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Four district branch presidents-elect came to Washington, D.C., to air their members’ concerns and frustrations at the Board of Trustees meeting in Washington, D.C., in September.
APA President Herbert Sacks, M.D., initiated the reports, begun in June, to improve communications between APA and the district branches.
The four presidents-elect were Mark Hutto, M.D., of the Georgia Psychiatric Physicians Association; Paul Summergrad, M.D., of the Massachusetts Psychiatric Society; Arnold Goldman, M.D., of the New Jersey Psychiatric Association; and William Arroyo, M.D., of the Southern California Psychiatric Society.
A fifth president-elect, Sidney Weissman, M.D., of the Illinois Psychiatric Society was unable to attend and sent written comments instead.
The foremost concerns of psychiatrists in Southern California are inadequate Medicare reimbursement for psychotherapy visits and Medi-Cal’s recently implemented mental health carveout, according to Arroyo.
Members who work in the public sector in Los Angeles County have complained that a partial mental health carveout limited to psychotherapy compromises access to care for psychiatric patients.
Under the new structure, primary care providers rather than psychiatrists are responsible for ordering relevant laboratory studies of lithium levels, for example, and SSRI’s, antianxiety agents, and stimulants for patients, Arroyo commented.
Splitting treatment in this manner "places an onerous burden on our patients, many of whom are too disorganized and impaired to follow through on such procedures."
In the meantime, only one of two managed Medicaid health plans has agreed to honor prescriptions and lab requests from public sector psychiatrists.
"This has created confusion among psychiatrists, public service mental health agencies, and patients," observed Arroyo.
Moreover, Medi-Cal officials have indicated little support for changing the current carveout structure, Arroyo complained.
In Massachusetts, parity, managed care, and confidentiality are the hot legislative issues this year, with parity being a top priority, reported Summergrad.
"As a member of the Mental Health Coalition, MPS was successful in getting the Joint Committee on Insurance to report out the coalition’s version of a parity bill favorably," he said.
He and MPS Executive Director Dottie Mooney are participating in a coalition that is led by the Massachusetts Medical Society. The coalition is working on redrafting proposed confidentiality legislation that is too prescriptive, added Summergrad.
Managed care and the erosion of patient privacy also ranked high among the concerns of the New Jersey district branch, according to Goldman.
"Managed care continues to threaten the doctor-patient relationship and the scope of psychiatric practice," he said.
He recommended that APA develop standards that protect patient confidentiality and minimally satisfy the needs of insurance companies to obtain medical information.
Goldman also observed that "criteria for providing patient care are subject to each managed care company’s internal policies."
"APA’s practice guidelines should be the standards for all managed care companies."
Meanwhile, the Georgia district branch is stepping up its fight against psychologists’ prescribing privileges, Hutto told the Trustees.
"Our DB has designated a special expenditure above its usual lobbying expenses to hire more lobbyists," he reported. "Every board member has pledged to contribute extensively to this effort."
However, "this is just a fraction of what the Georgia Psychological Association is doing for its campaign."
Hutto asked APA to designate funds to be used by district branches for lobbying against psychologists’ prescribing legislation when it is introduced.
"It would be appropriate for APA to designate funds equal to what the other APA [American Psychological Association] is spending. Another option would be to match DB funds with a maximum of $30,000," Hutto suggested.
APA can also help DB’s with recruiting new members by designing and implementing a generic membership campaign to be individualized by district branches, recommended Hutto. APA can provide matching funds for membership activities.
In other membership news, Summergrad reminded the Trustees that psychiatrists in Massachusetts continue to complain about the high cost of APA and district branch membership dues.
"Clearly the structure of APA needs to be streamlined. For example, what is the cost of APA components? Is the current structural relationship between APA and the DB’s organized in the most effective and cost-effective manner?"
Summergrad also recommended to the Trustees that district branch presidents or presidents-elect continue to meet and discuss their concerns during scheduled APA meetings.