Reports to the Membership
2019; American Psychiatric Association; Volume: 176; Issue: 7 Linguagem: Inglês
10.1176/appi.ajp.2019.176701
ISSN1535-7228
ResumoBack to table of contents Previous article Next article APA OFFICIAL ACTIONSFull AccessReports to the MembershipPublished Online:1 Jul 2019https://doi.org/10.1176/appi.ajp.2019.176701AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractThe following are edited/abbreviated versions of the annual reports of the APA Secretary, Treasurer, CEO and Medical Director, Speaker, and Speaker-Elect and the chairpersons of the APA Committee on Bylaws, Membership Committee, Committee of Tellers, and Elections Committee. The full reports were presented at the APA Annual Business Meeting in San Francisco, May 18, 2019.Report of the SecretaryPhilip R. Muskin, M.D., M.A.It is my constitutional duty and personal privilege as Secretary of the American Psychiatric Association to report to the membership on the actions taken by your Board of Trustees over the past year. The following are some of the highlights.American Foundation for Firearm Injury Reduction in Medicine (AFFIRM)At the December 2018 Board of Trustees meeting, the Board approved APA joining the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) consortium. AFFIRM is a physician-led foundation that aggregates private-sector financial resources to fund high-quality, high-impact research to prevent firearm injury. The AFFIRM health consortium currently includes the American Medical Association, the American College of Emergency Physicians, the American College of Surgeons, the American College of Physicians, and the Annals of Internal Medicine, to name a few.New Committee on Well-being and BurnoutAt the July 2018 Board of Trustees meeting, the Board approved the formation of a Committee on Well-being and Burnout, under the Council on Medical Education and Lifelong Learning, as a permanent home for the efforts that were undertaken by the Board of Trustees’ Ad Hoc Work Group on Well-being and Burnout. The workgroup completed its primary deliverables, which included the following: an online resource center, an online self-assessment tool, a series of articles in Psychiatric News, a Well-being Ambassador slide deck and manual, and a series of sessions at the 2018 APA Annual Meeting and IPS: Mental Health Services Conference. Nearly 2,000 individuals have completed the online burnout assessments.Position StatementsPosition statements can be found on APA’s website (www.psychiatry.org) under “Policy Finder.” The APA Board of Trustees addressed several position statements throughout the year. Seventeen new position statements were approved, 10 position statements were revised, four position statements were reaffirmed, and three position statements were retired.New position statements.The Board of Trustees voted to approve the proposed position statement Peer Support Services at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement Discrimination of Religious Minorities at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement Weapons Use in Hospitals and Patient Safety at its July 2018 meeting.The Board of Trustees voted to approve the position statement Risks of Adolescents’ Online Activity at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement on Solitary Confinement (Restricted Housing) of Juveniles at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement on Psychiatric Services in Adult Correctional Facilities at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement Research with Involuntary Psychiatric Patients at its July 2018 meeting.The Board of Trustees voted to approve the proposed position statement Utilization of Measurement Based Care at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Physicians Health Programs in the Treatment of Addiction and Substance Use Disorders in Physicians at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Police Brutality and Black Males with minor editorial changes at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Mental Health Equity and the Social Structural Determinants of Mental Health at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Human Trafficking at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Conversion Therapy and LGBTQ Patients at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Role of Psychiatrists in Palliative Care at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Core Principles for Alternative Payment Models for Behavioral Health at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Use of the Principles of Recovery at its December 2018 meeting.The Board of Trustees voted to approve the proposed position statement Separation of Immigrant Children and Families at its December 2018 meeting.Revised position statements.The Board of Trustees voted to approve the revised position statement Telemedicine in Psychiatry at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Abortion at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Resolution Against Racism and Racial Discrimination and Their Adverse Impacts on Mental Health at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Religious