Assembly-APA
Fall Meeting - November, 2006
(Editor’s Note: Doctors Shirley Papilsky and Jeffrey Sverd served as our Representatives to the APA Assembly and Area II for the past 2 years. Following are their final reports. Thank you, Doctors Papilsky and Sverd, for working so diligently on behalf of GLIPS.)
Speaker Elect’s Forum
The Assembly opened with the Speaker Elect’s Forum. The topic was “Accessing Expertise: Improving Psychiatry-Primary Care Collaboration”. Nada Stotland, MD, the Chairperson of the Task Force to Review Psychiatric Needs in Underserved Areas, noted the importance that Psychiatry respond to the psychiatric needs of underserved areas, and described some beginning efforts. The underserved website will be part of the APA site, and will contain relevant topics. For example, J-1 Visa wavers will enable foreign medical graduates to work in these areas, but clearly this work might be appealing to others in our field. Indeed, model programs will be available for perusal on the site.
The “website” will include information and links on ways to address underserved areas and will be updated and changed periodically. Pages will consist of information regarding Federal manpower shortage areas, District Branch programs and surveys, telepsychiatry projects and links to American telemedicine, and model programs and projects. The latter will include information on APA private and Federal programs and projects. The project is to have a finished version by December 2006.
David Moltz, MD, presented a program involving psychiatric consultations to primary care practices in rural Maine. The project aimed at providing informal consultation by volunteer psychiatrists to primary care practices. He noted that paid, dedicated staff is essential, as is follow-up and marketing, in order to make the process known to the medical practitioners.
Arshad Husain, MD,, Chief of Child and Adolescent Psychiatry at the University of Missouri -Columbia, reported on a project to train primary care physicians and nurse practitioners in psychiatry, in order to meet the psychiatric needs in rural Missouri. He noted that there is an epidemic of severe and persistent mental illness, and a shortage of psychiatric beds and psychiatrists. In rural Missouri, primary care physicians must provide first line care. These practitioners reported that they see on average 36 patients per week and that about half of the patients are under 18 years. They are seeing the full array of disorders and prescribe all psychotropics and they refer 7 patients per month to a psychiatrist . Dr. Husain and his group were awarded a U.S. Department of Labor grant for the project. The project successfully educated the participants and Dr. Husain proposed setting up non-accredited fellowships in psychiatry and child psychiatry for pediatricians, family medicine physicians, general psychiatrists, and nurse practitioners.
Finally, Roberta Stillman, MD, described her experience in providing care in rural New Mexico, noting that these areas welcome psychiatrists and are often able to provide salaries equal to those in well-served areas. Psychiatrists in these areas are positioned to impact legislators.
Treasurer’s Report: Donna Norris, MD
As noted in our last report, APA’s financial status is sound, with the Association moving successfully toward the goal of an undesignated reserve to equal 100% of operating budget. Revenue exceeds year to date forecast by $1.1 million, and expenditures are less than the year to date budget. Membership, annual meetings and publication revenues represent the greatest
sources of revenue, $10 million, $14 million and $26 million respectively. Pharmaceutical funding year to date August, 2006, is almost $14 million, and is comprised of advertising, annual meetings and education, advocacy, and research revenues. In turn, the APA spent $10 million in these areas. Projected sources of unrestricted revenue for 2006 is $56.4 million and unrestricted expense is $48.5 million.
Council on Membership and DB Relations
Dr. R. Viswanatha reported on grant awards to District Branches. Twenty three of 33 proposals centering around issues related to membership recruitment, foundation development, access to care, special projects, and website were funded. Awards totaled $276,900, and ranged from $2,000 to $65,000 per proposal.
