REPORT FROM THE AACP REP TO THE APA ASSEMBLY

Jeffrey Geller, MD, MPH

Action by the Assembly*:

[Actions passed by the APA Assembly are not APA policy or practice until passed by the BOT.]

• 2018 A2  12.R; The Assembly voted to approve the action paper on reducing the burden of treatment plan documentation, which asks that the APA shall convene a  joint Board of Trustees and Assembly Work Group to address the administrative burden of treatment plan documentation, with the intent of producing a position statement on the matter to be presented to Assembly in the May 2019 meeting, and that the APA make it an advocacy priority to engage with CMS, the Joint Commission, SAMHSA, and other relevant stakeholders in addressing the administrative burden of treatment plan documentation. {This was initiated by AACP}

• 2018 A2  1. A. 1; was passed by the Assembly and previously been passed by BOT – see below.

• 2018 A2  4. B. 2; Retain the 2013 Position Statement on Legislative Intrusion and Reproductive Choice.

• 2018 A2  4. B. 4; approved the Revised Position Statement on Consistent Treatment of All Applicants for State Medical Licensure.

• 2018 A2  4. B. 5; Retain the Position Statement on Residency Training Needs in Addiction Psychiatry for the General Psychiatrist. 

• 2018 A2  4. B. 6; Retain the Position Statement on Neuroscience Training in Psychiatry Residency Training.

• 2018 A2  4. B. 7; Approve the Proposed Position Statement on Utilization of Measurement Based Care. 

• 2018 A2  4. B. 9; Approved the Proposed Position Statement on Physician Health program in the Treatment of Addiction and Substance Use Disorders in Physicians.

• 2018 A2  4. B 10; Approve the Proposed Position Statement on Police Brutality and Black Males.  See below:

• 2018 A2  4. B. 11; Approved the Proposed Position Statement on Mental Health Equity and the Social and Structural Determinants of Mental Health.

• 2018 A2  4. B. 12; Approved the Proposed Position Statement on Human Trafficking.

• 2018 A2  4. B. 13; Approve the Proposed Position Statement on Conversion Therapy and LGBTQ Patients.

• 2018 A2  4. B. 15; Approved the Proposed Position Statement on Role of Psychiatrists in Palliative Care.

• 2018 A2  4. B. 16; Approved the Proposed Position Statement on Elder Abuse, Neglect and Exploitation.

• 2018 A2  4. B. 18; Approved the retention of the 2007 position statement:  Family Planning.

• 2018 A2  4. B. 19; Approved the Proposed Position Statement on Core Principles for Alternative Payment Models for Behavioral Health.

• 2018 A2  4. B. 20; Approved the Proposed Position Statement:  Use of the Principles of Recovery

See below:

• 2018 A2  4. B. 21; Approved the Proposed Position Statement on Separation of Immigrant Children and Families. – See below.

• 2018 A2  12. A; Asks that the APA will create a process for biannual review of the World Health Organization’s Essential Medicines List, focused on essential medications for the treatment of psychiatric and substance use disorders.

• 2018 A2  12. B; Asks that the Council on Children, Adolescents and Their Families develop model legislation for psychiatric quality assurance programs of psychiatric treatment in the child welfare and juvenile justice systems.

• 2018 A2  12. D; Asks that the APA, through its Council on Healthcare and Financing and other appropriate Councils and Committees in concert with DBs, review the experience in behavioral health managed care, including substance use disorder treatment, of different States, especially those successful in maximizing quality care and controlling costs while minimizing physician burden.

• 2018 A2  12. E; 

1. Approved action that the APA develop a volunteer time audit survey for psychiatrists to complete that itemizes the amount of time required by psychiatrists to completed the existing Medicare/Medicaid clinical documentation.

2. Approved that APA correspond with all State Medicaid and Medicaid Medical Directors encouraging collaboration among state insurance agencies in regard to narrowing which quality measures will be focus of attention over given period of time such that the time required for clinicians to complete is sensible, reasonable.

• 2018 A2  12. F; Approved that the APA refer this paper to the Assembly Committee on Public and Community Psychiatry to propose modifications to the APA Position Statement on Peer Support and the modification shall reflect the sentiment of the Assembly the APA supports the value of family peer support services given the role of these services in improving access to recovery-oriented, quality psychiatric care and treatment.

• 2018 A2  12. H; Approved APA Communications Department monitor the Scientology misinformation campaigns on various media, including their television channel, and to report back to the Assembly on trends and the effect that Scientology misinformation is having and the Public Affairs department of the APA provide speaking points for members to address the incorrect and dangerous information about psychiatry being disseminated on the Scientology Channel.

• 2018 A2  12. I; Approved the American Psychiatric Association and the APA Foundation work in a timely incremental and fiscally responsible manner to end all financial investments or relationships (divestment) with companies that generate the majority of their income from the exploration for, production of, transportation of, or sale of fossil fuels; and retirement account may be exempt at the discretion of the APA CFO; and the APA Treasurer report back to the Assembly by May 2019 and at Assembly meetings annually thereafter on the schedule and progress of these divestment activities.

