB. Linnea Lindholm, PhDNicole A. Maggio, PsyDDonald A. McMurray, PhDJennifer H. Mendoza, PhDElizabeth Ann Michas, PhDStefanie Mihalopoulos, PhDDeborah S. Mintzer, PsyDGail W. Mock, PsyDDavid M. Parlapiano, PsyDD. Renee Pinto, PhDSusan M. Recinella, PsyDNilsa Rivera, PhDRobert Stewart Rosen, PhDDonald L. Sanz, PhDJill Scarpellini Huber, PhDAndrew Scherbarth, PhDLynne Schettino, PhDKarmon Sears, PsyDNancy J. Simons, PhDEldra P. Solomon, PhDRobert D. Stainback, PhDHyman Sternthal, PhDRobyn Tapley, PsyDJohn R. Thibodeau, PhD, ABPPKenneth A. Visser, PhDJanice W. Walton, PhDPatricia Marie Watts, PhD

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Florida Psychologist • 15

Sustaining Members

A special thanks to our sustaining members for their continued support! To become a sustaining member, send in the form below. Thank you for your generosity!

Judith Abramson, PhDSue E. Antell, PhD, ABPP, ABN

William M. Beecham, PhDDeborah C. Beidel, PhD

Myron Bilak, PhDRaquel Bild-Libbin, PhD

Serena L. Bloomfield, EdDStephen I. Bloomfield, EdD

Tom Bonner, PhDErnest J. Bordini, PhDPhilip C. Boswell, PhD

Russell Bourne Jr., PhDArthur H. Brand, PhD

Kathrin S. Brantley, PhDRhonda S. Cameron, PhD

Samantha E. Carella, PsyD, ABPP-CCSylvia F. Carra, PhD

Joan Alice Carrillo, PhDKimberly Church, PsyD

Priscilla Wilson Clancy, PhDLaura A. Cohen, PhD

Myles L. Cooley, PhD, ABPPJoseph E. Crum, PhD

Amy E. Danser, PhD, MBARoxane H. Dinkin, PhD

Patricia Donly, PsyDTashawna K. Duncan, PhD

Ron M. Ellis, PsyDMichael G. Epstein, PhDKatherine Falwell, PhD

Sheila C. Furr, PhD, ABPNMiles E. Glazer, PsyD

Barbara L. Goldman, PhDHector P. Gonzalez, PhD

Joshua M. Gross, PhD, ABPPTaryl A. Holbrook, PhDMatthew Hollimon, PhD

Jane Janer, PsyDSheila Katt-Beck, PhD

Suzanne L. Keeley, PhDAna Kelton-Brand, PhD

Robert J. Kennerley, PhDTimothy Usher Ketterson Jr., PhD

Larry C. Kubiak, PhDPurnima Kumar, PhD

Yolanda Caridad Leon, PsyDHarold R. Linde, PsyD

Robert P. Ludwig, PsyDThelma Ferrell Lynch, PhD

Joan T. Magill, PsyDPriscilla V. Marotta, PhDJudith B. Marquit, PsyD

Kimberly M. McCabe, PhDValerie R. McClain, PsyD

Jennifer H. Mendoza, PhDAnn Monis, PsyD

Melodie K. Moorehead, PhD, ABPPGeorgann T. Norton, PsyD

Karen C. Parker, PhDDavid M. Parlapiano, PsyD

David S. Peters, PhD, ABPPJames R. Reed, PhD

Susan C. Reeder, PhDMichelle Renee Reitman, PsyD

Nilsa Rivera, PhDChris Lucia Rothman, PsyD

Patricia Jo Ryan, PhDKaren Bailis Saef, PhD

Wendy Satin Rapaport, PsyDKevin D. Scholz, PsyD

Angela M. Segal-Glazer, PhDDeborah C. Silver, PsyD

Michelle Janice Slapion-Foote, PhDMichael T. Smith, PhD

Molly M. Snell-Crider, PhDCarolyn A. Stimel, PhD, ABPP

Felix J. Subervi III, PhDCheri G. Surloff, PhD, PsyD

Samuel S. Thomas, PhDCarmen I. Tozzo-Julian, PhD

Gary S. Traub, PhDSusan D. Trutt, PhD

Derek G. Turesky, PhDJacqueline C. Valdes, PhD

Nancy M. Vrechek, PhDMarcy Weinberg, PhD

Anastasia E. Wells, PhDKristina Winchell, PhDDominic Zaccheo, PhD

Richard Bruce Zonderman, PhD

16 • Winter 2013 / Vol. 64, No. 3

Transitions are happening at FPA At the time of this publication, I will be President after

