CONTENTS OF THIS ISSUE
Spring 2021 Issue |
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APA Assembly/Area 5 Meeting Report
By John P.D. Shemo, MD, DLFAPA
APA Assembly Representative
Psychiatric Society of Virginia
The Area 5 meeting was held virtually on March 20, as will be the upcoming Assembly Meeting on April 24-25, 2021. I remember when virtual meant “not real.” In any case, it was a busy meeting as usual. A few highlights are as follows:
The APA Board of Trustees (BOT) has recently reviewed its relationship with the American Board of Psychiatry and Neurology (ABPN) and the National Board of Physicians and Surgeons (NBPAS). This was in part in recognition of a recent study conducted by the APA of APA members participating in Maintenance of Certification (MOC), in which most felt that participating in MOC is a time-consuming, expensive, overly complicated, and burdensome process.
The BOT reaffirmed its position that MOC should not be used as a condition of employment, insurance paneling, or state licensure.
The BOT voted to acknowledge NBPAS as an alternative to ABPN’s maintenance of certification program with recognition that NBPAS certification is still recognized at far fewer hospitals than is ABPN certification.
The BOT voted to approve a feasibility study related to the possibility of the APA developing its own certification and MOC programs.
The issue of diversity and equality within the APA was discussed. Actually, I have seen what I think to be significant strides in this at the Assembly membership level. There is still progress to be made at the “leadership” level, but hopefully this will follow.
An APA position statement was addressed that reaffirmed in strong language that, as a physician, a psychiatrist’s first obligation is to patients. As an increasing number of psychiatrists are employed, this statement emphasizes that we need to guard against the problems of dual agency – that the interest of the institutions, agencies, or organizations should not take precedence over our responsibility to our individual patients. The exact wording of this position statement is as follows:
“It is the position of the American Psychiatric Association that a treating psychiatrist shall regard responsibility to the patient as primary. When relationships between the treating psychiatrist and other entities or patients conflict with the clinical needs of a patient, the treating psychiatrist must strive to resolve the conflict in a manner that the psychiatrist believes is likely to be beneficial to the patient. This means that treating psychiatrists should strive to eliminate potential compromising dual roles by attending to the separation of their work as clinicians from their roles as institutional or administrative representatives. When it is not possible to resolve a competing obligation, the treating psychiatrist must remain committed to prioritizing patient interests, including by informing patients about the potential for competing obligations within the treatment.”
As part of the Area 5 meeting, area representatives are asked if they have anything occurring in their district branches/states that would be of general interest. In this context we did discuss some of the actions that came out of the recent Virginia legislative session. Of particular note was the highly dedicated and successful contribution made by Adam Kaul, Stephen Cunningham, and John Urbach to the construction and passage of HB 2008 and SB 1269 entitled “Health Insurance: Authorization of Drugs Prescribed for the Treatment of a Mental Disorder.’
Briefly, this bill specifies the following:
Any prescribing contract between a carrier and a participating Healthcare provider with prescriptive authority, or its contracting agent, contain provisions that require, when a carrier has previously approved prior authorization for any drug prescribed for the treatment of a mental disorder listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, no additional prior authorization can be required if (i) the drug is a covered benefit; (ii) the prescription does not exceed the U.S. Food and Drug Administration-labeled dosages; (iii) the Prescription has been continuously issued for no fewer than three months; and (iv) the prescriber performs an annual review of the patient to evaluate the drug’s continued efficacy, changes in the patient’s health status, and potential contraindications.
The bill also requires that such provider contract contain provisions requiring a carrier to honor a prior authorization issued by the carrier for a drug regardless, if the drug is removed from the carrier’s prescriptive drug formulary after the initial prescription for that drug is issued.
It is my understanding that the maintenance of carrier responsibility to maintain coverage is retained even if the patient’s coverage is acquired by a different carrier.
I would have wished that the stipulation regarding medication dosage had not been retained. On the first page of the introduction to the PDR it is stipulated that the FDA does not regulate physician prescribing, it regulates pharmaceutical company advertising and marketing and that physicians should use their clinical experience and the current medical literature in making prescriptive decisions. It seems to me that if a higher dose has been justified in a prior authorization, that authorization should hold, as long as continuing clinical evaluation is documented.
It does now remain to be seen whether the insurance companies will comply with this law and how the state bureaucracy will respond to noncompliance. Nonetheless, passage of this bill was an impressive achievement and we do owe our gratitude to Drs. Kaul, Cunningham, and Urbach for their important contribution. (I apologize if any other members were involved in this process of whom I am unaware.)
As always, Adam Kaul, Varun Choudhary and I remain available to address PSV member concerns within the Assembly.
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PSV 2021
FALL MEETING
September 24-25, 2021
Hilton
Norfolk The Main
Norfolk, VA
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