• 2018 A2  12. J; Approved that the Board of Trustees will convene a work group to include members of the Board, the Assembly, the Council on Quality Care and the Council on Research to develop an APA position statement encouraging non-biased and divers membership of expert panels that develop treatment guidelines; especially in regard to IPT and PDT.  The work group shall report back to the May 2019 Assembly about progress, and shall completed development of this position statement by the November 2019 Assembly.

• 2018 A2  12. K; Approved that the APA advocates for add-on billing codes for suicide risk assessments to the AMA CPT Editorial Panel, and that the suicide risk assessment billing codes reflect the complexity of the assessment with the purpose of providing sufficient time for screening, but also for counseling, and treatment.

• 2018 A2  12. L; Approved that the APA will continue to safeguard access to quality services that are developmentally, culturally and linguistically appropriate to meet the mental health needs of any person presenting to the U.S. border including and not limited to all immigrants and refugee children, adolescents and their families by: developing resources that promote best practices on prevention for immigrant children and adolescents.  Creating culturally and developmentally competent educational toolkit with the appropriate information and support.  The tools should address the underlying ethical and medical-legal barriers in treating these populations.  Endorsing the use of qualified professionals in conducting the assessments of these children and adolescents.  Making the relevant screening instruments and other resources publicly available on the APA website.  Providing these resources to Immigration and Customs Enforcements (ICE) detention centers and persons doing asylum evaluations so that gaps in providing culturally competent care for these children and adolescents can be effectively addressed.

• 2018 A2  12. M; Approved that a web-based toolkit addressing racial discrimination against psychiatry trainees and practicing psychiatrists be developed and maintained by the Council on Medical Education and Lifelong Learning and the Council on Minority Mental Health and Health Disparities in coordination with the Division of Education to include proposed frameworks, resource documents and instructional video modules available o APA members and the public and also disseminate information to Directors of Residency Training programs and Chairs of Department so Psychiatry, and that the APA explore funding sources for research, such as the APA Foundation, to support efforts to further characterize the prevalence, incidence and characterization of racial discrimination against psychiatry trainees and practicing psychiatrists.

• 2018 A2  12. N; Approved that the American Psychiatric Association convene a Suicide Prevention Work Group whose goal will be to develop a suicide prevention strategic plan, which includes a focus on high-risk groups and underserved populations.

• 2018 A2  12. O; Approved that the APA advocates for the necessity of keeping the family units together while they are going through the asylum-seeking process.

• 2018 A2  12. Q; Approved that the APA shall convene a joint Board of Trustees and Assembly Work Group to draft a Position Statement regarding the need for psychiatrists’ input into the process of psychiatric facility design, construction, and renovation.

Reports and Next Steps from the Assembly Committees/Work Groups

Assembly Committee on Public & Community Psychiatry

Isabel Norian, MD, chair

Topics discussed 

• include tracking of Position Statements headed to the JRC on hospital based care, 

• national concerns about immigrants being potentially denied status if they enroll in Medicare or Medicaid,

•  a pilot project announced by Bob Cabaj, MD in San Mateo County, CA to address opioid addiction treatment.

Assembly Committee on Psychiatric Diagnosis & the DSM

Vincenzo Di Nicola, MD, chair

Topics discussed included

• new thinking process in upcoming DSM revisions, which are an ongoing process, on the use of“Z codes” in the military,

•  a possible forensic dilemma as to whether the print or online version of the DSM should be regarded as the authoritative version,

•  whether online screening tools for addiction disorders are behind or ahead of the curve, an 

• understanding of the distinction between a diagnostic manual (DSM) and a diagnostic classification system (ICD), the importance of social and clinical responsiveness in development of future editions of the DSM, as well as a discussion regarding the overall use of diagnosis.

Assembly Committee on Access to Care

Dr. Eliot Sorel, MD, chair

Topics discussed included 

• aspect of the Committee’s mission to address issues raised by members and patients by using data, to wit, results of the first qualitative access to care survey distributed to all Area Councils will be available sometime after this meeting. 

• Access is necessary, but not sufficient without parity.

•  A bill on behavioral health parity is likely to pass in the District of Columbia in the near future.

Assembly Committee on Maintenance of Certification

Russell Pet, MD, chair

Topics discussed included 

• the ABPN’s current MOC Pilot Program, of which there are about 5000 participants, 

• a recent ABMS initiative to solicit feedback on MOC in which only 12% of MDs thought it was useful, while most other stakeholders were in favor of board certification, though not necessarily by ABMS. 

• Different specialty boards apply different passage standards, some using minimal competence, while others use standard of excellence. 

• DOJ is exploring competition among certifying boards.

Assembly Liaisons to the Committee on Practice Guidelines

John Shemo, MD, chair

• A practice guideline on schizophrenia is nearing a first draft; look for a comment period by the end of the year

Assembly Work Group on Increasing Voter Turnout

Edward Thomas Lewis, MD, chair

The group recognizes the chronic challenge of increasing voter turnout. They concluded that the more personal the invitation, the better the turnout.

The next meeting of the APA Assembly is just before the APA Annual Meeting on May, 2019.  Any member of the APA can author an Action Paper for the Assembly to consider.  The Action paper must be sponsored by any Assembly member.  If you are interested in authoring an Action Paper let me know and I’ll talk you through the process.