I read with interest the Viewpoints article in the June 2 issue by Dr. Jerry Rogoff of the Massachusetts Psychiatric Society (MPS) regarding APA–district branch communication and describing the development of the outpatient treatment report (OTR) disseminated by APA last year. As chair for the past three years of APA’s Managed Care Committee, which was responsible for the development of this form, I would like to address a few of Dr. Rogoff’s comments.

First, I would like to clarify two inaccuracies in Dr. Rogoff’s description of the form. He suggests that it was designed only for medication management authorization requests, that is, "to fill out in requesting additional follow-up medication visits," and states that it is three pages long. Neither of these statements is correct. The form is two pages long, a definite improvement over the numerous lengthier forms (some up to eight pages) that the committee reviewed in the course of its work. The form may be used for an initial request for treatment (including psychotherapy) or for follow-up reports. It can function as a request for medication management authorization but is not limited to that purpose.

The two pages are designed to be used separately so that the psychiatrist has the choice of limiting the information sent to the insurer to one page and to provide only that information absolutely required for authorization and reimbursement. The second page, containing more sensitive patient information, is to be released only with the patient’s signed informed consent.

Dr. Rogoff’s major point is that he believes APA’s district branches (DBs) were not consulted directly during the three years that the Managed Care Committee was developing the OTR. As he noted, the APA Assembly does not discuss all component initiatives and some only on their completion, but such was not the case with the OTR. In fact, the initiative for such a form arose out of the Assembly, where DB representatives discussed the burden of dealing with the large number and variety of forms required by multiple managed care organizations (MCOs). As the form was being developed, it was discussed not once but several times in the Assembly over nearly four years, and after numerous permutations the final product was reviewed and subsequently approved by the Board of Trustees.

Wearing another hat, as a Colorado representative to the Assembly, I was present at lengthy discussions on the floor of the Assembly and in the reference committees about the form. Presumably, the MPS representatives reviewed the form on the DB’s behalf during those years and provided valuable input. Moreover, I am aware that many representatives did circulate the form at their respective Executive Council meetings, as I did several times in Colorado. It was precisely because of the extensive data gathering and review that the form took three and a half years to complete.

Dr. Rogoff makes an excellent point that the information transfer between DB and APA components and the Assembly is not always adequate. It is hoped that the new APA Office of Member and District Branch Relations will help to correct some of the communication deficiencies. Other efforts for improved DB-APA communications include having DB presidents-elect attend the fall meeting of the Assembly and meetings of the Board of Trustees on a rotating basis. Also, at this year’s annual meeting, DB representatives were invited to meet with the Managed Care Committee about important projects concerning utilization review arising from the Texas DB.

Finally, I would like to thank Dr. Rogoff for his comments and invite him to contact me or the new committee chair, Dr. Larry Lurie, and forward a copy of the MPS form. We anticipate that, if successfully piloted for a year by two or more MCOs, the APA form will be reassessed and revised; furthermore, a second form may be designed with input from the American Academy of Child and Adolescent Psychiatry for use with child and adolescent patients.

Joanne Ritvo, M.D.

Immediate Past Chair

APA’s Managed Care Committee