Nature photographs in the consulting room of Jon Meyer, M.D., include
closeups and panoramic views, leaves, and landscapes.
An avid photographer whose work commands gallery shows, Meyer now serves as
president of the American Psychoanalytic Association (APsaA). In a recent talk
with Psychiatric News, the Baltimore psychiatrist and psychoanalyst
provided a "big picture" view of APsaA's current concerns and
At the grass-roots level, Meyer said, APsaA steps in to aid its members
when local health insurers threaten patient privacy, make unsupportable
intimations of fraud, or deny reimbursement for analytic treatment, alleging
lack of proof of medical necessity.
In Washington, D.C., for example, a model mental health law provides"
extraordinary" protections for patients' privacy, Meyer said.
Nonetheless, he continued, insurers have sought access to information on
diagnosis, prognosis, progress, treatment plans, and other patient material
that APsaA believed would breech its standards of
Jon Meyer, M.D., poses with a sampling of his nature photographs. His
work appears in gallery shows.
At meetings brokered by the district's insurance commissioner, Meyer said,
APsaA and insurance industry representatives are working to develop guidelines
specifying the types of information that can be released. APsaA's efforts, he
said, aim to keep the District of Columbia's model statute from being watered
down. The satisfactory resolution, he suggested, will hold implications for
state legislatures and other insurance carriers nationwide.
APsaA faced a similar challenge in New York, where Oxford Health Plans
Inc., a large insurer in that area, had deemed many psychotherapy patient
records inadequate and sought repayment of fees. That action threatened the
reputations and livelihood of APsaA's 650 New York members, Meyer said. APsaA
joined the New York State Psychiatric Association, APA, and other
organizations to confront Oxford.
To date, a preliminary agreement that both sides have reviewed defines
mutually acceptable standards for clinical record documentation by
psychiatrists, psychologists, and social workers who treat Oxford subscribers
for documentation review by Oxford. Oxford has agreed to require only
reporting of operations performed by the clinician—"interpreted,
clarified, consulted, prescribed," for example—and not those of
the patient, said Meyer. Oxford also has agreed to assume responsibility for
getting contemporaneous, informed consent from the patients if the insurer
needs more information.
On a broader scale, APsaA is among a group of 19 professional, consumer,
and advocacy organizations and individuals suing the U.S. Department of Health
and Human Services. The group contends that the Health Insurance Portability
and Accountability Act of 1996, as currently promulgated, gives away patients'
medical information without patients' authorization.
"Since privacy and confidentiality are absolutely central to the
psychoanalytic process and its effectiveness," Meyer said, "we
have to take a stand on this issue."
As a long-term goal, Meyer said, APsaA seeks to expand access to
psychodynamic treatment. "We don't want to lose a generation of people
who could benefit from this type of therapy to the vagaries of managed
care," he said. Community-based clinics, he suggested, could provide
affordable alternatives to managed care.
Meyer ran a community clinic in Milwaukee of the type he envisions
nationwide. It was affiliated with the Medical College of Wisconsin, where
Meyer served as director of the divisions of psychoanalysis and psychotherapy
and of mental health services for 20 years. He retired from those positions
earlier this year, before returning to Baltimore, his previous home.
Psychiatry residents staffed the Milwaukee clinic, and members of the
Wisconsin Psychoanalytic Society and Institute supervised their work. The
clinic used a sliding-fee scale that allowed people to pay out of pocket,
Meyer said, yet stay in the black. "Psychoanalysis does not break the
bank," he asserted. "For those who need it, it does what nothing
else will do."
Similar clinics now exist in Pittsburgh, Detroit, and New York City, Meyer
said. Five states, however, have no APsaA members.
Increasing the nation's pool of psychoanalysts thus represents another key
goal for APsaA, Meyer said. Because many physicians incur large debts for
their professional education, aspiring psychoanalysts often defer analytic
training. At the Washington, D.C., psychoanalytic institute, each training
analyst takes on at least one low-fee payer, he said, making earlier training
Young analysts are in short supply: more than 75 percent of APsaA's 3,600
members are aged 50 and older. By comparison, 53 percent of APA members fall
into that age group.
Educating the general public about the process of psychodynamic treatment
and its benefits, Meyer said, will help drive demand for it. "We have a
fabulous product," he said, but many people believe their mental
problems stem from a biochemical imbalance in the brain that medication can
fix, or that adjusting thinking in a formulaic manner can bring about
Such tactics may prove insufficient, he suggested, "yet we haven't
offered an alternative."
A private practitioner, Meyer also works part time in a Baltimore community
clinic affiliated with the Johns Hopkins University School of Medicine, where
he is an associate professor of psychiatry.
Many clinic patients spend hours riding a bus to get to their therapy
appointments, he said. Their diligence underscores the importance of
meaningful human interaction, he asserted, even in a context of medication
Meyer relishes the challenges of his two-year term in office. "The
president of APsaA does not sit back and think deep thoughts about
psychoanalysis," he said. "He or she has to be willing to talk to
insurance commissioners, medical directors of insurance agencies, bureaucratic
regulators, congressmen, and others, to go outside the consulting room to
speak up on behalf of the patient." ▪