a year of service as FPA’s President-Elect. The year was productive and we accomplished many things. One of my President-Elect duties was to chair the programming committee. After years of dormancy, we revived this committee’s role to help FPA central office, divisions and chapters plan their events. The education com-mittee, under Dr. Bob Woody, ensures that all programs adhere to the strict standards required of the American Psy-chological Association. The program-ming committee does not concern itself with the CE component; this body helps schedule events, suggest topics and find speakers. Chair-ing this committee was a great experience and we held a very successful convention in July of 2013.

Lori Butts is taking over as chair in 2014 and we are looking forward to another great annual convention. We put together a program that meets the expressed needs of our membership: training and continued education that is relevant to our practices; networking; mentoring; social-izing. Oh, of course the setting is awesome. We will be holding our convention in Bonita Springs at the Coconut Point Hyatt from Thursday, July 17 through Sunday, July 20.

We are starting on Thursday with a pre-conference workshop on practice development (separate registration),

followed by our convention kick-off din-ner on Thursday night. On Friday, our Board of Directors will meet and develop a strategic plan for FPA. They need your input before that meeting.

We have added panels to our for-mat; the divisions and the ECP commit-

tee will be hosting a panel for early career psychologists and Sunday breakfast will be a networking experience for ECPs and students. Of course, some mid and late career folks will be around to offer sage advice and wisdom. We also plan to repeat our brown bag networking lunch; this was very successful last year.

In addition to our well attended and fun member re-ception, we have added a golf tournament. Michael Smith will be coordinating that event.

We are hoping there is something for everyone. Practice relevant workshops; panel discussions, lots of networking time; social time; a beautiful venue; and fel-lowship. Be sure to include FPA 2014 Summer Convention in your summer plans.

By Steve Bloomfield, EdD

Summer ConventionMark Your Calendars!

Florida Psychologist • 17

By Jessica Garcia, PhDPediatric Psychology Associates

As specialists in child development and behavior, psychologists evaluating and treating children and adolescents are often a critical part of multi-disciplinary teams. However, when we work outside of a medical group or hospital setting, such as in a private practice, it becomes more chal-lenging to collaborate across disciplines given the difficulty of coordinating communication. However, because working with professionals across disciplines is beneficial for helping to coordinate care for our patients, it is critical that we do not overlook the importance of de-

Collaborating With Providers Across Disciplines in a Child and Family Practice

veloping collaborative treatment plans when appropriate. Developing the most effective plan of treatment for our patients may require a referral to treatment providers in other disci-plines, such as a learning specialists or speech and language therapist. Furthermore, when our colleagues in other disciplines view psy-chologists as providing complementary care for their patients, these relationships have a good potential for growth. Some benefits and suggestions for collaboration are provided below:

Learn about the expertise of other

18 • Winter 2013 / Vol. 64, No. 3

professionals. Like psychologists, profes-sionals in other disciplines often have their own areas of specialty. Learning about the treatment approaches of other profession-als allows us to make appropriate referrals for our patients. Furthermore, understanding how other professions conceptualize and treat a child’s challenges can provide us with a unique perspective and assist us in consider-ing evidence-based approaches to treatment we may not be familiar with. Connecting with other providers affords us the opportunity to ask questions about their areas of expertise and their approach to treatment.

Develop Collaborative Relationships. Talking to professionals in your community by phone or meeting for coffee provides an op-portunity to share information about your ar-eas of specialization and ask questions about their expertise. Although this requires us to allocate time for networking with profession-als in the community, these relationships are likely to help us expand our practice. Further-more, developing collaborative relationships with professionals in the community informs others regarding how our services can be a useful adjunct to help patient’s reach their treatment goals.

Obtain parental consent. Obtaining parental consent is critical to being able to de-velop a complementary plan of treatment with allied treatment providers. Explaining the purpose of communication and outlining what information will be communicated is helpful. Parents may be hesitant to consent if they are uncomfortable that information regarding a diagnosis or other sensitive information may be shared. However, when they understand the purpose of developing collaborative treat-ment goals, parents often want to ensure that providers are aligned and committed to providing complementary services.