Persecution and Genocide at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Access to Care for Transgender and Gender Diverse Individuals at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Discrimination Against Transgender and Gender Diverse Individuals at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Inquiries about Diagnosis and Treatment of Mental Disorders in Connection with Professional Credentialing and Licensing (2015) at its July 2018 meeting.The Board of Trustees voted to approve the revised position statement Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum at its December 2018 meeting.The Board of Trustees voted to approve the revised position statement All Applicants for State Medical Licensure at its December 2018 meeting.The Board of Trustees voted to approve the revised position statement Elder Abuse, Neglect and Exploitation at its December 2018 meeting.Reaffirmed position statements.The Board of Trustees voted to approve the retention of the 2013 position statement Legislative Intrusion and Reproductive Choice at its December 2018 meeting.The Board of Trustees voted to approve the retention of the 2014 position statement Residency Training Needs in Addiction Psychiatry for the General Psychiatrist at its December 2018 meeting.The Board of Trustees voted to approve the retention of the 2015 position statement Neuroscience Training in Psychiatry Residency Training at its December 2018 meeting.The Board of Trustees voted to approve the retention of the 1973 position statement Family Planning at its December 2018 meeting.Retired position statements.The Board of Trustees voted to approve the retirement of the 1981 position statement Confidentiality of Medical Records: Does the Physician have a Right to Privacy Concerning His or Her Own Health Records at its December 2018 meeting.The Board of Trustees voted to approve the retirement of the 2000 position statement Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) at its December 2018 meeting.The Board of Trustees voted to approve the retirement of the 2007 position statement Reactive Attachment Disorder at its December 2018 meeting.Report of the TreasurerGregory W. Dalack, M.D.For the year ended December 31, 2018, APA had a net loss of $5.5 million, based on $47.3 million in revenue and $52.8 million in expenses (see Figures 1 and 2). The $5.5 million net loss compares to $11.2 million net income during 2017, a change of $16.7 million, and the 2018 budget, which projected revenue to equal expenses. In 2017, the $11.2 million in net income was based on revenue of $60.5 million and expenses of $49.3 million.FIGURE 1. RevenueFIGURE 2. ExpensesThe variances in net income noted above are attributable to the change in investment returns. During 2017, APA’s investments generated $13.3 million in revenue, a 15.3% return. In 2018, the investment values declined by $3.3 million, a 3.6% loss. The 2018 budget anticipated using $2.2. million in investment returns to fund operations in accordance with the reserve spending policy.Revenue-producing activities, which are those business lines that generate a positive return and fund the Association’s programs and operations, include membership programs, publishing activities, and medical education and meetings. These activities provided $24.9 million in revenue after expenses. This amount was $.7 million higher than in 2017. The higher revenue is attributable to higher revenue from the annual meeting, higher dues revenue, and higher DSM print sales offset by lower print advertising revenue. The 2018 annual meeting was held in New York and saw increases in attendance and the number of exhibitors and sponsors. The year 2018 included a one-time 2% dues rate increase, which resulted in a dues revenue increase of $.4 million. Print advertising for Psychiatric News and the American Journal of Psychiatry continued to decline in 2018, as pharmaceutical companies have fewer psychiatric drugs in development.Expenses for Programs and Services, which includes federal advocacy, policy development, research, education, diversity, and communications, was $.4 million higher than in 2017. The increase is due to the filling of vacant federal advocacy positions.The Board has set aside reserves to fund state advocacy initiatives, expansion of the PsychPRO mental health registry, expanded development of practice guidelines, and the expansion of legislative grant program to district branches. During 2018, $1.5 million was expended on these efforts, a reduction of $.5 million from 2017.Report of the CEO and Medical DirectorSaul Levin, M.D., M.P.A.I am pleased to present the CEO and Medical Director’s report for the APA President’s year May 2018–May 2019, which outlines the Administration’s actions, activities, and accomplishments in the past year according to the APA’s strategic initiatives.Advancing the Integration of PsychiatryThe Opioid EpidemicIn October 2018, Congress passed comprehensive opioid-related legislation. The bill, H.R. 6, contained a broad range of initiatives to curb the epidemic, including several APA-supported provisions:Telehealth: Eliminates