PSV Virginia News

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:

The review of Assembly generated action papers included Assembly approval of Action Papers which:

Position statements not approved included:

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.)

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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