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May 2013 Edition 

Greetings!
 
Greetings!

MPS Mission: "The Michigan Psychiatric Society represents the interests and professional needs of psychiatric physicians in Michigan while striving to ensure quality care for people with mental disorders and their families through promotion of education, research, and advocacy."

 

As I reach the end of this year of service as your president, I am pleased by the tasks we have accomplished together including two scientific meetings, training in the new CPT codes, plans for training in DSM5, updates to our bylaws, advocating for our profession and collaboration with other groups on the issues important to us (parity, appropriate training for juvenile competency, standards for health insurance providers, care integration, promoting the concept of the multidisciplinary team). Yet I am fully aware that we have much work to do.

 

In my travels around the state thus far (which I plan to continue in the upcoming year), I have heard about a variety of issues; however, they boil down to a few overarching themes, and if one is a "lumper" (which I sometimes am), perhaps just one theme: how can we in MPS support each other in fully realizing our professional identity?  With so much day to day juggling of our responsibilities it can be tempting to let go of the "little" items that we think probably don't matter much, like choosing the medication that is on the insurance formulary even though we may have substantial clinical reasoning behind the choice of the non-first line medication, or acquiescing to expectations that we will focus on "medication management" in the shortest increments of time possible.

 

Simply put, we must get better at ensuring the best available care for our patients and to accomplish that goal we must stand willing to advocate for our professional identity and the importance of professional standards. At the same time, we will need to find new and creative ways to improve access to care by collaborating to develop systems of care.  The mission of MPS is to be our professional home, supporting all of the activities needed for us to achieve our shared goals.  If you are an MPS member, but have not been active, please find your area of passion and use that energy to make these changes. 

 

As you find challenges in your daily practice, please let your MPS colleagues know so that we can support your efforts for your patients.  If you happen to be reading this and are not an MPS member, please join!
 
In this issue
Gavel passes to Achytes
New MPS Officers
Take me out to the ball game!
Mental Health Commission
DSM-5 Workshops coming
Advocating for Medicaid
Parity in the Insurance Exchange
View from BCBSM Tower
Survey-participants needed!
STOP CPT CODING ABUSES
Do you know about the Sunshilne Act?
Member Communications Award
Plan on Stratford
Advertisements...visit our advertisers!
Pythi....
Eric Achtyes, MD
   Gavel passed to Eric Achtyes at MPS Spring Meeting

Preparing to assume the Presidency of MPS, Eric Achtyes offered the following remarks at the MPS Annual Meeting:

There are numerous challenges facing psychiatry today: a national discourse on violence and mental illness; the re-integration of behavioral science and psychiatry with the rest of medicine; the pending release of the DSM-V and all the economic and sociopolitical implications, not to mention diagnostic and treatment challenges, this will bring for providers and patients alike; the questions of how we as a Society help negotiate and manage the reality of the Affordable Care Act, and can we do this in a way in which the needs of our patients' are placed first?  Can we as practitioners effectively balance our personal lives with the needs of our institutions and patients, while meeting an ever increasing licensing and regulatory burden?  Can we nurture the fragile link between the doctor and the patient in an ever more rushed, technologically driven clinical interaction?  These and other questions will dominate the landscape over the next 12 months, and likely for years to come.  The leadership of MPS certainly cannot face these challenges alone and will need your support, expertise, and wisdom to help our professional society navigate these many known, as well as unforeseen, challenges. 

 

Yet, I'm hopeful, that by working together, we can accomplish great things such as: realizing appropriate reimbursement for the service we provide while genuinely meeting the needs of our patients; conducting ground-breaking research to unlock the secrets of the mind-both when functioning optimally, and when broken by illness and disease; teaching and inspiring the next generation of trainees not only to follow in our footsteps, but to look further, see deeper and understand psychiatric illness and its treatment better than we do today.  I am also committed to encouraging and growing the role of psychiatrists in administering psychotherapy.  A skilled psychotherapist provides critical, evidence-based interventions that we as psychiatric team leaders need to direct for the benefit of our patients.  I also believe we need to encourage talented psychiatrists among us to develop the administrative tools necessary not just to run psychiatric units and departments, but to run entire hospitals and health systems.  We as physicians and psychiatrists, myself included, have been complicit in allowing the healthcare system to be guided by colleagues who may not share our conviction that the care of the patient should come first.  The fact that medical debt is the number one cause of personal bankruptcy in the United States today is a tragedy in which we all have a stake and ought to work tirelessly to change.  If the practice of medicine is to survive in any sort of meaningful, relational, and fiduciary way, we cannot afford to be complicit bystanders in this effort.