Action Papers
The Assembly voted on a number of interesting action papers. Among the proposals passed were: 1) that the APA should support the construction of a barrier on the Golden Gate Bridge to prevent suicide by sending letters signed by the APA President and Medical Director to the Board of Governors of the Golden Gate Bridge and elected officials; 2) that the APA develop “invisible wristbands” embossed with the inscription “Healthy Minds” for raising mental health awareness; 3) that the APA join with other distinguished scientific groups in protesting attempts to boycott institutions of higher learning, scientists, clinicians and researchers that do not oppose certain Israeli policies; 3) that action be taken against the practice of managed care pharmacists inciting patients to change medication regimens without disclosing their profit motives; 4) that the APA be directed to address the problem of Medicare Part D Pharmacy Benefit Plans which establish obstacles to the dispensing of medications; 5) that the APA should
sponsor an annual summit meeting of professional and mental health advocacy groups; 6) that the APA take action to accomplish the goal of maintaining the financial health of District Branches by restoring a revenue sharing program; and 7) that the Assembly support the practice guidelines for the Treatment of Patients with Alzheimer’s Disease and other Dementias of Late Life, 2nd Edition. Several papers met with the approval of the Assembly. A proposal for the development of an APA summit meeting of key professional and mental health advocacy groups was accepted. Recommendations were made to address the problem of Medicare Part D Pharmacy Benefit Plans and the obstacles by the plans in hindering dispensing of medications. The Assembly endorsed a proposal to convene a panel of experts to assess and then to advocate with the Centers for Medicare and Medicaid Services with regard to coding restrictions that adversely affect billing by psychiatrists, though the services may be medically necessary.
Emerging Issues: Psychiatric Care for Military Members and Families
Robert Ursano, MD, Chair, Department of Psychiatry of the Uniformed Services University, delivered a talk on the psychiatric problems and disorders of military personnel and their families during times of deployment to Iraq, Afghanistan and other areas. Among the findings reviewed, one study showed that exposure to combat was significantly greater among personnel who were deployed to Iraq than those personnel deployed to Afghanistan. Sixteen percent of subjects deployed to Iraq met screening criteria for major depression, generalized anxiety, or PTSD, versus 11 percent of subjects who were deployed to Afghanistan. Only 23 to 40 percent of subjects with positive responses for mental disorder sought mental health care, and these individuals were concerned about stigmatization. It was stressed that the needs of personnel and families are great,
and that American psychiatrists should be prepared to be of assistance in providing care and assisting in eliminating barriers to accessing mental health care.
Dr. Eliot Sorel, Vice-Chairman, APA Access to Care Work Group, discussed the need for the development of collaboration with our medical colleagues, in order to facilitate earlier detection of psychiatric illness, so that psychiatric services can be provided sooner to those in need. Similarly, our patients have significant medical needs that require detection and treatment. Such links, as of now, are not well established and need development.
Dr. Deborah Cross, Chair of the Committee on Public Affairs, described the success of the Healthy Minds, Healthy Lives initiative. Now in its second year, the campaign to change the perception about psychiatrists and to inform the public about mental illness is well underway. The website has had 1.2 million visits!
The President-Elect, Dr. Carolyn Robinowitz, described the focus of the presidency: Our Voice in Action, to advance service, care and the profession. Communication in all arenas will be addressed, including policy makers, patients, the public, advocacy groups, physicians and other mental health professionals.
Dr. Althea Stewart, President of the American Psychiatric Foundation, informed the Assembly that 50 psychiatrists had received grants from the Disaster Recovery Funds, and that many schools have benefited from the provision of relevant mental health information. NAMI, too, has received grant money.
John Wernert III, Chair of APAPAC, described the program’s steady efforts in working with Congressional and Senate leadership, to advocate for our patients and our field. $364,000 was distributed to 49.50% of both Republicans and Democrats.Unfortunately, PAC membership remains flat.
Dr. Ronald Burd, Chair of Committee on Codes and Reimbursements, described the changes in evaluation of coding by Medicare. The 908XX codes have decreased in value and 99XXX codes have increased. Many sources of information are available from the APA, NYSPA., or directly from CMS.