In This Issue
PRESIDENT'S MESSAGE
AZ PSYCHOLOGISTS TRY AGAIN FOR RxP
APS FEATURE SECTION: SERIOUS MENTAL ILLNESS
VOICE, CHOICE AND RECOVERY FOR CENTRAL ARIZONA'S SMI
PAINTING THE VOICES
THE SMI SYSTEM:...A CLINICIAN AND RESIDENT PERSPECTIVE
FOUNDER OF NEURO-PSYCHOANALYSIS TO SPEAK IN TUCSON
MEET DR. OLE THIENHAUS
MENTORSHIP OPPORTUNITIES
REPORT FROM AREA VII ASSEMBLY
CPT CODING CHANGES
UPCOMING CME OPPORTUNITIES AND SAVE THE DATES
RESIDENTS, ECP, AND MEMBERSHIP NEWS
FREE EDUCATION FROM APA
American Professional Agency, Inc. (paid advertisement)
ARIZONA PSYCHIATRIC SOCIETY NEWSLETTER       FALL 2012
Painting the Voices (copyrighted image)Welcome to the Fall 2012 issue of the Arizona Psychiatric Society's Newsletter. Our top articles describe the push by Arizona psychologist to gain prescription writing authority and the introduction of Dr. Ole J. Thienhaus, Professor and Head of the Department of Psychiatry at the University of Arizona College of Medicine in Tucson. We also present a triad of articles on the Seriously Mentally Ill (SMI). We hope you enjoy these features, together with the Report from the Area VII Assembly meeting held in August, and other timely membership news.

PRESIDENT'S MESSAGE

Hope you all had a peaceful and relaxing summer. Here at the Arizona Psychiatric Society (APS) we had our traditional break from regular monthly meetings in July and August. Things were happening, however, with our representative, Dr. Jay Bastani, attending the Area VII meeting in Boise, Idaho...and a couple of weeks ago our Education Committee having its first meeting to start planning our Annual Spring Meeting; let us know if you have any specific ideas in terms of topics and/or speakers for the meeting as soon as possible. Now, as the summer heat is relenting things are heating up on another, an unwelcome but familiar, front with Arizona Psychologists yet again vying to add prescription pads to their armamentarium of testing materials. We are planning a robust response to counter this yet repeat quest for prescription privileges by non-physicians to protect our profession's integrity and our patients. We will need your help to do this...!! You will be receiving specific communication and solicitation in this regard from APS, please respond in affirmative. Although this issue will surely consume much of our attention and energy over these next several weeks, we intend to fully keep up with our other responsibilities and tasks....and that includes a Winter Social Meet-Up; let us know of your ideas and thoughts on this. Let's stay in touch and be involved in what matters to you and your profession!!

 

Tariq Ghafoor, M.D.

President, Arizona Psychiatric Society

 
ARIZONA PSYCHOLOGISTS TRY AGAIN TO OBTAIN PRESCRIBING PRIVILEGES

On August 31, 2012, the Arizona Psychological Association filed a new proposal to introduce legislation allowing prescriptive authority for Arizona psychologists (the "2012 Sunrise RxP").

In the Arizona legislature, the process for introducing legislation addressing scope of practice issues begins with a "Sunrise Proposal" which is presented to the Joint Health Committee of Reference ("Sunrise Committee") for discussion and hearings. The committee then votes on whether to allow the proposed legislation to be introduced to the full legislature for action during the session. In 2011, the Sunrise Application filed by psychologists seeking prescription privileges was withdrawn prior to the hearing date.

 

The APS Lobbyist has learned that there is well-organized lobbying on behalf of the current psychologists' proposal, and the 2012 Sunrise RxP has the support of the Arizona Board of Psychological Examiners, the Arizona Council of Human Services Providers (who stood neutral in response to the 2011 Sunrise RxP), as well as the potential support of some other key stakeholder groups.

 

Your help is needed to mount a strong response to the 2012 Sunrise RxP. Contact Teri Harnisch, APS Executive Director, by e-mail (teri@azmed.org), or telephone (602-347-6903), to join the efforts of the Legislative Subcommittee on RxP. By serving on this Subcommittee, you can help by contributing to the research and discussion on the 2012 Sunrise RxP, developing the talking points in response, and participating in meetings with the members of the Sunrise Committee.

 

As closely fought as was the battle in 2011, we anticipate the Sunrise 2012 RxP will prove to be an even greater challenge. Our goal is to prevent the proposal from passing out of the Sunrise Committee and into the upcoming regular legislative session for further action.

