APA Board of Trustees Approves Practice Guideline for Borderline Personality Disorder

APA’s Board of Trustees approved a practice guideline on “Treating Patients with Borderline Personality Disorder” during its meeting this past December in Washington, D.C.

The guideline, written by APA’s Guideline Writing Group on Borderline Personality Disorder and chaired by George Keepers, M.D., was reviewed and approved by the Assembly last November. Input on the guideline was included from the Council on Quality Care and other APA councils, as well as national and international professional and patient groups interested in the care of people with borderline personality disorder.

APA practice guidelines provide evidence-based recommendations for the assessment and treatment of people with psychiatric disorders and are intended to assist in clinical decision-making by presenting systematically developed patient care strategies in a standardized format. Borderline personality disorder is characterized in DSM-5-TR as being associated with a long-term pattern of instability of interpersonal relationships, unstable self-image, marked impulsivity, and/or affective instability that occurs across a broad range of personal and social situations. (Detailed information about the guideline will appear in a future issue.)

The approval of the practice guideline was one item on a packed agenda that included the selection (during executive session) of a new CEO and medical director to succeed outgoing CEO and Medical Director Saul Levin, M.D., M.P.A. The name of the individual will be announced after a contract has been finalized.

Also importantly, the Board received an update about PsychPRO, APA’s clinical registry, from APA Director of Research Nitin Gogtay, M.D. He said in order to continue to build and expand PsychPRO, the registry will use multiple technology vendors to address its specific functional requirements. Until now, PsychPRO has utilized a single vendor for all functions, but this has placed limits on its growth. The goal is for APA to eventually administer the registry in house.

The Board discussed and approved the 2024 budget proposed by the Finance and Budget Committee for APA and for the APA Foundation. APA Treasurer Richard Summers, M.D., said APA’s balance sheet is strong, with unrestricted net assets totaling $71.3 million as of October 2023, but revenue from meetings and book sales were down while expenses due to inflation were significantly up in 2023 and expected to continue into 2024. Trustees also voted to modify the APA budgeting process to allow for the Finance and Budget Committee to present a preliminary budget to the Board at its October meeting for its input on strategic initiatives and the final budget at its December meeting. At the end of 2023, a budget shortfall required a reduction in force of 21 APA staff positions, including 10 APA employees and 11 vacant positions. The 2024 budget, which went into effect on January 1, reflects this reduction in force.

Medicare Update

In his medical director’s report, APA CEO and Medical Director Saul Levin, M.D., M.P.A., noted that although payment rates under the 2024 Medicare Physician Fee Schedule are 1.25% less than the 2023 rates, the Centers for Medicare and Medicaid Services (CMS) included an increase in reimbursement for the psychotherapy standalone codes and psychotherapy with evaluation and management (E/M) service codes (see Psychiatric News, https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2023.12.12.43.) Initially, CMS had included a bump only for the standalone codes, but after discussions with CMS, APA was successful in securing the increase to include psychotherapy and E/M, Levin told the Board.

Also included in the 2024 fee schedule are telehealth provisions for which APA had advocated. These include reimbursement for outpatient telepsychiatry in the patient’s home at the same rate as in-person care; continuing virtual supervision of trainee physicians when the resident is delivering telehealth; the allowance of Medicare billing practitioners to report their practice location rather than the home address when providing services via telehealth from their homes; and telehealth services delivered by Federally Qualified Health Centers and Rural Health Centers without a prior in-person visit.

Other Actions

Trustees approved Arizona state Rep. Amish Shah as the 2024 recipient of APA’s Jacob K. Javits Public Service Award and approved the nomination of Sidney Zisook, M.D., for the Vestermark Psychiatry Educator Award.

Finally, the Board voted to approve the following new or revised position statements:

New Position Statements

• Position Statement on Contingency Management for the Treatment of Stimulant Use Disorder (2023)

• Position Statement on Harm Reduction (2023)

• Position Statement on Housing, Homelessness, and Mental Health (2023)

Revised Position Statements

• Position Statement on Abortion, Family Planning, Legislative Intrusion, and Reproductive Decisions

• Position Statement on Peer Support Services

• Position Statement on the Role of Psychiatrists in Reducing Physical Health Disparities in Patients With Mental Illness

• Position Statement on Firearms Access: Inquiries in Clinical Settings

• Position Statement on Police Interactions With Persons With Mental Illness

• Position Statement on Utilization of Measurement Based Care ■