Collaborate with Schools. Parents and teachers often view the challenges that a child is experiencing from different points of view given the different demands across the two settings. Furthermore, teachers may make dif-ferent attributions regarding a behavior than a parent based upon their experience and observations. Because children and adoles-cents spend such a significant part of the day in school, collaboration will help to maximize our student’s success. Although schools vary in their degree of openness to collaboration, initially discussing the expectations for work-

ing together and your desire for feedback from your patient’s teacher or counselor helps set the tone for developing a collaborative relationship. If you are making recommenda-tions that a teacher cannot implement, it is not going to be effec-tive. Briefly explaining your conceptualization of the child’s challenges and the rationale for your recommendations can help teachers more effectively support a student across situa-tions. Helping teachers to understand the underly-ing basis for our patient’s challenges and how they can help improve their student’s functioning in the classroom setting is invaluable.

Furthermore, connecting with a school counselor regarding additional resources that may be available through the school is very helpful. There may be services being offered at the school that would be beneficial ad-juncts to individual or family psychotherapy For example, a behavior therapist may be able to work directly with our patient’s teacher, there may be an ongoing social skills group, or there may be a therapy group for children whose parents have recently divorced. In or-der to most effectively help our patients reach their goals, communication between home and school allows us to develop complemen-tary treatment goals and prevents duplication of services.

Collaborate with other Disciplines. Although the possibilities for working with professionals across disciplines is extensive, a few suggestions are provided below:

• Connecting with a patient’s pediatrician/ primary care physician is helpful in order to develop a joint conceptualization for how a patient’s emotional and/or behav-ioral challenges interact with their physi-cal health.

• Pediatric neurologists, pediatric psychia-trists, and Developmental and Behavioral Pediatricians often refer to psychologists

Talking to professionals in

your community by phone or

meeting for coffee provides

an opprotunity to share

information about your areas of

specialization and ask questions

about their expertise.

contined on page 21

Florida Psychologist • 19

Professional Organizations for Need-Fulfillment

By Robert H. Woody, PhD, ScD, JD, ABPP (Clinical & Forensic)

psychoLegaL notebook

One’s self-concept influences strongly virtually all as-pects of the psychologist’s personal and profession-al life. The substance of the self-concept reflects the psychologist’s underlying unique need system, that is, the factors that provide a sense of gratification.

Self theory was formulated initially by Henry Alexander Murray [1893—1988] and Gordon Willard Allport [1897—1967]. Murray (1954, 1968) emphasized “hedonic payoffs . . . the level of pleasantness or unpleasantness aroused by an interaction” (VandenBos, 2007, p. 433). On the other hand, Allport (1961) believed that the self-concept was the result of unconscious needs, fostered by desires and feel-ings of tension. The affiliation need was fundamental to both theories: “To draw near and enjoyably cooperate or reciprocate with an allied other (an other who resembles the subject or who likes the subject)” (Hogan & Smither, 2008, p. 149).

The Affiliation NeedResearch in social psychology supports that affiliation

needs are predicated on social comparison theory (i.e., evaluations of self compared to others). Also, the person (e.g., psychologist) seeks and maintain relationships in which rewards exceed the costs. The cornerstone of join-ing a professional association embraces desire for social comparison and desire for social exchange (Franzoi, 2012). Said differently, a psychologist can gain fulfillment of his or her affiliation-related needs by involvement in a profes-sional association.

Given the confidentiality of clinical services and unrelenting boundaries of relationships with clients, the psychologist does not have a plethora of interactions with other psychologists, although relations with similar people can be highly rewarding. Said differently, clinical practice imposes a lonely role; that is, providing clinical services constitutes a “risky business.”

The Future Under the Affordable Care ActAt this particular point in time, psychology is facing

considerable ambiguity about its future under the Afford-able Care Act (i.e., “Obama Care”). Notwithstanding cer-tain support for mental health services (e.g., parity), the prospect of reduced fees and decision-making from third-party payment sources may impose considerable hardship on psychologists (Kennedy, 2013).

In general, a professional association is recognized as being a “learned society,” bringing its specialized knowl-edge into society as a whole. Although committed to the public interest, a professional organization, such as the Florida Psychological Association, is entrusted (by it nonprofit status) to influence, control, and oversee (within legal- and tax-related limits) the membership in a given profession.