 

In addition to serving on the Subcommittee on RxP, you can make significant contributions through grass roots advocacy of your own:

  • Call, email or write any member of the Sunrise Committee of whom you are a constituent. Or any member regardless of constituency. Below is a list of Sunrise Committee members and their contact information.  
  • Sign up to attend a political fundraiser where you can meet and speak personally to key members of the Legislature.
  • Let us know if you have a personal relationship with any member of the Legislature. Those relationships are in general the most useful in terms of getting our message out.
  • All of the above items are important, but contacting legislators, especially those you know personally, is critical. If you are a constituent in their district, be sure to mention that.

Here is the link to find your legislative district.

 

List of Sunrise Committee members and their contact information (click on the member name for their e-mail address):

  

SENATE HEALTHCARE AND MEDICAL LIABILITY REFORM COMMITTEE OF REFERENCE

 

NAME                                                    PHONE      

 

Sen. Nancy Barto (R) (Chair)              602-926-5766

Sen. Rick Murphy (R)                         602-926-4444     

Sen. John Nelson (R)                         602-926-5872   

Sen. Paula Aboud (D)                         602-926-5262  

Sen. Linda Lopez (D)                         602-926-4089      

 

HOUSE HEALTH AND HUMAN SERVICES COMMITTEE OF REFERENCE

 

NAME                                                      PHONE                                 EMAIL

Rep. Heather Carter (R) (Chair)         602-926-5503  

Rep. Cecil Ash (R)                             602-926-3160  

Rep. Kate Brophy McGee (R)              602-926-4486     

Rep. Matt Heinz (D)                          602-926-3424     

Rep. Katie Hobbs (D)                         602-926-5325       

 

Please contact me or the APS Lobbyist, Joe Abate, with any questions.

 

Tariq Ghafoor, M.D.

President, Arizona Psychiatric Society

 

Joseph F. Abate

602-380-8337

 

ARIZONA PSYCHIATRIC SOCIETY - FEATURE SECTION ON SERIOUS MENTAL ILLNESS

We start off this section with an article from Dr. Ghani who describes Magellan Health Services role in the SMI system for central Arizona. The follow-up article is done by Deborah, a local artist who graciously shares her thoughts and emotions through her art. Finally, with enthusiasm, Dr. Mebane offers a clinician's view of the SMI system and integration of psychiatric residency training into his work.  

 

We thank those who made this section a reality, especially Dr. Gurjot Marwah, and hope readers are enlightened by the unique insights of each author.  

VOICE, CHOICE AND RECOVERY FOR CENTRAL ARIZONA'S SMI

Shareh Ghani headshot  

Voice, Choice and Recovery for Central Arizona's SMI

By Shareh O.Ghani, M.D., Chief Medical Officer

Magellan Health Services of Arizona

 

INTRODUCTION

There are more than 20,000 individuals diagnosed with serious mental illness (SMI) in the Central Arizona health system. The goals of the region's mental health providers are for those people challenged with SMI to have a voice in their care plan, a choice of where and how they are treated, and the resources and support to achieve and maintain their highest possible level of health and self-sufficiency.

 

Adults in Maricopa County and parts of Pinal County with SMI receive services from Magellan Health Services of Arizona (Magellan) and one of its Provider Network Organizations (PNOs), which operate 20 community-based clinics. The PNOs are Southwest Network, CHOICES Network of Arizona, People of Color Network and Partners In Recovery. The Arizona Department of Health Services, Division of Behavioral Health Services (ADHS/DBHS) provides a guide that details covered behavioral health services to assist, support and encourage each recipient. The guide is available at: http://www.magellanofaz.com/media/455763/2012_maricopa%20handbook_english.pdf.

 

DEMOGRAPHICS-About Central Arizona's SMI population

 

Figures 1-3 show system demographics. Demographic data shows the majority of services being provided to Caucasians between the ages of 25 and 64 with both genders about equally represented.

  

Figure 1  

Figure 1

Figure 2  

Figure 2

 

Figure 3 

Figure 3

 

SMI ELIGIBILITY CRITERIA

 

Initiation of Care

ADHS/DBHS has established criteria that determine eligibility for care. See http://www.magellanofaz.com/media/156446/3-10_smi_eligibility.pdf.

 

Qualifying Diagnoses

Generally, to be considered SMI, a person must have an SMI Qualifying Diagnosis (and documentation to support the diagnosis)

 

  • Qualifying diagnoses include, but are not limited to, Schizophrenia, Schizoaffective Disorder, Bipolar Disorders, Major Depressive Disorders, Panic Disorder, PTSD, OCD, Generalized Anxiety Disorder, and most Personality Disorders (not Antisocial PD).