 

We are privileged in so many ways to do the work we do.  Patients come to us in moments of intense distress and need.  We get to hear about their deepest fears, dreams, and desires, things they may have told no other human being, including their partner, children, parents, best friends or clergyperson.  We have been trained and equipped with tools that can help, and have the responsibility to see that our patients receive the best assistance that can be offered.  What an honor!

Jonathan Henry
       New officers join the MPS Council...
  departing officers are thanked for their service


Jonathan Henry, MD assumes the office of President-elect. He will shepherd the strategic planning role helping MPS hew to our mission as we field an era of change in healthcare systems. 

 

 


Nina Anderson, MD will take over the job of MPS Secretary-Treasurer as we sincerely thank Duane DiFranco, MD for his diligent oversight and thoughtful leadership in that role for two years.

 

 

 

We welcome two new officers serving as MPS Councilors, as we extend our gratitude to our departing Councilors, Isha Salva, MD and Deepika Sastry, MD


Michael Fusillo, MD ...

                                          
                                             ...and Amy Rosinski, MD 

  Join MPS for a Tigers baseball game at Comerica Park

 On Sunday, June 23rd at 1:30, the Tigers play the Boston Red Sox

We have 20 tickets available for $20 each. Members will be limited to 2 tickets each--first come, first served--by emailing the MPS office at [email protected]

We have an additional 10 tickets for Residents.  The first 10 Residents to email [email protected] get the free tickets!

Everyone will meet up at the Elwood Bar and Grill beginning at 10 am...where the tickets will be distributed.
 
            Mental Health and Wellness Commission holds first hearing  
                   and forms Committees---MPS offered testimony 

Lt. Governor Brian Calley presided at the first hearing of the Mental Health and Wellness Commission on April 23rd, having requested public feedback and
proposed solutions to help bridge the gaps that exist between the state's needs and the ability to care.  

The commission, which includes members of both legislative houses and is bipartisan, heard testimony about the inadequacies of the current system, which were acknowledged by the Lt. Governor, as was the previous work done by predecessor commissions.

MPS testimony was delivered by President-elect Eric Achtyes and included many of the elements of the message included in this newsletter as well as encouraging the department to provide medical leadership at the state-level.

Five workgroups have been assigned, to be lead by members of the Commission.  Sen. Rebekah Warren (D-Ann Arbor)
will oversee a workgroup concerned with education, employment and veteran issues; Sen. Bruce Caswell (R-Hillsdale) will focus on society impacts, data/outcomes and stigma reduction; Rep. Matt Lori (R-Constantine) will oversee public safety, beneficiary rights and protection issues; Rep. Phil Cavanagh (D-Redford Township) will look at integrating mental health and physical health services;  and Community Health Director James Haveman
will chair a workgroup on housing, independent living support and long-term care. MPS will report on workgroups and encourage members to participate. Contact the MPS office with any questions or concerns. 
 
CLICK HERE for the Commission website and updates.
 
                 MPS will provide DSM-5 Workshops

Northern Members...save-the-date for a 4-hour course at the Grand Traverse Resort on Saturday morning--July 27th at the ACONP Summer Meeting...watch your inbox for registration and details

Michael Jibson, MD, Eric Achtyes, MD, and Beth Ann Brooks, MD were trained at the APA Annual Meeting at a special DSM-5 Train-the-Trainers session.

MPS will be scheduling local meetings. For information on conducting training for your programs or practices, contact the MPS office at [email protected]

Watch your inbox for opportunities to attend DSM-5 workshops  
presented by MPS experts.
MPS joins health and mental health advocacy groups
to urge legislature to approve Medicaid expansion provided under the ACA

Governor Snyder, in his budget recommendations, proposed that Michigan accept federal money to expand Medicaid under the Affordable Care Act. Expanding Medicaid coverage to those who earn up to 133 percent of the poverty level could help cover 320,000 more low income Michiganders. Supporters include virtually all health and many business groups who maintain that the makes financial sense for the state and also could lead to a healthier population.