For future conditions, monetary or otherwise, there is no assurance that psychology will have an influential “seat at the table.” To maximize positivism, psychologists must have a unified voice. For the individual psychologist, it is obvious that a lone voice will be less authoritative and persuasive than a collected chorus from a professional organization.

ReferencesAllport, G. W. (1961). Pattern and growth in personality.

New York: Holt, Rhinehart & Winston.Franzoi, S. L. (2012). Social psychology (6/e). Redding,

CA: BVT Publishing.Hogan, R., & Smither, R. (2008). Personality: Personality

theories and applications. Tulsa, OK: Hogan Press.Kennedy, K. (2013). Health law may not broaden access to

mental treatment. USA Today, December 29 (http://usat.ly/1cfTabU)

Maslow, A. H. (1954). Motivation and personality. New York: Harper & Row.

Maslow, A. (1968). Toward a psychology of being (2nd ed.). New York: Van Nostrand Reinhold.

VandenBos, G. R. (Ed.). (2007). APA dictionary of psychol-ogy. Washington, DC: American Psychological Association.

Robert H. Woody, PhD, ScD, JD, ABPP (Clinical & Forensic), and ABAP is Chair of the FPA Education and Conference Planning Committees. From 2002-2007, he served as the Florida Representative to the APA Council of Representa-tives (COR), and is presently a COR Representative for the APA Division of Psychologists in Independent Practice. He is the author of thirty-five books, the most recent being: Woody, R. H. (2013). Legal self-defense for mental health practitioners: Quality care and risk manage-ment strategies. New York: Springer Publishing.

20 • Winter 2013 / Vol. 64, No. 3

to provide comprehensive evaluations and treatment for children with neurodevelopmental disorders, emo-tional challenges, and behavioral difficulties. Providers that discuss the various evidence-based treatment options with families are going to be the most help-ful to collaborate with when you are recommending pharmacotherapy as an adjunct to psychotherapy.

• Collaborating with medical specialists, such as gas-troenterologists or endocrinologists, is critical when our patients have a medical condition. Children with medical conditions commonly struggle with behavioral management and emotional factors related to their medical conditions and medical treatment. Develop-ing a team approach to helping the patient and their family better manage the child’s medical condition can improve children’s treatment outcomes.

• Speech and Language therapists specializing in build-ing pragmatic and social language can help patients improve their communication, social understanding, and social problem solving skills.

• Occupational therapists can help families address children’s motor weaknesses and sensory challenges that often contribute to behavioral difficulties. Further-more, they can help children with disabilities build the skills necessary for independent functioning.

• Learning specialists and tutors can provide students with intervention for primary learning disorders or interventions tailored to learning or organizational challenges that may be secondary to neurodevelop-ment disorders, such as ADHD or ASD.

• Referring for group psychotherapy as an adjunct to individual therapy often provides children with the op-portunity to rehearse social skills as well as build their social understanding and social problem solving skills in a supportive environment.

• Behavior therapists can provide more intensive support for families that need regular assistance to implement a behavioral treatment plan in their home environment. This allows you to work with the family on complimentary treatment goals, such as building family relationships.

Overcome Barriers to Effective Commu-nication. Busy schedules are often a barrier to communicating with other treatment providers; therefore, the following recommendations may be helpful for simplifying this process:

• Aim to keep communications brief. Make note

of a few bullet points you would like to discuss

regarding your conceptualization of patient’s challeng-es, treatment goals, and/or a plan for follow-up. Make note of the questions you would like to ask ahead of time.

• Providers across disciplines are likely to have different viewpoints and may conceptualize a child’s challenges differently. Because we often see different components of the same problem it is important to remain respect-ful and jointly determine if you are working towards shared goals.

• Contact office staff or email the treating provider with times you are available in order to coordinate a time to talk by phone. Ask if it is possible to leave a mes-sage on confidential voicemail or send an email when following-up to prevent the need to schedule a specific time to speak.

• When a child is seeing multiple services providers it may be helpful to schedule a time for a brief phone conference on a monthly basis so that there is com-munication regarding treatment goals and progress across disciplines. This helps providers develop com-plimentary treatment plans rather than duplicating services.

In sum, although collaborating with providers across disciplines to developed shared goals presents its own set of challenges, often times this collaboration helps to maximize our patients’ progress. Further-more, developing collaborative relationships with providers in our communities fosters a greater understanding of how the services psycholo-gists provide can be a helpful adjunct to their patient’s treat-ment.