Severe Impairment

They must also show severe impairment in their ability to function as a direct result of the qualifying diagnosis, in at least one of the areas below, for at least the past 12 months, or the past six months with an expected duration of another six months. The three areas are:

  • Inability to live in an independent or family setting without supervision;
  • A risk of serious harm to self or others; and
  • Dysfunction in role performance.
  • Or, if the person does not currently meet the functional impairment requirements above, but they are expected to deteriorate to such a level without treatment, then they may qualify for SMI benefits.

INNOVATIVE CARE FOR CENTRAL ARIZONA'S SMI

 

Measuring Outcomes, Providing Choice- To enhance information transparency, providers created "Outcome Dashboards" which provide information to recipients, families and providers about metrics that show recipients success toward recovery. Information is available for each clinic, enabling recipients to evaluate where they want to receive their services, as they have the choice to receive care at any of the 20 care centers located throughout the county.

 

Suicide Prevention and Intervention- Individuals with SMI are six to 12 times more likely to die by suicide. So providers, and community and governmental agencies worked to develop a suicide prevention initiative. The Programmatic Suicide Deterrent System has received several national and international awards. It utilizes SAMHSA's best practice Applied Suicide Intervention Skills Training, and since its implementation, suicide rates among those with mental illness have dropped 42 percent. Currently, a system-wide suicide prevention screening, assessment and intervention program is being introduced.

 

Peer Support- More than 460 peers (individuals challenged with mental illness, but in recovery and managing their symptoms) and family members are engaged in meaningful roles throughout the system. They provide support to their peers as individuals and groups. Each SMI clinic has peer and family mentors who engage, advocate for and support recipients. The inclusion of peers in the system is another way to provide voice to those challenged with SMI.

 

Health, Wellness and Longevity-The average life expectancy for Arizonans with SMI is reduced by nearly 32 years, largely due to inadequate management of chronic health conditions, such as diabetes, obesity and heart disease. Those with SMI are at increased risk for developing chronic conditions because of factors such as the use of some second-generation antipsychotic medications. To improve length and quality of life for people with SMI, Magellan developed Integrated Health Home (IHH).

 

The IHH approach focuses on and integrates three areas, behavior health, community health, and lifestyle management. IHH is behavioral health led and provides an expanded multi-disciplinary approach, coordinated care plans and high quality health care through health information technology and evidence-based guidelines. Figure 4 shows care provided through IHH.

 

  Figure 4  

Figure 4

 

Services for IHH participants start with health assessments.

 

Sharing of information through health information technology, peer support and ongoing coordination of care via frequent team communications support the recipient in recovery, reducing lifestyle risk factors and management of chronic conditions. Through the collaboration of regional providers, SMI recipients have the choice of receiving both behavioral health and physical health care in the behavioral health clinic setting. For more information about IHH, access Magellan by clicking here.

PAINTING THE VOICES

Painting and Narrative on SMI from a Patient Perspective

Painting the Voices (copyrighted image)
"Painting the Voices," Artwork Copyrighted (reproduced by permission)

 

Hello my name is Deborah and I am an artist.  I have been working in sculpture and painting for many years.  I am 55 years old and I have been diagnosed with schizo effective disorder.  I was in my early 20s when I had my first psychotic break, although I have been hearing voices as far back as I can remember.  I have also been doing art for as long, since early childhood.

I studied fine art and psychology at Eastern Michigan University and earned a bachelor's degree in both.  I have continued to study art throughout the years.  I have worked mainly in surreal contemporary sculpture.  My current inspiration is exercising my illness on canvas with paint.

The art creates itself the same way that the voices come to be.  There is no control of their occurrence just as there is no control of when my art will be inspired.  My art has been created during every phase of my illness; manic, psychotic, and depression. 

This particular painting was created in the winter of 2012.  I was hospitalized that January with severe auditory and visual hallucinations.  Once stabilized and released I began to sketch this piece at home.  It was painted and completed in February.  The images on the canvas are all interrelated in that they are all connected by color, form, and movement.

One brush stroke initiates another.  One direction initiates the next direction.  The color moves and changes, bringing energy to the painting.  It is a process that once complete, represents more.  For a moment I feel good.  It is not in me.  It is outside me.  For a moment they are no longer haunting me.  I am free.  And sometimes when I walk by and look at the painting I feel free.

The painting is a self-portrait.  I am surrounded by voices and their visual representations.  I am trying not to hear them, but I hear them.  I am trying not to see them, but I see them.  One voice is commanding.  It commands me to think a certain way, to feel a certain way.  It commands me to stay or move.

