Responding to concerns that the APA Consultation Service's work in the area of managed care may create disadvantages for some APA members, the APA Board of Trustees took several steps at its meeting last month in Washington, D.C., to modify the service's operation.

The Board's actions were designed to reduce the likelihood that the Consultation Service will become engaged in projects that help one group of members increase practice income at the expense of their psychiatrist colleagues. The Consultation Service has been caught in a tug of war between APA members who want its help in setting up or increasing participation in managed care activities and those who want APA to stay out of the managed care consultation business entirely, explained Area 5 Trustee Charles Bowden, M.D.

Bowden chaired a panel appointed to review the operations of the Consultation Service, and the panel offered several reform recommendations, all of which the Board endorsed.

Part of the concern provoked by the Consultation Service's activities is attributable to the charge its staff got in 1994 when the Assembly, in response to requests from APA members that the service consult on forming networks and helping them respond to the managed care juggernaut, urged APA to provide consultation in these areas.

This new orientation came with an instruction to turn the service from a "cost-recovering" operation--as it had been since its founding in the late 1940's--into a revenue-producing one. This change of direction came with insufficiently detailed guidelines governing the areas in which it was to offer consultations, so producing income became a guiding principle, pointed out APA President Harold Eist, M.D.

The Board "has the responsibility to maintain oversight regarding revenue-producing activities, and in some cases this hasn't occurred," Eist stated.

Connecticut Controversy

A recent lightning rod for the anger of some Trustees was a project in which the Consultation Service assisted a group of 30 Connecticut psychiatrists in winning a contract to provide mental illness and addiction treatment on a capitated basis to 140,000 individuals insured by Blue Cross/Blue Shield of Connecticut (Psychiatric News, November 1, 1996). The five-year contract, worth between $25 million and $30 million, gave psychiatrists and other mental health professionals in 14 group practices instant access to a substantial number of the state's insured citizens and kept management away from an out-of-state organization.

The contract award, however, left many of Connecticut's other psychiatrists seething over the likelihood that their access to a large number of patients would be blocked by a business arrangement in which an APA service provided assistance.

Several proposals to reform the mission of the Consultation Service and provide a heightened level of oversight were enacted by the Board to try to head off similar controversies in the future.

One change was to identify the Consultation Service as a member benefit that is expected to pay its own way through the fees it charges and to be budget neutral rather than "a major revenue generator for the Association."

New Guidelines

Another proposal the Board adopted will allow the service to continue offering managed care consultations, but with the following guidelines made clear to potential clients:

• The service is intended to help groups of psychiatrists position themselves to regain control over delivery of psychiatric services, to put the psychiatrist back in charge of patient care, and to improve the quality of care in evolving organized systems.



• It is to encourage psychiatrist groups seeking its guidance to include as many APA members as possible in the geographic areas in which they will function.



• The service will not prepare bids for a contract, but will provide education and technical assistance to groups of psychiatrists who want to improve current operations or develop new ones.

The Consultation Service's board, chaired by Rodney Burgoyne, M.D., has also been charged with providing a greater degree of oversight and developing more specific "rules of engagement" that will help keep the operation from becoming enmeshed in controversial projects.

The Trustees also approved the recommendation that the Consultation Service's director report more often to the APA Board to describe programs and receive "course corrections" if necessary.

In another related action, the Board of Trustees voted to extend for one year a requirement that "any APA entity, District Branch, or Area Council" that plans to run or become involved with a managed care operation "must first have its plans reviewed by the Board of Trustees, in consultation with the Assembly Executive Committee." This mandate will permit APA officials to assess these programs for potential legal liability for the Association.

(Psychiatric News, April 4, 1997)