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August 2013 Edition 

Eric Achtyes, MD 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."

 

DSM-5 - What it means for psychiatrists...?  

 So much has been written about the new DSM-5, positive, negative, or in between, that I'm hesitant to join the fray.   And whether you love it, hate it, or are currently indifferent, it is the manual we will all be using to diagnose psychiatric illness in our patients.  At least the DSM-5 authors are willing to acknowledge up front the need for our science to continue to mature, calling the DSM5 a living document that will need modification as our understanding of psychopathology advances.  We may very well see a DSM-5.1, 5.2, etc.  This is how progress in science is made-through incremental observation and questioning, testing of hypotheses, and subsequent validation of those discoveries.  Examples of some of the major changes include the collapse of Autism, PDD-NOS, Child Disintegrative Disorder, Asperger's, and Rett's Disorder into Autism Spectrum Disorder.  The multiaxial system of diagnosis has been dispensed with, as have GAF scores, replaced by a much more involved disability assessment call the WHODAS, 2.0.  Other changes involve renaming or collapsing disorders to reflect current norms, such as the renaming of Mental Retardation as Intellectual Development Disorder, or the merging of Substance Abuse and Dependence into Substance Use Disorders, with severity measures to illustrate seriousness of the illness.   

 

Do I believe the DSM-5 is perfect?  No.  Some of the new disorders leave practitioners scratching their heads for best approaches to treatment, such as the newly released Disruptive Mood Dysregulation Disorder, which is meant to eliminate overdiagnosis and overtreatment of childhood bipolar disorder.   

 

Does DSM-5 begin us on a path toward a more biologically sound nosology?  I think it may.  The order and structure of the chapters allow for a developmental approach to be taken.  Authors indicate that now child and adolescent psychiatrists will need to read the whole manual, not just the first few chapters, as developmental themes guide not just the overall order of the chapters, but also the content within each chapter.  It also separates out Obsessive Compulsive Disorder from other anxiety disorders, which is appropriate given what is known about the neurocircuitry involved in OCD.  Other changes are more minor, such as eliminating the exclusion that prevented bereaving patients from being diagnosed with Major Depression and renaming Dementias and Minor Cognitive Impairment as Major and Mild Neurocognitive Disorders, respectively.  All in all, the manual makes incremental changes that will allow for continuity in treatment of our current patients, with the ultimate goal of moving our field to a more objective assessment based on neuropsychiatric principles.  An empiricist and neurologist, Sigmund Freud would have loved that!

 

{If you'd like to learn more about the changes in the DSM-5, plan to attend the MPS DSM-5 educational session at the Fall Scientific Meeting, scheduled to be held on 9/20/13-9/21/13 at the Postema Center of Pine Rest in Grand Rapids, Michigan.  Come to learn about DSM-5 as well as hear an update on addictions: Bath Salts, Gambling and Medical Marijuana.  While in town, stay for the Artprize event, which will be going on simultaneously.  To register: visit our website at: www.mpsonline.org and watch your inbox for more information.}

 

 - Eric Achtyes, MD

In this issue
MPS Fall Meeting
Mental Health Commission
Parity in the Insurance Exchange
Survey-participants needed!
STOP CPT CODING ABUSES
Do you know about the Sunshine Act?
Plan on Stratford
Advertisements...visit our advertisers!
Pythi....
MPS Fall Meeting September 20th and 21st in Grand Rapids--
                                 Save the Date
 
              Friday, September 20, 2013 * 12:30 PM to 4:45 PM

           High, Low & In Between:
              Gambling, Bath Salts & Medical Marijuana

 

Saturday, September 21, 2013 * 9:00 AM to 1:00 PM 
DSM-5: Classification, Criteria, and Use

 

Postma Conference Center * Pine Rest Campus * 300 68th St SE  * Grand Rapids, MI 49501

 

Come to Grand Rapids for either or both sessions of the MPS Fall Meeting
and also make time to take in the citywide ArtPrize event

 