Another voice comments on my behavior.  It tells me I look funny and everyone is staring at me.  It often makes me feel paranoid which can lead to more voices and I wonder if people are conspiring against me. 

There are many voices insulting me and degrading me.  This painting attempts to show how I am feeling as I am surrounded by voices.
THE SMI SYSTEM:  A CLINICIAN AND RESIDENT PERSPECTIVE

THE SMI SYSTEM:  A CLINICIAN AND RESIDENT PERSPECTIVE

By Andrew H. Mebane, MD

 

Introduction

As the Senior Consulting Psychiatrist for Southwest Network, I support the diverse duties of the Chief Medical Officer, supervise the providers of four network clinics, treat a substantial panel of patients, and introduce PGY3 psychiatry residents from the Banner Good Samaritan program to their experience in Community Psychiatry.   My professional background is diverse and includes active duty military, academic psychiatry, psychosomatic medicine, addiction medicine, Medical Directorships in HMO and Specialty Care organizations, Chief of Staff and Chief Knowledge Officer with the Veteran's Administration, and Chief Medical Officer for a publically held company. In my present position, the supporting, supervising, and treating responsibilities associated with my job functions are fairly straight forward. Introducing residents to the Arizona SMI system of care? That's something else entirely different.

 

Multilayered system

Even as a professed lover of complexity and avid dweller in the grey zones of medical diagnosis and therapeutics, the public sector system of care in the State of Arizona can be quite daunting even if, on the surface, it may initially appear familiar even simple at times.   Much like an onion, the SMI system has layers of administration at the State, RBHA (regional behavioral health authority), PNO (provider network organization, non-profits) and third party levels of oversight. Vertical duplication of medical management, utilization management, quality improvement, formulary management, and housing may either strengthen or obscure initiatives based upon the effectiveness of communication from the proverbial top down.   Add to this multiplicity regulatory oversight, contractual risk sharing arrangements between the State and RBHAs, and the historical divide between the medical and behavioral health divisions within the Medicaid, AHCCCS, population -- which has historically stalled any meaningful integration of services -- one sees the immense challenges inherent in this system of care. These challenges are, in my opinion, admirably engaged by all layers.

These levels of oversight and the existence of vertical silos are, perhaps, less relevant to the training of residents and more the focus of leadership. Yet, the outcome of such complexity demands clinical flexibility and adaptability in response to regular and occasionally dramatic shifts in benefits and services, outcomes of microscopic quality oversight, or the addition of new mandates such as the implementation of important initiatives like suicide screening. On the front lines of community psychiatry a "no fear" policy is required; that is to say, no matter what happens we are committed to do our best on behalf of our patients.

 

Integrated services

More germane to our residents in training is the requirement for communication laterally across the SMI system of care. Gaining competency in integrating laterally is a very important goal in residency training for community psychiatry. Public sector or community mental health systems necessitate the integration of care in oftentimes totally unfamiliar ways.   There is, of course, the more familiar internal integration within the SMI system - like leading a multidisciplinary team. There is the routine and necessary integration with primary care and other specialty care providers. Extending to a more novel area, lateral integration is needed across social service systems - like interacting with supportive housing programs. Add to this integration with the legal system - like court ordered treatment and the petitioning process. Lastly, we extend our integration across institutions with different missions - like prison systems.

 

Psychiatry resident experiences

Unfortunately, without a community psychiatry experience residency education does not routinely provide experiences that prepare or excite residents to seek service or even a fellowship in this area. There is also a stigma associated with community and public sector psychiatry that psychiatry residents may face when confronted with important career choices toward the end of training. The stigma is, as expected, strongly correlated with a lack of exposure to the system for many of the potential future providers.

 

During our "introduction" residents spend one day a week for three months at our Saguaro Clinic which is the largest of the SWN Clinics located in North Phoenix and comprised of six provider/nurse teams each organized in a "village model" environment. Think of the village model as a greatly expanded multidisciplinary team occupying a large room and with an open door approach. This model allows for team awareness of all patients and facilitates communication between peer mentors and case managers to the nurse and doctor who occupy rooms just off the main area. It is noisy but highly efficient. The residents schedule allows for time in and out of the clinic. Team meetings start the morning's activities, during which time important day to day information is relayed from the previous day's work (no shows, increased symptoms) and sharing information relating to the resident's current schedule. New SMI patient intakes are done, transfers from other clinics seen and staffed, new treatment plans established and follow-up visits accomplished. Exposure to the seriously mentally ill, developing accurate multi-axial diagnoses and implementing evidenced based treatment plans are clinical objectives. The SMI qualifying diagnoses represented at our clinic include a high prevalence of patients with schizophrenia, schizoaffective disorder, bipolar disorder, severe recurrent major depressive disorder and a high incidence of co-occurring substance use disorders. Resilience and recovery are the explicit goals of our comprehensive treatment.

