NYSPA ALERT: PSYCHOLOGY PRESCRIBING BILL INTRODUCED IN STATE SENATE

From NYSPA:

Earlier this month, State Senator Catharine Young (R – Olean) introduced S.7488, a bill that would grant prescribing privileges to psychologists licensed in New York State. A companion bill has not yet been introduced in the Assembly.

NYSPA urgently needs your support to oppose this bill and any related bills that would grant prescribing privileges to psychologists licensed in New York State. Please act NOW by writing to your State Senator to urge him or her to oppose the bill and vote “No” if it comes before them for a vote.

Early next week you will be receiving a Cap Wiz Alert from the APA, which will enable you to send a message directly to your State Senator regarding S. 7488 and its dangerous encroachment on the practice of medicine. The Cap Wiz Alert will be sent to the email address you have on file with the APA.

If a companion bill is introduced in the State Assembly, we will issue a second Cap Wiz Alert for letters to Assembly members.

Back in 2002, NYSPA worked strenuously to secure an explicit statutory ban on psychology prescribing in New York State. Thank you for your support as we work together to ensure that the ability to prescribe psychotropic medications is limited only to those individuals who possess the requisite education, training and experience to safely do so.

A copy of the bill may be viewed here.

APA Advocacy Leads to Changes in MOC Program

From NYSPA:

NYSPA is pleased to report that American Board of Psychiatry and Neurology (ABPN) recently revised its Maintenance of Certification (MOC) program to adopt the following changes:

1) Patient survey is no longer mandatory and will now be listed as one of several options in the category of assessment of practice.

2) Lifetime Certificate holders will no longer be referred to as “not participating in MOC.” Instead, ABPN will utilize the phrase “not required to participate in MOC.”

Qualifying Quality Improvement projects will now satisfy Performance in Practice requirements for chart review.

These changes to the MOC program are a direct result of the advocacy of the APA and the Assembly Work Group on MOC, which worked closely with ABPN to make these necessary clarifications. Special thanks and recognition to Ramaswamy Viswanathan, M.D., Brooklyn DB Representative and newly elected NYSPA Secretary, for his leadership in this area.

NYSPA Election Results

Dr. Ramaswamy Viswanathan has been elected Secretary of the New York State Psychiatric Association.

Dr. Subhash Chandra has been elected APA Area 2 RFM Representative and Chair, Committee on RFMS for the New York State Psychiatric Association.

A huge congratulations to them both!

Psychiatry Embraces Patient-Centered Care

Lisa Dixon, M.D., M.P.H.; Jeffrey Lieberman, M.D.

From the President

January 29, 2014 DOI: 10.1176/appi.pn.2014.2a15

Lisa Dixon, M.D., M.P.H.; Jeffrey Lieberman, M.D.

Psychiatry has long been considered the medical specialty most attuned to listening to the patient. With few diagnostic laboratory or imaging tests available or other physical indicators of illness, psychiatrists have been trained to attend carefully to their patients’ histories and subjective reports of symptoms to make a diagnosis and determine the course of treatment. But the nature of the doctor-patient relationship was traditionally one-sided. Patients talked and their physicians listened, and then the doctor prescribed the treatment and the patient followed.

But now psychiatry is changing as the field of medicine adopts patient-centered care. This model of care places greater emphasis on the patient’s involvement in determining the goals of treatment that are meaningful to them and the nature of their care. Meaningful goals for patients generally go beyond symptoms to include quality of life, functioning, and a sense of hope and self-efficacy. Patient-centered care isn’t just about putting the patient at the center of the care equation. Rather, it shifts the balance of authority and responsibility of the doctor-patient relationship and incorporates shared decision making (SDM) between the clinician and the patient, particularly when it comes to treatment. SDM is defined as “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” Practicing SDM requires that psychiatrists assess the patient’s interest in participating in decisions, providing information to them on the risks and benefits of specific treatments or approaches in an understandable format, and dialogue with patients about their choices. SDM does not mean that psychiatrists don’t make strong recommendations; rather, it means that those recommendations need to be reconciled with patients’ views and choices.

The promise of this change is that, with patients taking a more involved role in their treatment decisions, physicians will better understand their patients’ needs and concerns and be better able to offer an informed course of treatment. It also brings the hope that patients will be more inclined to adhere to treatment and share important information about their response (including side effects), thereby enabling their physician to make adjustments as needed. This is not an insignificant change. In psychiatry, as in all of medicine, patient adherence is a prevalent problem and major limitation of treatment. For numerous reasons, many patients are unable or unwilling to follow through on “doctor’s orders,” with worsening symptoms as a consequence. In this context, doctors may discover that their orders may cause problems that the patient has not previously been willing to reveal.

There are other benefits to patient-centered care. Shared decision making between psychiatrist and patient can improve the efficiency and productiveness of patient visits, both indicators of quality care and precursors to improved patient mental health.