FRIDAY:High, Low & In Between: Gambling, Bath Salts & Medical Marijuana
  • Gambling Disorder: Clinical characteristics and treatment considerations  
    - David M. Ledgerwood, PhD --Asst. Professor Psychiatry and Behavioral Neurosciences,WSU
  • Intoxication By Design: Considering the Effects of Synthetic Cannabinoids and Synthetic Cathinones - G. Scott Winder, MD --Chief Resident, Univ Hosp, Dept Psychiatry U of M
  • Who put the "Medical" in "Medical Marijuana"? -Richard Berchou, PharmD- Clinical Associate   Professor, Dept of Psychiatry and Behavioral Neurosciences WSU
  • Brief review of recent legislative and regulatory responses to substances in Michigan
    - Kathleen Gross --MPS Executive Director
 SATURDAY: DSM-5: Classification, Criteria, and Use
  • Workshop presented by Eric Achtyes, MD, MS,
    Director, Division of Psychiatry and Behavioral Medicine,  Michigan State University - College of Human Medicine;  Staff Psychiatrist, Pine Rest Christian Mental Health Services; Consulting Psychiatrist, Cherry Street Health Services; Heart of the City Health Center, Grand Rapids;
 
Watch your inbox for the opportunity to register for one or both sessions
or go to the MPS website 
www.mpsonline.org
            Mental Health and Wellness Commission
 
Lieutenant Governor Brian Calley is overseeing the work of the Mental Health and Wellness Commission and has charged participants with seeking proposed solutions to help bridge the gaps that exist between persons needs and the state's ability to providecare

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) is  focusing on society impacts, data/outcomes and stigma reduction; Rep. Matt Lori (R-Constantine) is overseeing public safety, beneficiary rights and protection issues; Rep. Phil Cavanagh (D-Redford Township) is taking a look at integrating mental health and physical health services;  and Community Health Director James Haveman is chairing a workgroup on housing, independent living support and long-term care.

MPS is participating with the workgroups and encourages members to participate. Contact the MPS office with any questions or concerns. 
 
CLICK HERE for the Commission website and updates.
 

 
 
 
Michigan Department of Insurance and Financial Services will oversee  
Health Plans and Insurer's implementation of mental health parity 
 
Essential Health Benefit parity requirements promise fair and equitable coverage to Michigan's privately insured employees and individuals both on and off the Exchange. 

14 insurers and health plans have submitted applications to participate in the federal health exchange in Michigan. The Department of Insurance and Financial Services lists the plans and provides other information about the Health Insurance Marketplace in Michigan.   

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.
Survey Feedback
PLEASE PARTICIPATE... 
Attention psychiatrists who treat children:
Here is an important survey regarding Psychotropic Medication Management of Foster Children in Michigan...your input is needed 

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, if you haven't already done so, 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.

 

         Our goal: Achieve appropriate reimbursement, 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
            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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Seeking Psychiatric Practice to Purchase 
 
Outpatient psychiatric clinic or practice sought to purchase in southeast Michigan by a group of psychologists and psychiatrists.  

Please contact Dr. Ronald Fenton at 
(586) 286-5870 if interested.

                     
                           This Is An Emergency 

USHHS has published its 2012 report on Health in the USA, with a special feature on emergency room (ER) care. There were 130 million ER visits, accounting for 4% of total health care cost (about $550 per visit in 2000 and almost $1000 in 2010). A visit for a non-emergent problem costs 7x a community clinic appointment. Approximately 20% of individuals had at least one visit per year, and 7% had two or more. The total visits increased by a third since the mid-1990s while the number of ERs decreased by a tenth (nationally, 3700 in 2010). Thus, the remaining ERs have become much busier. "High users" are only 1% of patients but represent 18% of visits. "Semi-urgent" plus "non-urgent" visits represent about 3/7 of all visits. Median wait time was 30 minutes, but because of long waits in some circumstances the mean is almost an hour. Roughly 10% of those 18-44 years old, 20% of 45-64, and 40% over 65 were admitted.

 

Visits for mental health problems were not separately identified in the report, but research in the past two decades has addressed this issue. Approximately 1/8 of all ER visits are for psychiatric problems: 1/12 of all visits for mental disorders, 1/32 of all visits for substance abuse, and the rest with both, and the total number is rapidly rising (e.g., by 75% between 1992 and 2003). More than 80% were between 18 and 65 years old, and 40% of visits led to hospitalization. Medicare plus private insurance paid for more than 55%; Medicaid (threatened) 20% plus uninsured was more than 45%. Mood and anxiety disorders together accounted for about 2/3 of diagnoses; psychoses were 20%. High ER use by these patients is due in significant part to poor outpatient follow-up and lack of community resources (only 42% actually were given and kept an initial outpatient appointment, especially considering that a third required a medication while in the ER).

 

As the country battles over what health care to pay for and provide, there is a great risk that closing ERs could become a target for cost savings. Indeed it appears that it might have already started. Our patients will suffer inordinately because they are so dependent of ER care. Perhaps this is another example of the cure being more problematic than the disease.

- Pythi 

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