 

To achieve competency in lateral integration it is vitally important for the resident to have experiences outside of the office. These activities may seem much more like social activism than medicine, at times.   Lateral integration is all about mobilization of whatever support the patient needs in the community to successfully live, work and recover. Home visits often reveal much about how a patient is doing. These experiences often stimulate ideas for our regular clinical Grand Rounds. For example, we recently had an excellent presentation and discussion on hoarding with conceptual models for differential diagnosis and treatment. Another topic stimulated by a patient with acute, atypical psychosis delved into the endogenous cannabinoid system and the impact of Spice on our young adult population. Residents also meet with patients and their residential teams for more comprehensive treatment planning while patients are living in structured environments.   One resident recently went into the jail system for a "home visit" and successfully consulted with mental health staff to have a young patient moved from the general population to the mental health unit. These interventions allow the resident to team with both case management and peer support staff in a prototypical kind of extended therapeutic "family" essential to the recovery process in our SMI system of care.
 

Finding the fix and not the fault

Without question, responding to frequent top down initiatives, adapting to benefit changes, understanding the need for unerring quality oversight, and incessant workload pressures make for a very challenging professional environment for a resident or staff physician. Why then would a psychiatrist choose to work in community psychiatry in Arizona? As it turns out, residents take to the clinical challenge and team supported structure of the system like "ducks to water."   For those of us well out of our residency years, I would say that the Arizona SMI system of care is for the psychiatrist that enjoys the challenge of clinical complexity; who understands the power and support of the clinical team; who realizes the importance of quality oversight and of "finding the fix and not the fault"; who is gratified by engaging with patients on their journey in recovery; and, who, like a middle linebacker, is good at moving laterally.

FOUNDER OF NEURO-PSYCHOANALYSIS TO SPEAK IN TUCSON ON SATURDAY, NOVEMBER 10
Eli Lane WorkshopProfessor Mark Solms, best known for his pioneering work integrating psychoanalysis and contemporary neuroscience, will present the second annual Eli W. Lane Memorial Master Workshop titled "Neuroscience and Psychoanalysis Converge," to be held at the Hacienda del Sol resort in Tucson on November 10, 2012. Professor Solms will present a new model for a 21st century treatment of depression that is deeply rooted in attachment theory and affective neuroscience. He will discuss modern views of the dreaming brain, current research on drives, instincts, and emotions, and the separation-loss system implicated in depression. Clinical cases will be discussed. The workshop fee of $150 includes a lecture in the morning, lunch and an interactive clinical workshop in the afternoon. Registration information may be found online. 

 

Professor Solms holds the Chair in Neuropsychology at the University of Cape Town and Groote Schuur Hospital in South Africa. He is president of the South African Psychoanalytic Association and has been awarded Honorary Membership in the New York Psychoanalytic Society. He has published over 250 articles and chapters and 5 books. He is the editor of the forthcoming "Revised Standard Edition of the Complete Psychological Works of Sigmund Freud" (24 volumes) and "The Complete Neuroscientific Works of Sigmund Freud (4 volumes). 

APS:  MEET YOUR FELLOW MEMBER - OLE J. THIENHAUS, MD
Ole Thienhaus, MD 

Ole J. Thienhaus, M.D., attended medical school in Germany and Ireland, graduating from the Free University of Berlin in 1978. He started residency training in surgery but switched to psychiatry, at the University of Cincinnati, after two years and finished his training in 1983. He added fellowship training in geriatric psychiatry and  was named as chief of the Geropsychiatry service at the University of Cincinnati Medical Center in 1985. He was hired as Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine in 1996 and from 2008 to 2010 served as Dean. On March 1, 2012, Dr. Thienhaus assumed the position of Professor and Head of the Department of Psychiatry at the University of Arizona College of Medicine in Tucson. As of May 2012 he also serves as a member of the Board of Directors of the University of Arizona Health Network. He hopes to facilitate the establishment of a Center of Emotional Health at the University of Arizona.