Collaborating with Providers continued

Florida Psychologist • 21

Florida Psychological Association State Affiliate of the American Psychological Association 408 Office Plaza Drive Tallahassee, FL 32301 www.flapsych.com • (850) 656-2222

2014 Psychologically Healthy Workplace Awards Program Nomination Form

The Florida Psychological Association (FPA) has established a program to honor and recognize the best companies and non-profit organizations in the State of Florida that reflect psychologically healthy policies, practices and environments for their people. This Psychologically Healthy Workplace Award (PHWA) program is designed to recognize organizations that make a commitment to programs and policies that foster employee health and well-being while enhancing their own organizational performances. In conjunction with the national program developed by the American Psychological Association (APA), this State of Florida program encourages all types of organizations to apply – small, medium and large, profit and non-profit, as well as government, military and educational organizations. Our 2014 period is now open for organizations to apply for this award! We accept applications and nominations for this meaningful and prestigious award! In fact, we would welcome your assistance in identifying those organizations that are special and unique in how they operate, how they manage their people, and how they impact the lives of those that work with them. Our PHWA Committee looks at these five key criteria in assessing organizations:

Employee Involvement Employee Growth and Development Employee Recognition Work-Life Balance Health and Safety

Since its start five years ago, the Florida Psychological Association PHWA program has selected three state winners: Tallahassee Memorial Hospital (Tallahassee, FL), Saint Leo University (St. Leo, FL), and Tykes & Teens (Palm City, FL). Tallahassee Memorial Hospital also went to on to be recognized at the national level by APA for their outstanding policies and practices. We are proud of all three of our PHWA recipients who demonstrate how organizations can focus on the welfare of their employees while conducting their business. If you know an organization that is special and a “cut above” the rest, encourage them to apply or fill out the nomination form for them. All nominated organizations will be contacted by the PHWA Committee to discuss the application process and the many benefits of applying. The application deadline for the 2014 PHWA award is April 30, 2014.

22 • Winter 2013 / Vol. 64, No. 3

2014 PHWA NOMINATION FORM Florida Psychological Association

I would like to nominate the following organization to be considered to receive the Psychologically Healthy Workplace Award (PHWA) that is sponsored by the Florida Psychological Association. I understand the PHWA Committee will follow up and talk with the organization about this award program. Organizations must complete the application process no later than April 30, 2014. Organization Information: Name: Address: Contact Person: Position: Phone Number: Email: Date of Nomination: Number of Employees: Person Making This Nomination Request: Name: Address: Phone Number: Email: Your relationship with the Organization: Reasons For Nomination: I am nominating this organization for the following reasons (check all that apply): ( ) This organization has a solid community reputation for treating employees fairly. ( ) This organization appears to have low employee turn-over and good morale. ( ) Current and past employees speak highly about this organization. ( ) This is one of those organizations that everyone wants to work for and takes pride in. ( ) This organization values and promotes employee safety and well-being. ( ) This organization is dedicated to and supports the community. ( ) There is a positive feeling for the organization, and the employees appear to be happy. ( ) To me, this place is a great place to work and is worthy of such an award. ( ) Other: ( ) Other: Thank you for nominating this organization for the PHWA program award that recognizes those organizations that promote psychologically healthy environments. Please send back this sheet via email, scan or fax to the number listed below. You will be notified when your nominated organization has been contacted. Also, feel free to contact the Chairman of the PHWA Committee for more information. James P. Atsaides, Ph.D., Chairman Psychologically Healthy Workplace Awards Committee, Florida Psychological Association Email: jpa@AtsaidesAssociates.com Phone: 410-913-4189 Fax: 941-388-0835

Florida Psychologist • 23

? ? What position has Dr. Carolyn Stimel not held during

her years of service to FPA? a. Director of Professional Affairs b. President of FPA c. Executive Director d. LAPPB Chair

2) “HIPAA” a. Stands for Health Insurance Portability and Accountability Act b. Is really HIPPA or Health Insurance Portability and

Privacy Act c. Is part of the policies enacted under USDA umbrella d. Is not an law but a policy recommendation

3) According to Jessica Garcia, what is a benefit to group psychotherapy?

a. Children can rehearse social skills b. Children are in a supportive environment c. Social problem solving skills are enhanced d. All of the above

