Psychiatric News December 3, 2004
Volume 39 Number 23
© 2004 American Psychiatric Association
p. 14
Assembly Members Tackle Wide-Ranging Agenda
Ken Hausman
Several key issues related to patient care had a prominent place on the
Assembly's agenda last month, but a substantial part of formal and informal
discussion was on the fate of one state's new structure for organized
psychiatry.
While APA Assembly members deliberated a variety of issues at their
November meeting in Washington, D.C., the future of organized psychiatry in
Texas was the topic of much discussion during the plenary sessions as well as
during Area Council meetings and informal
discussions.
| |
Richard Kaye, D.O., wins the APA Assembly's 2004 Profile of Courage
Award for his fight against Virginia's plan to close inpatient beds at state
psychiatric facilities. Kaye feared the plan would leave many indigent
patients without access to treatment for serious mental illness and increase
the number of people with mental illness who end up in jails and prisons.
"I never thought that patient advocacy would become a major part of my
practice," Kaye said.
|
|
Assembly Speaker James Nininger, M.D., set aside an hour after the first
plenary session ended to provide a forum in which members could quiz the Texas
representatives about the details and impact of a controversial restructuring
for organized psychiatry in that state that has drawn substantial opposition
from both the Board and Assembly (Psychiatric News, November 19).
Later in the three-day meeting, the Assembly voted to ask the Board of
Trustees, which meets later this month, to hire an independent mediator, at an
estimated cost of $12,000 to $15,000, to see whether Texas district branch and
APA leaders can reach some agreement that would satisfy both sides of the
dispute. The Assembly chose that option over doing nothing, supporting the
Texas "experiment," or allowing the Board of Trustees to
"de-link" the Texas district branch from APA and replacing it with
a new district branch.
The Assembly also passed several action papers concerning patient-care
issues.
The members voted, for example, to support federal legislation or
regulatory efforts to eliminate a 30-patient limit on the number of
opioid-dependent patients that can be treated with buprenorphine in an
outpatient practice. The representatives were not persuaded by arguments that
removing the limit could lead to the establishment of "prescribing
mills" by physicians who passed the mandatory buprenorphine-prescribing
course but had little other addiction treatment experience.
They also backed a proposal that urges APA to "develop and regularly
update procedures to apply the principles of medical necessity to the practice
of psychiatry." The action paper states that the motivation underlying
the proposal is the belief by some members that APA is not adequately
monitoring how managed care companies are defining medical necessity and
applying their definitions to coverage decisions. This calls on APA to take a
more "proactive" role and meet more often with insurers about
their medical necessity principles and with district branches about their
efforts to deal with insurers in setting medical necessity standards for
psychiatric care.
Nininger also devoted one plenary session to workforce issues in
psychiatry. The presentations will be described in the next issue of
Psychiatric News.
In other actions, the Assembly voted to
- have APA explore whether to develop criteria for the diagnosis of
bipolar disorder in children that would be included in the next edition of
the Diagnostic and Statistical Manual of Mental Disorders
(DSM). The authors noted a substantial increase in the last few years
of articles and presentations on the diagnosis and treatment of bipolar
disorder in children, but indicated that only one sentence in DSM-IV
refers to this disorder in children, since the latest edition appeared before
much of the recent research was presented. The DSM "should
reflect the current understanding of this disorder," the paper
states.
- continue to support federal legislation to establish an open
clinical-trials registry for new medications that would include studies
whose findings were negative as well as positive. The Assembly also urged APA
to promote awareness of such a registry, should it be established, at all of
its scientific meetings and continuing medical education sessions and to
publish both negative and positive study findings in APA journals.
- urge APA to work to terminate Medicaid's Institution for Mental Diseases
(IMD) exclusion, which bars hospitals, nursing facilities, and other
institutions from eligibility to receive Medicaid reimbursement if they have
more than 16 beds. When Congress approved this exclusion when Medicaid was
enacted in 1965, it signaled the federal government's intention to leave the
burden of paying for long-term psychiatric care in these facilities with the
states. The exclusion applies to indigent adults aged 21 to 65. Ending this
exclusion should provide psychiatric patients with "their fair share of
health care dollars," said Jeffrey Geller, M.D., one of the paper's
authors. Concern was expressed, however, over the possibility that eliminating
the exclusion could threaten a funding source for general hospitals that treat
psychiatric inpatients and have 16 or fewer beds. Others maintained that this
could halt a nationwide closure of psychiatric beds because more facilities
would be eligible for reimbursement through Medicaid, thus increasing access
to the mental health care system.
- amend APA's position statement on same-sex unions to add a phrase
indicating that APA not only "supports the legal recognition of same-sex
unions and their associated legal rights, benefits, and
responsibilities" but also "opposes restrictions to those same
rights, benefits, and responsibilities."
- add additional incentives for psychiatry residency programs to get all
of their trainees to join APA and thus qualify for the 100% Club. It wants
the Board of Trustees to change the $100 annual contribution the program
receives toward buying APPI books to one that provides programs with
"one major APPI textbook for each year the program qualifies" for
the 100% Club. These programs would also receive a free online subscription to
the APA continuing medical education journal Focus.
- approve minor technical revisions to several APA position statements
related to HIV/AIDS, including those on confidentiality in outpatient
psychiatric services, HIV in adolescents, and HIV infection in pregnant women.
The changes were to add updated statistical data, clinical information,
current treatment protocols, or text references.
- endorse a new position statement on the psychiatric implications of
comorbid HIV and hepatitis C infections. The statement was developed by
the Committee on AIDS to respond to the mental health implications of the
growing public health problem posed by this type of coinfection and its
treatment. About 25 percent of HIV-infected Americans have comorbid hepatitis
C infection. The statement describes the dimensions of the neuropsychiatric
aspects of the problem and of its treatment. Among the statement's
recommendations are that patients be treated for mood disorders prior to
initiating treatment for hepatitis C and that psychiatrists should closely
monitor changes in neuropsychiatric functioning in patients with this
coinfection. This monitoring includes drug-drug interactions and interactions
of antiretroviral treatments with substances of abuse.
- ask the Board of Trustees to decide whether APA should meet with the New
York Academy of Medicine to discuss joining its group Doctors Against Handgun
Injury. This is a coalition of a dozen national medical societies whose
mission is to "enhance awareness of the link between handguns and
suicide and to increase clinical and public health programs" focused on
this issue. The paper noted that since mental health issues are intimately
bound up in suicide decisions, APA has considerable expertise to contribute in
this area.
- encourage the medical director and Board of Trustees to continue their
lobbying efforts to have the Virginia legislature change a state law
prohibiting employers from offering health insurance to the domestic partners
of their employees. Virginia is the only state to have codified such a
ban. The issue became critical to APA when it moved its headquarters from
Washington, D.C., to Arlington, Va., in late 2002. At that time APA learned
that it was no longer permitted to offer the benefit, which had been available
to staff for more than a decade.
A summary of the Assembly's actions is posted in the "Members
Corner" section of APA's Web site at
<www.psych.org/members/gov/assembly/maynovmtg/nov04final.cfm>.
Related Article:
-
Hundreds Walk Pennsylvania Avenue To Raise Mental Illness Awareness
- Eve Bender
Psychiatr News 2004 39: 2-43.
[Full Text]
Get information about faster international access.
Privacy Policy
Copyright © 2004
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