 

Dr. Thienhaus has been married for 31 years to Teri, an attorney and HR specialist. They have one son, Lukas Samuel Thienhaus, who is 21 and recently graduated from McGill University in Montréal, Canada, with a Bachelor of Science degree in Chemistry. Dr. Thienhaus, who also holds an MBA degree in marketing and management from the University of Cincinnati, is interested in health care economics and mental health issues as a function of the life cycle. He is Board-certified in psychiatry, geriatric psychiatry and administrative psychiatry. Outside psychiatry, he is an enthusiastic student of Midrash, and an instrument-rated private pilot. He was attracted to our field, first by the model of his late father, a psychoanalyst, and, secondly, by his experience as a surgical resident having to deal with the psychiatric symptoms in patients after neurosurgical procedures. He is fascinated by the intersection of biological sciences with both philosophy, psychology and sociology as they converge in psychiatric nosology. He is especially attracted to fundamental, conceptual thinking as it applies to diagnosis and treatment of behavioral disorders. He is quite taken with the current research efforts at the University of Arizona pertaining to mind-body medicine. Dr. Thienhaus, as clinician and educator, tries to counteract current trends in psychiatry to reduce the affliction of mental illness to a litany of syndromes that await the right pill to reverse them. His thanks for his professional success go to his adored psychiatric teacher, Marshall Ginsburg, M.D., at the University of Cincinnati, as well as to Rabbis Jakob Petuchowski and Edward Boraz, both of the Hebrew Union College, who immeasurably widened his horizons of understanding the essence of human suffering. Dr. Thienhaus, to this day, and without qualification, still finds the encounter with a psychiatric patient the most rewarding, challenging and exciting motivator to make him go to work every morning. His clinical practice is primarily focused on care for the chronically and severely mentally ill, and the care of Native Americans, as well as delivery of psychiatric services to incarcerated populations. Two textbooks he edited on Correctional Psychiatry, published in 2007 and due in 2013, attest to his commitment to his clinical areas of interest.

BE A MENTOR, CONNECT WITH A MENTOR
 
Several APS members have volunteered to be available to our early career members as mentors to answer questions and lend a personal insight to a career in psychiatry.  Please call Teri at 602-347-6903 or e-mail Teri with the nature of your mentor question (public or private psychiatry, academic, etc.) and the best way for a mentor to contact you.  If you are an APS member interested in serving as a mentor, please contact Teri.  Your support of our early career members is valued greatly. 
REPORT FROM THE AREA VII ASSEMBLY
 

APA BenReport to APS of the Area VII Council Meeting of the APA Assembly

  Aug.10-11, 2012 Boise, ID

Jehangir "Jay" Bastani, MD, DLFAPA, Assembly Representative

 

The summer meeting of the Area VII Council meeting was held at the Hampton Inn in downtown Boise, Idaho on August 10-11, 2012 with all except the Colorado District Branch in the Area VII represented. Themes permeating this meeting were: (1) Scope of Practice legislation (2) resources of APA available for the membership and (3) declining membership. Guests from APA were introduced: Mindy Young MD, Speaker Elect of the Assembly, Kate McCollister, APA Legislative Field Specialist and Jay Scully MD, Medical Director of the APA.

 

An Action Papers from Area VII for the Fall Assembly meeting was introduced for discussion on the "Relative effect of rising Medical School Debt choice of Psychiatry as a Career" for residency match. There has been no increase (average 4% of all applicants) in the past 8 years of applicants for psychiatry residency.

 

Following is the goings-on in the Area VII District Branches (DB) as per Representative presentation:

 

New Mexico - Scope of Practice bill for psychologist was passed by their legislature 10 years ago. Of 700 psychologists in their state, only 30 are registered to prescribe. They believe this reflects the professionalism of their psychologist. Of these 30 registered psychologists, 10 are residing out of state. In the New Mexico state larger cities, Albuquerque has 6, Santa Fe-2 and Las Cruces has 6. The original intent of push for rural care was not borne out with the psychologist congregating to urban areas. Oregon - Consumer Care Organizations (CCO) are being rolled out and issue of fair payment and access for the mentally ill was being discussed. Some of the CCOs are physician-led where the psychiatrist have better representation. Others are hospital and county led. Currently they are dealing with a high profile ethical issue arising from some deficits in the APA Ethics Guidelines on Confidentiality. Their current Executive director and lobbyist are retiring. Oregon DB has developed a checklist for Suicide.

 

Utah - They are planning a Fall conference with focus on DSM-5. Their state dues were increased as was unchanged for 20 years. They have a new Doctorate for Nurse Practitioner program and graduates will be referred to as "Dr." OPTUM, their state mental health contractor, has unilaterally placed a ban on reimbursing for ECT for all mentally ill receiving it as well as future requests. An OPTUM staffer (non-MD) comes weekly for in-hospital staffing and "recommends" treatment. Their University residency program has increased from 6 to 8 residents a year with an increase to 10 residents anticipated.

