Lloyd Sederer, M.D., is ready to contribute the expertise he gained through 25 years of clinical and administrative experience in the private sector to a much larger venue—the public policy arena in Washington, D.C.

Last month Sederer joined APA in the new position of director of the Division of Clinical Services. Itself a new creation of Medical Director Steven Mirin, M.D., the division will coordinate the work of two APA departments—Quality Improvement and Psychiatric Services (QIPS) and Healthcare Systems and Financing (HSF)—that will play critical roles in gathering data and helping develop APA policies to influence the rapidly evolving health care system.

Sederer comes to APA after 11 years at McLean Hospital in Belmont, Mass., where he most recently served as medical director and executive vice president. He is also a past president of the Massachusetts Psychiatric Society and one of the district branch’s representatives to the APA Assembly. In addition, Sederer chaired the APA Council on Health Care Systems and Financing.

Sederer already has some ideas of where both departments he oversees will focus their efforts in the near future.

QIPS will be addressing new kinds of challenges as it develops and revises APA’s practice guidelines for treating psychiatric and substance use disorders. In the past, he pointed out, "randomized clinical trials were the gold standard" used to evaluate the validity of data used to develop each guideline. Information from day-to-day clinical practice was on a lower rung of the empirical ladder.

As the project moves forward, however, Sederer wants to ensure that the guidelines "are more effectively used in everyday practice. We know that they are underutilized by practitioners, in part because of the daily time pressures and burdens of running a practice." He is looking forward to the day when practice guidelines are part of "standard operating procedures" for psychiatric practice. "They are a data-driven orientation to delivering psychiatric care" and will go a long way toward ensuring that physicians are accountable to the public and have the public’s trust, he said.

Sederer also will bring considerable expertise to the increasingly important issue of outcomes assessment, He has researched and written extensively on the topic and while at McLean helped develop a well-regarded outcomes measurement program.

He expects that APA, through the QIPS department and the Council on Quality Improvement and its Committee on Quality Indicators, will develop clinical quality measures that will substantially increase APA’s influence in defining the clinical standards and in assessing quality of care and how satisfied patients are with that care.

"Quality, to my mind, needs to be a defining concept for our profession," Sederer said. "If we can define, measure, report, and improve quality, it becomes the foundation for advocating for our patients and our profession."

On the health care financing side of the Division of Clinical Services, Sederer said the department is gearing up to address imminent changes in the Medicare program. The Health Care Financing Administration (HCFA), the federal agency that administers Medicare, is in the process of updating outpatient payment schemes for hospitals and clinics and is in the midst of a five-year review of Part B physician-billing payments, he pointed out.

Shifting to private-sector financing issues, Sederer said he plans to continue discussions with managed care companies in an effort to help them see opportunities to improve their practices. He wants to see other companies follow Magellan’s lead in lowering barriers that have kept residents and early career psychiatrists from gaining credentials required to join provider panels and being paid for their services.

He emphasized as well that it is critical that APA continue its work to convince managed care companies that they need to end their practice of splitting treatment between psychiatrists for medication and mental health professionals for psychotherapy. Mental health care needs to be integrated for patients to receive optimal care, he noted. "We also have to see to it that those services are reimbursed at adequate rates," he added.

Another area on the agenda of the clinical services division, Sederer said, is assessing the role of pharmacy benefit management companies in determining what prescription drugs patients can receive and how these firms interact with managed care and pharmaceutical companies. "We need to know just who [these companies] are, what populations’ benefits they manage, and what their practices and policies are," he said. "Then APA has to decide what stands we need to take regarding these companies."

Sederer also addressed the controversy that arose last month over the policy of the psychiatry department at Kaiser Permanente’s Southern California Medical Group to require psychiatrists to write prescriptions for patients they haven’t seen on the recommendation of nonphysician therapists.

He noted that APA issued a sharply worded press release condemning the practice and citing possible ethical violations on the part of psychiatrists who adhere to Kaiser’s policy. Sederer said that one next step is up to the district branch in the area where the practice is occurring, the San Diego Psychiatric Society. That will be to respond if someone lodges charges of ethics improprieties or unethical care.

He added that APA "has been invited to have further discussions with the Southern California Permanente Medical Group," whose lead psychiatrist implemented the prescribing policy, about what corrective actions the medical group can take to undo this form of "substandard care." It gives APA an opportunity to not only recommend remedies, but also help Kaiser "take a unique step forward in the quality-of-care area," he said. "Some good may actually come out of this."

One more area in which Sederer will be involved is the development of Medem.com, APA’s Internet initiative. He said his contribution will be to help shape the way in which APA builds psychiatric content on the soon-to-be launched multispecialty Web site.

Saying that he was "honored to be selected" as the first director of APA’s new Division of Clinical Services, Sederer explained that he welcomes the chance to take the knowledge and experience he gained in patient care, hospitals, and health care systems and "translate that into the policy-making arena in Washington."