However, many Republicans have been skeptical of the plan and it was not included in the budget legislation that recently passed both houses for the fiscal year that starts in October.

HB 4714, sponsored by Representative Matt Lori (R- Constantine) would allow for Medicaid expansion in a separate bill, however the bill currently contains reform measures that would affect much of the overall system. Many observers are concerned with a proposed 48-month cap in eligibility for non-disable adults that is designed to promote personal responsibility.

CLICK HERE to read our group advocacy letter making the case for expansion benefits for those with mental health needs


 
 
 
Michigan Department of Insurance and Financial Services will oversee  
Health Plans and Insurer's implementation of mental health parity 
 
Essential Health Benefit parity requirements will bring fair and equitable coverage to Michigan's privately insured employees and individuals both on and off the Exchange.  
 
MPS has engaged in discussion with the state insurance authority and federal HHS officials to ensure that there is a common understanding of what constitutes a parity mental health and substance use disorder benefit. The most recent communication we received in response to our request for the parity benchmark or standard is as follows:

"Thank you for your concern regarding the lack of mental health parity in the Michigan Benchmark plan. Director Fossitt asked me to respond to your request. We hope this provides you with the information you require. 

The Department of Insurance and Financial Services (DIFS) is aware that the plan chosen as the Michigan Benchmark plan does not meet the requirements of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Michigan's selection for the Benchmark Plan was a small group plan, and therefore, it was not required to meet the MHPAEA requirements at the time of its selection. States are required to take their Benchmark plan "as is" however, states may supplement the Benchmark to comply with the requirements of the Affordable Care Act and other laws.

Because the Affordable Care Act expanded the MHPAEA, extending it to qualified health plans as established by the ACA (See Affordable Care Act � 1311(j); see also PHS Act � 2726, ERISA � 712, Internal Revenue Code � 9812.), states have been informed that all health plans must comply with the MHPAEA as of January 1, 2014. Accordingly, DIFS will review each plan submitted for purchase, both on and off the Exchange, for compliance with all applicable state and federal laws, including the MHPAEA. DIFS will utilize the most current guidance for ensuring compliance with the MHPAEA, including 45 CFR 146.136."  

Michigan is among eight states selected by APA's Health Systems and Financing Division for a close focus on the implementation of parity under ACA.
BCBSM tower
Viewpoint from the BCBSM Tower:

        Communication Comes Before Integration

 

I have returned from the APA meeting in San Francisco, a meeting with the sobriquet "Pursuing Wellness across the Lifespan".  Then I was leafing through a copy of Clinical Psychiatry News, and noted a headline "Integrative care is the future of psychiatric care".  According to Dr. James Scully CEO and Medical Director of the APA, "we are going to have to change the way we do business in order to survive.  We have to change our availability."  How right he is, and in more ways than one!

 

As part of our upcoming NCQA accreditation process, Blue Cross and Blue Shield of Michigan recently completed a survey of the primary care charts of patients who had received care from various specialists in order to determine how frequently there was communication between the specialist and the primary care doctor (PCP).  For other non-psychiatric specialties, the reviewers found a note, letter or other evidence of communication from the specialist to the PCP about two thirds of the time.  When the charts of patients who were receiving a prescription drug from a psychiatrist were reviewed, such communication was found only one percent of the time!   Although I did not expect the number to be as high as those of other specialists, I was surprised to see how low the actual number was.  And, I must say, I was somewhat embarrassed.  Perhaps there are some methodological difficulties with the survey, but not enough to explain this difference.  I bet you are all pretty shocked, too.

 

Dr. Scully is telling us that we need to be ready to change our model, that we need to find ways that we can better integrate our work with that of the primary care (and other non-behavioral health) clinicians.   It's hard for me to imagine us delivering integrative care when we are not even communicating important clinical information to our patients' primary care physicians. 