 

Washington - Their annual meeting was held in Eastern Washington to make it easier for psychiatrist from that part of the state to attend their meeting lost them $10,000/- due to poor attendance - only one DB member attended from that half of the state. No foreseeable plans to host a meeting there. A workshop on "Suicide" is planned for October 6, 2012 sponsored by their University faculties. The Shrinks and Drinks talks are proceeding favorably with their former DB president, meeting members monthly from King County and giving talks on assorted topics such as E&M Codes, Codeine etc. Their legislature passed a bill requiring all allied mental health professionals to take 8 hours annually in CME training on Suicide- psychiatrist were exempt from it. There was a major change on mental health care delivery to children and adolescence from a law suit with their State given 4 years to implement it.

 

Western Canada - Enrollment in their Vancouver University psychiatry residency program is projected to increase to a total of 120 residents in their 5 year program. Currently shortage of psychiatrist is faced in Alberta province. Pharmacist prescribing, though legislated, is limited to them filling weekend medications and for a 30 day med-renewal till a new medical provider is found. They are reluctant to take on regular prescribing responsibilities. The Colorado shooting event is very much on the mind of their psychiatrists.

 

Wyoming - Governor is expected to expand Medicaid program. Doctorate Nurse Practitioners can practice freely but for hospital privileges. Telemedicine is firmly entrenched since there is paucity of psychiatrist and is utilized for child assessment and placement recommendations. There is a strong push to move geriatric mentally ill out of State Hospitals into the community Nursing homes. With their small MD population, APA awarded them the Award for the most percentage increase in membership.

 

Alaska - With their DB President in Sitka, the Executive Committee has met three times to date. A nurse practitioner is running for the Alaska house seat. The state has no plans for a Psychiatry residency. Responsibility of funding for the mentally ill is being passed on to the Mental Health Trust Authority. It is a land grant and this funding responsibility falls outside it original charter that was limited to certain illnesses, primarily organic in origin (TBI, Alzheimer disease etc.).

 

Colorado - There was no representatives from Colorado at the meeting.

 

Hawaii - Membership has dropped since the annual meeting held a year ago, though their call list has been successful to a limited extent, calling on those members. Their members are not interested in CME as per their surveys. They have held successful blogs and interviews on Internet radio on relevant psychiatric topics. Scope of practice remains an issue. APA has reviewed their By-Laws and finances. Idaho - Their membership is down to 50 and declining with reduction in their budget. Their website is up and running. They have 3 psychiatry residents who plan to reside in Idaho post-graduation.

 

Montana - They are under financial constraints arising from the scope of practice legislation and expect this legislation to resurface in 2013. Their legislative representative resigned for health issues. They continue to have difficulty recruiting psychiatrists. There are no med schools in Montana.

 

Nevada - Their annual Psychopharmacology Update seminar (over five days) is getting popular and next year the site is relocated to Paris Hotel in Las Vegas (Feb. 2013). Their State DB dues are going up from current $200/-. They plan to hire an Executive Director in Las Vegas where 75% of state membership is located. Scope of practice is not an issue as their legislature meets every 2 years.

 

ECP Report - APA Focus On-line version will be made free to all ECP as part of their membership benefit on a trial basis. The Philadelphia Meeting workshop on "Transition to Private Practice" was successful and will be holding another one in San Francisco. Monica Taylor Desir, MD (from the Arizona District Branch) will represent Area VII ECPs at the Council & Component meetings with other identified ECP to work on projects for 1 year to benefit APA.

 

MIT Report - The MITs are working on 3 issues pertaining to: (1) Membership- encourage them in joining the APA by targeting their residency directors,(2) Mentorship- create database and (3) Policy on Pharmaceutical involvement- in some residency programs, the latter is grounds for disciplinary action. Area VII Trustee's Report - Area Trustee was absent at the meeting.

 

Medical Director's Report - Jay Scully MD was present at the meeting and shared the crafting and coordinating of the DSM 5 which will be voted by the Assembly (up or down vote) in November and the APA Board of Trustees in December 2012. Members can currently view it under www.DSM5.org website and it is subject to changes. It will be released in its final format at the APA annual meeting in May 2013. There will be special train-the-trainees (medical and allied professionals) seminar for the DBs at the Annual Meeting. The Supreme Court decision on ACA will have ramifications especially post-election. Though federal budget 'sequestration' has been put off till March 2013, Medicare payments will see cutbacks as early as January 2013. APA is currently meeting with 14 Medicare specialties for combined response to this. The political approach in Washington used to be "I am right, you are wrong" making it amenable to debate and compromise. The current atmosphere is "I am right, you are bad" making debate by both parties impossible. Budgetary cuts in graduate medical education (residency slot reduction) are now a certainty. With this cutback, we are looking at a looming crisis with the graduating medical oversupply of MD/DO in 2016. Financially, the APA is getting back on sound fiscal track.