4) True or False: Senator Schwartz and Representative Altman filed our insurance bill from last year:

a. True b. False

5) Under the Affordable Care Act, the role of psychology: a. has yet to be well-defined b. assures much higher income than in the past c. provides a powerful voice in determining policies

that are applicable to medical practitioners d. will not be advanced by a professional psychological organization (e.g., FPA)

6) Research in social psychology supports that affiliation needs are based on:

a. an inherent wish for dominance and hedonic payoffs b. a search for financial security c. social comparison theory d. investing in the nexus between government and

professionalism

7) Clinical practice of psychology: a. provides ample opportunities for socialization b. tends to impose a lonely role on the practitioner c. mandates being able to access an electronic

database to check the latest research relevant to the intervention objectives for each particular service user (client or patient)

d. allows the psychologist and service user (client or patient) to pursue mutual social-emotional need fulfillment in the treatment context

8) True or False: Electronic Security refers to all areas of communication and use of technology except email, fax, and phone.

a. True b. False

9) Medicare uses CPT codes which are a. current procedure terminology b. critical practice terms c. cold polar tangents d. crowd pleasing tutoring

10) A lawyer should be consulted when a. you are being arrested for fraud b. you receive a letter requesting documentation c. you have a question about the law d. you are being sued on a practice matter e. all of the above

CPE Quiz Winter 2013

Name:

Address: Date Completed:

City: State: Zip:

I confirm that I personally have completed this quiz.

Signature: License#:

Evaluation of Program (Please Circle)1. The content of articles was: (Excellent) 1 2 3 4 5 (Poor)2. The CPE Quiz covered the article content: (Excellent) 1 2 3 4 5 (Poor)3. The content of the articles was of sufficient psychological content: (Excellent) 1 2 3 4 5 (Poor)*Free Benefit for FPA Members Only. Non-member submissions accepted with membership application and dues. To receive free CPE credit, send completed quiz to: Free CPE, Attention: Danielle Humphrey 408 Office Plaza Drive, Tallahassee, FL 32301-2757 / Fax: 850-942-4586

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24 • Winter 2013 / Vol. 64, No. 3

By Liz Campbell, PhD, LAPPB Co-Chair

Although the legislative session does not begin until March 4, your association has been hard at work protecting and enhancing the practice of psychology in Florida. Monitoring and molding legislation and public policy is a big part of what FPA has to offer its members, and a service that benefits all of the psychologists of Florida.

Did you know that FPA reads over all of the legislation filed each year? Please thank Connie and Carolyn for this valuable service. Any bills that are of concern are then re-read by the LAPPB co-chairs and passed on to members of LAPPB who may have particular expertise in an area covered by the bill. Bills are then flagged for monitoring or for aggressive action by our paid lobbyists, Ashley and Carole of Capitol Strategies.

I am pleased to report that our insurance bill has once again been filed by our sponsors from last year, Senator Altman (SB 436) and Representative Schwartz (HB 450). This is the third year that we have pursued this bill, which seeks equitable treatment for psychologists with regard to the period of time that insurance companies can attempt to recoup payments made in error. The current

Florida Psychological Association408 Office Plaza Drive Tallahassee, FL 32301

Ph: (850) 656-2222 Fx: (850) 942-4586

www.flapsych.com

www.mentalhealthflorida.com

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Subscrive to our YouTube Channel: www.youtube.com/flapsych

Legislative Update 2014

law allows them to “look back” for 30 months for psycholo-gists, but only 12 months for other doctoral-level health care providers.

We have marked several other bills for close moni-toring this year. HB 211/SB 240 addresses sex change therapy and opens our practice act (Chapter 490). This will be of special importance to us, because any time the practice act is opened, there is an opportunity for others to make changes in the rules that govern our ability to prac-tice psychology. You can believe that we will be watching this one very closely! Some other bills that have already made our watch list include one regarding bullying (SB 548), a bill attempting to amend the Baker Act (HB 37), and a telemedicine bill (SB 70/HB 167).

LAPPB chapter delegates have already been busy meeting with legislators in the home districts—a great way to get our voice heard when the legislators are not as busy. Your chapter delegate would be pleased to have some help in this area, so please contact him or her to offer your assistance. Psychologists need to have a presence both in Tallahassee and nationally. So please respond when you receive an “action alert” or similar request for you to contact your elected officials. It really does make a difference!

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