 

I wonder why this is and I imagine we all have our reasons: perhaps we do not want to take the time, or believe that it would be a violation of HIPPA or Michigan Mental Health Code. Maybe we feel that it is the responsibility of the patient to deliver information about his/her psychiatric diagnosis and/or pharmacotherapy to the PCP.  Perhaps we view our work as very private (which it is to a great extent) and think that patients would be upset if we asked for their permission to send (limited) information to the PCP, just as other specialists do.   Bu I think these arguments are spurious.  In my experience patients usually welcomed the communication and often requested it even before I made the suggestion.   Regarding HIPPA, it is perfectly legal to divulge patient information to others as long as the patient gives us permission.  (In fact, before I left practice, I was designing a combined release and medication information form to send to patients' physicians as a routine part of my patient evaluation process.)  Finally, our patients may forget to discuss their psychiatric medications with their PCPs, either in error or because they do not realize that is important.  Also, it would be a mistake to assume that all of our patients possess the requisite level of health literacy to pass accurate information on to their PCPs.

 

I believe that part of the problem relates to ambivalence regarding our place in the medical community.  We want to be valued as physicians but often do not act like physicians.  Even though many of us are primarily psychopharmacologists, we still carry a long tradition of "secrecy", possibly masquerading  as discretion. (Recall the analytic tradition of having separate entrance and exit doors to the consulting room.)    We need to remember that the medications that we prescribe are not benign and that many have significant impact on pre-existing disease states (e.g. the impact of a neuroleptic on serum glucose) and interactions with other medications.  Just as we should be asking our patients about all of their medications, PCPs need to know about all of the drugs that we prescribe, at the very least.  It is not only possible, but necessary, to communicate this and other information about our patients without divulging private information that the PCP does not need to know.

 

I urge all of you to make this kind of communication a routine practice.  I believe your patients will appreciate it as will their other physicians. Such a practice might even increase your referral rate!

 

Dr. Scully, how can we  think about integrating behavioral health treatment into the rest of medical care if we are not communicating?

 

Beth Goldman MD, MPH

 

Dr. Goldman is a past editor of the MPS Newsletter and is currently Medical Director, Behavioral Health, Blue Cross Blue Shield of Michigan

Survey Feedback
Second Request--Attention psychiatrists who treat children:

Please participate in an important survey regarding Psychotropic Medication Management of Foster Children in Michigan 

This research project is being conducted to find out more about physician comfort with prescribing medications for mental health problems to youth and the factors affecting their comfort level. Also, we ask about experience with treating foster care children and understanding of Michigan policies with respect to this population. Finally, we ask about what gets in the way of treating foster care children and what may improve their care.

Thank you in advance for taking the time to link to the survey: https://www.surveymonkey.com/s/psychfostercare  

STOP CPT CODING ABUSES--ACHIEVE MENTAL HEALTH PARITY NOW

                            APA and MPS ARE WORKING FOR YOU

 

CPT code changes were intended to more accurately reflect the work psychiatrists do and improve patient access to care, but instead have been used as an excuse by some payors to discriminate against psychiatric patients and their psychiatrists in violation of the Mental Health Parity and Addiction Equity Act (2008).  The issues differ from state to state and from carrier to carrier. The APA Board of Trustees has committed significant APA resources, both financial and staff, to understand the situation and use all reasonable means, including litigation, to correct the abuses taking place. MPS is coordinating with APA to understand the situation in Michigan.

 

                                           GET PAID, ACHIEVE MENTAL HEALTH PARITY

APA staff and attorneys have already begun implementation of a solid plan of action to combat this abuse.  However, you, the psychiatrists who contract with the payors, have the specific information we need to cause a change. The situation cannot be improved unless every one of you helps

 

                     Click here  and help us help you and your patients

Are you aware of the reporting requirements under the
Physician Payment Sunshine Act?

Under the Physician Payment Sunshine Act, manufacturers of drugs, devices and biologicals covered by federal health care programs are required to report any payments and transfers of value they make to physicians and teaching hospitals beginning August 1, 2013

 

In addition, any ownership or investment interests physicians or their family members have in the manufacturers or group purchasing organizations must be disclosed to the Centers for Medicare & Medicaid Services (CMS). Most of the information will be posted in a public online database to be launched by September 30, 2014.