 

Other items:

 

The Annual State Advocacy Day for DB Legislative Representative is being resumed annually in Washington DC, to be held in March 2013.

 

CPT Codes are being revised by CMS (former HHS) and APA members will know more in September 2012. In the meantime, members are encouraged to try working with the Evaluation & Management (E&M) codes in their practice, even though it require inclusion in their progress report of what they routinely do as part of patient care.  APA Members may check out the E&M codes by taking a 2-hour CME tutorial on the APA website.  After member log-in, it will be located under the Practice Section.

 

Kate McCallister, APA staffer from the Governmental Affairs Division, made a special one hour presentation on Legislative Issues that are facing District Branches that was well received.

CPT CODING CHANGES TO IMPACT PSYCHIATRISTS
APA Posts AMA Changes to CPT Coding for Psychiatrists

For 2013 there have been major changes to the codes in the Psychiatry section of the AMA's Current Procedural Terminology, the codes that must be used for billing and documentation for all insurers.

 

APA members may access specific information about the changes [Member login required], including a list of the new codes and a crosswalk of 2012 CPT Codes to their replacement 2013 CPT codes via this link to an APA member only webpage

 

For additional information or for help downloading the documents, Members may call (800.343.4671) or email (hsf@psych.org)  the HSF Practice Management HelpLine.  If you have forgotten your User ID or have never been issued one, please call the APA Answer Center at 888.357.7924 to request your APA User ID.

UPCOMING CME OPPORTUNITIES AND SAVE THE DATE INFORMATION

Arizona Suicide Prevention Coalition Hope Conference, The Power of Saving Lives in Today's New World, October 4-5, 2012.  Click here for more information.

The 21st Annual Psychopharmacology Review Course: Current Clinical Practice will be held February 18-22, 2013 in Tucson, Arizona.  This multi-day educational activity is organized to meet the needs of practitioners who treat mental health disorders.  It serves as an annual update of current clinical practices and research focusingon psychopharmacology topics.  Visit the Psychopharmacology Review Course webpage for more information.

Arizona Psychiatric Society Annual Scientific Meeting, April 2013.

American Psychiatric Association 166th Annual Meeting, San Francisco, California, May 18-22, 2013, Pursuing Wellness Across the Lifespan.

RESIDENTS 100% CLUB, ECPs FOCUS ONLINE, APA DUES CYCLE

Residency programs with 100% membership in the APA by October 31st (both new and renewed) receive free "Focus"

"FOCUS Online" will be available on an initial trial basis as a free MEMBER BENEFIT for ECPs as the result of an Assembly Action Paper.  

To all Members, the APA dues drop date was June 30th.  Act now to administratively reinstate by October 31st.  Contact the APA today!

FREE EDUCATION FROM APA ON CPT CODING, PERFORMANCE IN PRACTICE, AND MORE

Visit APA Education online for information on these and other FREE MEMBER BENEFIT education opportunities.APA free education highlight

 

Performance in Practice (PIP)

FREE for APA members! ABPN approved for MOC part 4, Earn 20 AMA PRA Category 1 Credits™

* Physician Practice Assessment Tool for the Assessment and Treatment of Adults at Risk for Suicide and Suicide-Related Behaviors Available Now

* Physician Assessment Module for the Screening of Adults with Substance Use Disorder (SUD)

* Physician Practice Assessment Tool for the Assessment and Treatment of Adults with SUD

 

Evaluation and Management Coding (CPT) and Documentation for Psychiatrists

New Course FREE for APA members! ($40 for nonmembers) How to correctly use the CPT codes for general medical evaluation and management (E/M) of patients. E/M codes are often the most appropriate codes to use for psychiatric care. Although medical evaluation and management is a critical part of current psychiatric practice, E/M codes remain an underused resource. The course can be accessed HERE. Participants earn up to 2 AMA PRA Category 1 Credits™.

American Professional Agency, Inc. (paid advertisement)
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PRMS Psychiatrists' Program (paid advertisement)
PRMS Resized Ad Sept 2012    
APS Newsletter Committee:  Robin Reesal, MD, Chair, Elizabeth Kohlhepp, MD, and Gretchen Alexander, MD

For address corrections or updates, please contact Teri Harnisch, Executive Director, Arizona Psychiatric Society, by reply e-mail or by calling 602-347-6903.