CONTENTS OF THIS ISSUE
Winter 2020 Issue |
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APA Assembly Report
November 7-8, 2020
Scheduled for Washington, D.C.
Held Online
By John PD Shemo, MD, DLFAPA
APA Assembly Representative
Psychiatric Society of Virginia
The 2020 Fall Assembly Meeting was held online in the context of the ongoing COVID-19 pandemic.
We met for more than eight hours on Saturday, November 7, and for about two hours on Sunday, November 8. This was rather less than our usual meeting time, but a lot more time than in the past was spent in smaller online meetings with reference and other committees to prepare for the full Assembly meeting. Adam Kaul, Varun Choudhary and I did all attend but unfortunately without the ability to cross consult as we would do at a live meeting.
The Assembly meeting did go reasonably well but, as I have noted also in the recent past, I do think a lot is lost in not having in-person meetings.
Interestingly, I do have a patient who is in a high level staff position with the Virginia Legislature who observed that the same is true at that forum with the switch from in-person to “virtual” meetings. I do remember when the word “virtual” meant “not real.”
Preliminary to the Assembly, I had had the opportunity at the request of the PSV board to consult with JLARC, the Joint Legislative Audit and Review Commission, which is a non-partisan staff utilized by the Virginia Legislature to conduct research, evaluation, and analysis to inform legislators about the evidence and research relevant to pending bills that they will be considering. This was specifically relevant to a possible bill related to the problem with the non-adherence by insurance entities in Virginia with the Mental Health Parity Law passed now 12 years ago by the U. S. Congress, A recent study of such adherence by the Milliman Report demonstrated that Virginia is among the worst states in the country in regard to medical care parity for patients with mental illnesses.
I have been involved in advocating for legitimate mental health parity for more than 20 years and have a lot of data that demonstrates insurance company non-compliance with the Mental Health Parity Law, especially in Virginia, as well as data related to laws passed in states where mental health parity is being enforced. I did outline the “mental health parity story” in detail, with the JLARC members responding that they had not heard this story presented as clearly in the past. Unfortunately, the Chair of JLARC was subsequently assigned to another legislative post and it is not clear what impact our consultation will therefore have. I did extend my willingness to review and comment on any relevant proposed legislation. I can only hope that this time and effort will have some eventual positive impact for our patients.
More directly relevant to the November American Psychiatric Association Assembly Meeting, I will below outline a review of the Assembly actions that I think would be of broadest interest to the PSV membership. Andrew Mann did offer that this report “can be as long as you have time to write.” Since I can write fairly rapidly, no one should be exposed to that fate.
Below, therefore, is a truncated review of what I trust PSV members would find most relevant.
A number of APA position statements were considered. These position statements are developed by APA committees and then submitted for an “up or down” vote without amendment, although earlier input had been solicited. Several of those approved include:
- Impact of cannabis on children and adolescents.
- Suicide among black youth in the United States.
- Sexual abuse of migrants in ICE custody.
- Growing fear over coronavirus spread and mental health impact on ICE detention centers.
- Abortion and women’s reproductive healthcare rights. Retirement of 2014 position statement and approval of 2020 position statement.
- Screening and treatment of mood and anxiety disorders during pregnancy and postpartum.
- Use of the terms “Client” and “Provider.”
- Medicaid coverage for maternal postpartum care.
- Ensuring access to psychiatric services for the elderly.
- Reducing the burden of treatment plan documentation.
- The Assembly did approve the addition of “prolonged grief disorder” to the diagnostic and statistical manual (DSM-5).
The review of Assembly generated action papers included Assembly approval of Action Papers which:
- Asked the APA to form a work group to examine and create a resource document to help guide the use of seclusion and/or restraint based on patient choice and clinical considerations.
- Asked the APA to offer a position statement to agree with the American Medical Association policy titled “Independent Practice of Medicine by Advanced Practice Registered Nurses” which reads: AMA, in the public interest, opposes the enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state requirement for licensure to engage in the practice of medicine and surgery in all of its branches. The AMA opposes enactment of the Advanced Practice Registered Nurse (APRN) multistate compact, due to the potential of the APRN compact to supersede state laws that require APRN’s to practice under physician’s supervision, corroboration, or oversight.
- The APA voted to approve an action paper addressing “decreasing unnecessary restrictions on patient access to important personal items while psychiatrically hospitalized.”
- The Assembly did approve an action paper to clarify the concept of “medical necessity.”
Position statements not approved included:
- The role of psychiatrists in reducing physical health disparity in patients with mental illness.
The Assembly had concerns about the expansive recommendations in this position statement for increased residency training, removal of confidentiality protections, worsening of malpractice costs, and changes in the nature of what it means to be a psychiatrist. (I will note that my comments on the scope of this position statement, as a physician trained both in psychiatry and internal medicine, did seem to influence the Assembly request for considerable reworking.)
- An action paper was passed calling for the exploration of the development of a study for the accreditation of emergency psychiatry as a subspecialty.
- The Assembly voted to approve an action paper which asks that the Assembly endorse the position statement on “Misogyny and Gender Bias and their adverse effects on the health of women” and forward this to the Board of Trustees for approval.
- There was an action paper approved to create a task force to explore the ramifications of the potential change of the name of the American Psychiatric Association to the American Psychiatric Physicians Association (APPA) to help more clearly distinguish it from the American Psychological Association, especially in the context of the APA’s efforts to have psychiatry more clearly distinguished from psychology in the context of the American Psychological Association’s efforts to have psychologists designated as “physicians” under Medicare programs.
- The Assembly did approve an action paper which would require that annually, at least six months prior to approval of the next fiscal year budget, a detailed financial report be distributed by the CFO of the APA treasury to both the Board of Trustees and the APA Assembly to “enhance APA transparency and accountability regarding human and financial resource allocations across all APA components.”
- There was a paper presented potentially relevant to Virginia having to do with Northern Virginia and Southern Maryland being part of the Washington Psychiatric Society, which is problematic in that so many mental health legislative issues need to be dealt with at the state level. This is a greater problem for Virginia in that the involvement of Northern Virginia in the Washington Psychiatric Society puts it in Area 4 of the American Psychiatric Association and not in Area 5 as is the rest of Virginia. This is less of a problem for the Maryland counties in the WPS as Maryland and Washington are both in Area 4. However, a hopefully workable compromise has been negotiated with the WPS with the valuable assistance of Adam Kaul, MD, that we hope will be beneficial. This action paper offered by both the Maryland and Virginia district branches was withdrawn for now to allow evaluation of how well the above-referenced negotiation functions.
- Very critically, a central issue in this Assembly was the commitment of the APA to address openly and eliminate any elements of structural systemic racism within the organization. Your PSV representatives fully support this goal.
As noted, Andrew did ask that I write “as long a report as I have time to do” with one weekend notice. To paraphrase Mark Twain, “I would have written a shorter report if I had had time to do so.”
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