 
See more information on the AMA Sunshine Act Web Page
                Member Communications Award 

MPS was awarded a "Certificate of Continued Excellence in Member Communications" from the APA Council on Communications to acknowledge our use of new technology to effectively communicate with APA members and external audiences on matters of importance to psychiatry.
            Stratford plays are chosen...Save the date!

Treat yourself and make plans to head to Stratford next year with MPS 
On October 18th and 19th, MPS will be offering tickets to the Merchant of Venice and Romeo & Juliet. As we have every year, we are hosting our exclusive breakfast talk-back with the actors, an experience not to be missed. Watch your inbox for registration information. Plan on joining us at the Festival for an uplifting experience. 
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General Psychiatrist needed in Michigan--no call

 

Don't miss this opportunity to work at a premier facility providing comprehensive care for the community. Use your clinical and collaborative skills with a facility that values Psychiatrist input and contributions. All outpatient settings. No call!

 

Job Description:

         Collaborative clinical team

         All outpatient

         No call

         Picturesque shore community

         Enjoy all the activities of Lake Michigan

 

Job Benefits:

         Competitive compensation

         Generous paid time off

         Full medical benefits

         Malpractice covered

         Michigan loan repayment available

 

Please contact Amy Wylan at 800.365.8900 ext. 6675 or  [email protected] Ref job #213581

ESS logo
                      Full-time and part-time positions
                        for adult and child psychiatrists
  
Easter Seals Michigan is seeking full-time and part-time/independent contractor adult and child psychiatrists to work in various locations throughout Oakland and Macomb counties.

Easter Seals offers a comprehensive and competitive employee benefit package for full-time employees including medical, dental, vision, short and long-term disability, CME hours, generous vacation and personal time, and a 401k plan.  

CLICK HERE for more information or contact Easter Seals directly by contacting Danielle Morgan at 248-475-6418 or via email at [email protected] 
 
Job Posting for Psychiatrist (Part-Time)

 

Northbrook Psychological Clinic in Novi has part-time position open for board-certified/eligible psychiatrist to see our adult clients. Great if also could see adolescents/children. Excellent compensation and working conditions.

Email [email protected] or Fax resumes to: NPC (248) 344-7423

PSYCHIATRIST AND/OR MEDICAL DIRECTOR

 

New clinic opening in a well-established psychologist office in Livonia

The position will start off as part time but can become full time immediately, the psychiatrist will be able to set their own hours and time spent.There are approximately 20 patients that could be started within the first month.Experience is not required. Great pay plus bonuses will be offered.

 

Please contact:

 

Michigan Psychological and Counseling Institute, LLC
                     
               Pardon My Politics; No, Never Mind 
 
In a recent column Pythi wrote about guns and mental illness, and how it is not mathematically possible to accurately predict (and thus prevent) the type of fortunately very rare mass shootings that have occurred in the USA in the past several decades. Unfortunately, as long as guns are so widely available, we can predict that the high rate of completed suicides involving handguns will continue. According to the Centers for Disease Control and Prevention (see figure in The Economist, December 22, 2012, page 37), the suicide rate by firearms is almost 20,000 per year (almost 2/3 of all firearms deaths), and has not changed significantly in the past 30 years.

Gun advocates have tried to shift the blame from guns to people, especially "the mentally ill." Certainly, in the case of suicide, this is blaming the victim. Is it a person's fault that he or she is so depressed that the only escape seems to be death? "Guns don't kill people, people kill people." It is much easier for people with guns to kill people than people without. That includes people who kill themselves.

We are not going to rid ourselves of 300 million guns anytime soon. But, as the old adage goes about getting out of a hole, we first need to stop digging. That might mean keeping guns away from those who are going to use them destructively, but that is not just about people. It is also about reducing both the number and access to guns. It's not just the people that are the problem. To a very great extent the guns are the problem.

Pythi wades into this very politically contentious argument with trepidation. But it is our responsibility as caregivers and advocates for the mentally ill to not just be quiet while inappropriate blame is being assigned. 

- Pythi 

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