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Association News
Patient Care, Education Top Assembly Agenda
Psychiatric News
Volume 47 Number 1 page 18-24

At its November meeting in Washington, D.C., the APA Assembly voted to urge the Association to advocate for better management of patient access to Drug Enforcement Administration–controlled medications, including those often used for psychiatric illness, pain control, and insomnia. Assembly members cited concerns that misuse of these drugs “is responsible for suicide [and] substance abuse” and is taxing emergency departments that have to treat the sequelae of such misuse.

Among actions the Assembly urged APA to take were “prohibiting policies that include mandatory minimum durations, and support for policies that allow for periodic dispensing of larger quantities of controlled medications at the direction of the physician, with no negative impact on patient copays.”

The action paper was addressing situations in which Schedule II, III, or IV drugs are written for a 90-day supply—a practice increasingly mandated by health plans and pharmacy-benefit managers. A more effective alternative, the Assembly paper noted, would be for the pharmacy to dispense 30-day supplies at 25- and 55-day intervals after the initial supply. Assembly members maintained that “to enhance clinical flexibility, a mechanism should be provided that permits the prescribing physician to stop further dispensing of the medication covered by the 90-day prescription” before the patient receives the second or third part of a 90-day supply.

On another patient-care initiative, the Assembly approved a paper emphasizing that patients who can’t get an appointment with a general or subspecialty psychiatrist through their managed care organization panel “within the timeline standards (urgent care within 48 hours of efforts to obtain an appointment, and nonurgent care within 15 days of efforts to obtain an appointment) would be able to contract with any willing provider for treatment at that psychiatrist’s usual and customary fee for the duration of the treatment episode.”

In addition, Assembly members voted to urge APA to develop a position statement saying that “access to health care is a right.” (APA position statements, which become official APA policy, require approval by the Board of Trustees.)

The Assembly also addressed some psychiatrists’ continuing concerns about imminent changes to the maintenance of certification process. Representatives backed a proposal noting that “two potentially competing systems are evolving nationally to formally monitor physician activities that demonstrate that they are maintaining their competence”—one the purview of the American Board of Medical Specialties and, in the case of psychiatry, the American Board of Psychiatry and Neurology; the other being developed by the Federation of State Medical Boards. The former is called maintenance of certification (MOC), and the latter maintenance of licensure (MOL).

To expand APA’s efforts in educating its members about what they will need to do in these two areas, the Assembly voted to establish a work group of its members to study the revised MOC system and the new MOL models to see how each would work, evaluate the “appropriateness and effectiveness” of each system in maintaining psychiatrists’ competence, and coordinate efforts with the Board of Trustees work group addressing these issues. The work group is to report back to the Assembly at its November 2012 meeting.

Another area in which changes are in store involves CPT codes commonly used by psychiatrists. To ensure that APA members are kept up to date on coding-related developments, the Assembly endorsed a proposal that APA “develop and publish documentation templates meeting minimum required elements of CPT codes most commonly used by psychiatrists.” While the template-development process is under way, the proposal also calls on APA to publicize coding templates already available in the fourth edition of Procedure Coding Handbook for Psychiatrists, available from American Psychiatric Publishing at <www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62374>.

Among other issues before it, the Assembly voted to

  • establish a “Member-in-Training Mentor and Advocate Award” to honor psychiatrists who act as mentors to resident members. A mentor in each of APA’s seven Areas would be eligible each year. Members in training would identify candidates for the award.

  • urge APA to allocate funds for more staff for the Committee on Electronic Health Records (EHRs) “so that they can produce a Web site section on implementation of EHRs for solo practitioners that is practical, easy to read, well organized, and updated regularly.”

  • address “unintended consequences of the National Resident Matching Program’s ‘All-in’ policy for the match.” The Assembly’s concern was that under the new policy, international medical graduates (IMGs), who constitute a significant segment of psychiatry residents, might lose scheduling flexibility and be “unable to obtain visas and state medical licenses in time to begin training on July 1 each year.” The new policy is to take effect this May. The Assembly proposal says that APA’s Council on Medical Education and Lifelong Learning and/or the Council on Minority Mental Health and Health Disparities should monitor the resident match once the change is implemented.

  • begin the process of amending the APA Bylaws to remove the five-year requirement before a member can apply for APA fellowship. The paper noted that in most medical specialty organizations, a fellow is someone who has joined the organization and has achieved board certification. It was hoped that this change would be an additional incentive for early career psychiatrists to join APA and remain a member throughout their careers.

  • urge APA to consolidate into one statement the 15 official position statements that it has adopted on homosexuality since 1973. The Assembly agreed that “public education and the well-being of lesbian, gay, and bisexual people would benefit from a comprehensive and cohesive statement” from APA on a variety of mental health issues related to homosexuality. The recommendation was that the consolidated statement include the following positions:

  • Sexual orientation is not chosen;

  • The cause of sexual orientation is not scientifically known and likely is multifactorial including biological and behavioral roots that may be different between different individuals and may vary over time;

  • Same-sex orientation is not pathological and does not represent a mental health liability or imply any impairment in judgment, stability, reliability, or general social or vocational capabilities;

  • There is no credible evidence that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective, does sexual orientation need to be changed;

  • APA decries individual, familial, societal, group, and governmental discrimination, criminalization, and stigmatization of individuals with same-sex attraction, particularly with regard to occupation, education, matters of health, financial issues, and housing;

  • APA recognizes that individual, familial, societal, group, and governmental discrimination, criminalization, and stigmatization of individuals with same-sex attraction may adversely affect the mental health of individuals with same-sex attraction, necessitating intervention by a mental health professional, for which, APA supports the provision of adequate resources to provide that intervention. inline-graphic-1.gif

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At the APA Assembly’s November 2011 meeting, the following candidates for Asssembly office were announced:

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For Speaker-elect

  • David Scasta, M.D., of New Jersey, the Assembly liaison from the Association of Gay and Lesbian Psychiatrists

  • Melinda Young, M.D., of California, the Assembly recorder

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For Recorder

  • Daniel Anzia, M.D, of Illinois, the Area 4 Assembly representative

  • Jenny Boyer, M.D., the Assembly’s Oklahoma representative

  • Eric Plakun, M.D., of Massachusetts, the Assembly liaison from the American Academy of Psychoanalysis and Dynamic Psychotherapy

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At the November Assembly meeting, Area 1 presented its Warren Williams Assembly Speaker’s Award to Roger Peele, M.D., in one of the rare instances in which an Area gives its annual award to someone who is not a resident of that Area. Peele is a representative of the Washington (D.C.) Psychiatric Society, which is in Area 3, and, as APA secretary, he is also a member of the Board of Trustees.

Each of APA’s seven geographic Areas can give the award annually “to recognize outstanding recent or current activity or contribution in the field of psychiatry and mental health.” Each Area has $1,000 for its annual award. The award does not have to be given to a psychiatrist or even to an individual—several awards over the years have honored mental health programs. It is named for the late Warren Williams, M.D., a former speaker of the Assembly.

Area 1 cited Peele for being “a staunch defender of the value of the Assembly and a strong advocate of maintaining and increasing its status and power within APA governance. Over many years of service in the Assembly, he has submitted many action papers that have striven to advance the field of psychiatry; to protect and enhance the care of patients, especially in the public sector; to add to the clinical understanding of patients with severe and persistent mental illness; and to increase the efficiency, democratic process, and efficacy of the Assembly and of wider APA governance.”

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