This new paradigm is not without its challenges. Empowering patients to be active participants in their care often requires educating them about their disorder and options for therapy to ensure they are prepared to ask relevant questions and understand the answers. Certainly this process is more difficult for patients whose disorders impair their cognitive and decision-making abilities. In fact, these concerns are cited by some psychiatrists as the reasons they are reluctant to embrace this care model. However, it is our job to develop the means to facilitate this mode of communication with patients and their participation in care. Initially, clinicians may find this role difficult because of the increased time and effort it requires and uncertainty on how best to teach and motivate patients in this way.

There are several innovative efforts seeking to address these concerns by providing new direction on how to educate patients and increase their engagement in care. One study utilized group training on shared decision making among people with schizophrenia, comparing it with a control group that did not receive the training. Those patients engaged in the decision-making instruction were more involved in their own care, and more likely to continue to take their medications. CommonGround, a web-based application that facilitates shared decision making among individuals with mental illness, received APA’s 2013 Psychiatric Services Gold Achievement Award. Electronic tools have great potential in facilitating communication and shared decision making.

Family engagement that is contingent on the patient’s agreement and invitation can also be an important part of patient-centered care. Many prior efforts to implement family-based services for adults with mental illness have had a disappointing response, perhaps because there has been too little focus on the patient’s preferences. New models of family engagement are seeking to improve this component of treatment. A pilot program implemented within the Veterans Affairs system in Maryland and in California encouraged family participation contingent upon the interest and invitation of the patient. This program served to elicit significant and sustained engagement by both families and patients.

Psychiatry has always been the field of medicine that prided itself on emphasizing the doctor-patient relationship. We now need to extend this practice, to enhance patient involvement, and begin listening—and talking—to our patients in new ways. To do so will only enhance the physician-patient relationship and the quality of health care.

Posted in APA

Nominations Being Accepted for Area II Resident-Fellow Member Deputy Representative to the APA

Nominations now being accepted for the position of:

AREA II RESIDENT-FELLOW MEMBER DEPUTY REPRESENTATIVE
TO THE ASSEMBLY OF THE DISTRICT BRANCHES OF THE
AMERICAN PSYCHIATRIC ASSOCIATION, INC.

Interested Candidates Must Submit:

* A letter of interest

* A Curriculum Vitae

* A letter of support from your Residency Training Director/Chair
indicating you will have time to serve

* Two letters from members of your local District Branch

Additional information is posted below.

MATERIALS MUST BE RECEIVED BY FEBRUARY 3, 2014
See your Residency Training Director for more information
RFM DEPUTY REPRESENTATIVE TO THE ASSEMBLY

Responsibilities:

1. Represents Area II RFMs (New York State) in the Assembly of District Branches of the American Psychiatric Association (APA).

2. Represents interests of RFMs in the Assembly and the Area II Council.

3. Informs the Assembly and the New York State Psychiatric Association of issues of significance to RFMs.

4. Attends Assembly meetings in November and May.

5. Attends Area II Council meetings.

6. May serve on components (Task Force & Committees) of the Assembly and the New York State Psychiatric Association.

7. Is elected for a two year term with succession to RFM Representative in the second year. The two year term begins immediately after the APA Annual Meeting. In the second year, the RFM Deputy Representative succeeds to the position of RFM Representative.

8. Is available for at least six weekdays per year to fulfill these responsibilities.

9. Organizes and attends Area II RFM meetings.

Eligibility Criteria:

1. Candidates must have at least two years of training (including post residency fellowship) in Area II remaining at the time of election.

2. At the time of recommendation for nomination, a candidate must be either a Member in Training of the APA or have submitted an application. The successful candidate must be a Resident-Fellow Member when the term of office begins.

3. Candidates must submit Curriculum Vitae, a statement of interest and intent to fill the two year term of office and two letters of recommendation from local district branch members. The training director’s letter may count as one letter provided the director is a member of the local district branch.

4. Residency training directors or department chairpersons must write a letter stating that, if elected, the RFM will be excused from clinical responsibilities for at least six (6) weekdays per year and be allowed to honor this two year commitment as part of training.

Procedures:

Residents who wish to be recommended for nomination may recommend themselves or be recommended by a local district branch member, their training director or a residents’ group.

The following material must be submitted in the applications:

1. A statement of interest from the resident that includes a statement of intent to serve the two year term.

2. A letter of support from the training director or chair stating that the resident, if elected, will be allowed to honor this two year commitment as part of training and that the resident has at least two years remaining in training. (For the residents who are accepted into a fellowship, this letter is to come from the director of the fellowship.)

3. Letters of recommendation from two district branch members. (The training director’s letter may count as one letter provided the director is a member of the local district branch.)

Please send all material to:

Donna Gajda
New York State Psychiatric Association, Inc.
400 Garden City Plaza, Suite 202
Garden City, New York 11530

All material must be received by February 3, 2014
If you have any questions, please call:

Kendra Campbell, M.D.
RFM Representative to the Assembly 2013-2014
kendracampbell@mac.com

Kandace McAlister Licciardi, M.D.
RFM Deputy Representative to the Assembly 2013-2014
klicciardi@maimonidesmed.org

APF Seeks Applications for Advancing Minority Mental Health Awards

The American Psychiatric Foundation is accepting applications for its 2014 awards for advancing minority mental health. This annual award recognizes mental health professionals, programs, and organizations that have undertaken innovative efforts to raise awareness of mental illness in underserved minority communities, increase access to mental health care for underserved minorities, and/or improve the quality of care for underserved minorities. Application deadline is February 12.

Posted in APA

APA Announces Medicare Reimbursement Victory on Psychiatry Work Values

The federal Centers for Medicare and Medicaid Services has accepted work values for a number of psychiatric codes (90791/92 and the 908XX codes) that will result in increased Medicare payment for psychiatrists using those codes. The work values, which are recommended by the AMA’s Relative Value Update Committee, are part of a complex payment formula that includes practice expense and other variables to derive a fee for every code used by physicians. Go here to learn more!

Posted in APA

National Health Service Corps (NHSC) Loan Repayment Program accepting applications

The NHSC program supports qualified health care providers, including psychiatrists, in exchange for two-years of service in specific Health Professional Shortage Areas. The NHSC program is currently accepting applications for FY2014 Loan Repayment Program awards. This program is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed or are seeking employment at approved sites.

Integrated Care and Psychiatry

In the changing health care environment, one clear trend is greater integration of primary care and behavioral health care. APA has compiled extensive resources to help psychiatrists understand and stay abreast of the issues. Go here to see the latest research, news, analysis, policy, collaborative care models, and more, including short videos from leaders in the field and a Toolkit of practice resources.

APA Announces Medicare Reimbursement Victory on Psychiatry Work Values

The federal Centers for Medicare and Medicaid Services has accepted work values for a number of psychiatric codes (90791/92 and the 908XX codes) that will result in increased Medicare payment for psychiatrists using those codes. The work values, which are recommended by the AMA’s Relative Value Update Committee, are part of a complex payment formula that includes practice expense and other variables to derive a fee for every code used by physicians. Go here to learn more!

Posted in APA

Call for Applications: APA Medical Student Senior Elective in HIV Psychiatry

The American Psychiatric Association established the Medical Student Senior Elective in HIV Psychiatry in 2004 to provide an opportunity for 4th year minority medical students to participate in a one-month clinical or research elective in HIV psychiatry.

With improvements in HIV drug therapy there is a burgeoning demand to treat the mental health needs of those living longer with the disease. People with HIV have a higher incidence of mental health problems than the general population and people with serious mental illness are more at risk for contracting HIV. HIV attacks the brain, causing inflammation and tissue deterioration. Infection of the brain also can lead to clinical depression, mild or moderate thinking problems, and trouble with memory and focus. Unfortunately, the mental health needs of people living with HIV/AIDS are too often overlooked.

Undoubtedly, future physicians need to develop a working knowledge of HIV-related psychiatric and neuropsychiatric issues. The purpose of the Medical Student Elective in HIV Psychiatry is to foster the participation of racial and ethnic minority medical students in HIV-related care and research and provide them with a means of obtaining essential HIV-related mental health training through an integrated approach to patient care.

Description of the Project
This September the Elective in HIV Psychiatry begins with intensive two-day training in Washington, DC. Topics range from neuropsychiatric complications of HIV, somatic complaints, and mood disorders to special patient populations including people with substance use disorders and/or those suffering from severe mental illnesses. Training modalities include a combination of lectures, role playing, case vignettes, and first-person accounts through interviews with HIV positive people. Students then travel to training sites for their clinical or research experience for the month of September.

To date, seventy-one students have completed the full month-long elective. Prior sites have included: Cambridge Health Alliance/Zinberg Clinic; The New York Presbyterian Hospital at Columbia University; The New York-Presbyterian Hospital Cornell University Center for Special Studies (CSS); Emory University/Grady Infectious Disease Program; Howard University; University of Pittsburgh Medical Center; University of Cincinnati; University of Miami, Stanford University, Beth Israel Medical Center, Vanderbilt University, and the University of South Florida (for a research elective in HIV Neuroimmunology in Psychiatry.) Tentative dates for the elective are August 23 to September 20.

The application deadline is March 31, 2014 with selections to be announced in late April. Apply Now

Posted in APA

APA Fellows

Congratulations to the following Brooklyn Psychiatric Society members becoming APA Fellows:

William Florio, M.D.

Chinmoy Gulrajani, M.D.

Aron Pinkhasov, M.D.

Caroline Stamu-O’Brien, M.D.

Jonathan Weiss, M.D.