facility fees for the provision of telehealth services via Medicare and waives geographic requirements for “originating sites” for treatment of substance use disorders via telehealth under Medicare. In addition, the bill directs the Attorney General to promulgate final regulations within 1 year specifying the “limited” circumstances under which a special telemedicine registration can be issued and the process for issuing such a registration.Parity: Requires coverage of mental health and substance use disorder services as mandatory for Children’s Health Insurance Plan (CHIP) programs and imposes parity obligations on mental health/substance use disorder services covered by CHIP.Loan repayment: Creates a new student loan repayment program (maximum of $250,000 per individual) for substance use disorder treatment providers who agree to provide services in mental health professional shortage areas or areas with higher-than-average overdose rates for a period of 6 years.APA is continuing to play a leadership role with the Coalition to amend 42 CFR Part 2.During the last Congress, the APA Administration strongly supported legislation introduced by Representatives Markwayne Mullin (R-OK) and Earl Blumenauer (D-OR) that would modernize patient privacy protections by aligning 42 CFR Part 2 with HIPAA standards for treatment, payment, and health care operations. After a strong push with APA’s Capitol Hill and coalition allies, including outreach to multiple House offices and engagement from many members of APA’s Congressional Advocacy Network, the bill passed overwhelmingly by a vote of 357 to 57 in June of 2018. In April of this year, Reps. Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK), as well as Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV), reintroduced legislation in the House and Senate, respectively. The legislation provides a vehicle through which to continue to educate Congress and build support for modernizing Part 2, as the Coalition encourages HHS to propose strong new rules that would improve implementation of the law.Mental Health ParityTen years after passage of the Mental Health Parity and Addiction Equity Act (MHPAEA), the APA continues to pursue an aggressive federal legislative agenda to ensure robust enforcement of the original law. The cornerstone of this effort is the advancement of federal legislation designed to improve compliance with MHPAEA based on model state legislation advanced by the APA. If enacted, insurers would be required to submit information to the Department of Labor regarding how they design and apply managed care practices, such as prior authorization, step therapy, network admission standards, and reimbursement rates, among others.Federal Advocacy ConferenceIn April, 100 psychiatrists from across the country converged on Washington, DC, wearing their white coats, to lobby Congress during APA’s 2019 Federal Advocacy Conference. Attendees received hands-on advocacy training before they engaged in face-to-face meetings with their elected lawmakers. Through their efforts, APA was able to educate 135 congressional offices on issues vital to the practice of psychiatry, including achieving true mental health parity, ways to address the physician workforce shortage, and increasing federal investments in public mental health programs. The Jacob K. Javits Award was presented to Rep. Doris Matsui (D-CA) for her work on the Excellence in Mental Health Act and the 21st Century Cures Act.State Advocacy ConferenceThe APA hosted the State Advocacy Conference in Park City, Utah, in response to requests from multiple district branches. The main theme of the conference was “relationships matter.” Speakers explained how their relationships with legislators, medical societies, their communities, and coalitions can help shape policy and positively affect patients’ lives. Thirty-eight states were represented, and 91 members attended sessions on parity enforcement, positive approaches to scope of practice legislation, and community and coalition building. As a result of the Conference, DGR conducted multiple follow-up activities, including region-specific outreach by State Government Relations staff and individualized follow-up with each attendee to encourage ongoing involvement with APA and advocacy.Increasing Access to Care Through State Legislationstate associations are also/state associations are proactively promoting alternatives to increase access to care, including mental health parity, network adequacy, telemedicine, and the Collaborative Care Model. Last year, APA developed a 50-state model parity enforcement legislation that is adapted to each state law, complete with talking points, one-pagers, and an infographic on parity, for use by APA members.Progress of parity legislation: Last year, mental health parity legislation was signed into law in Delaware, the District of Columbia, Illinois, New York, Tennessee, and Texas. This year, legislators in California, Connecticut, Florida, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, and Pennsylvania have introduced parity legislation so far this session. Governors in New Jersey, Colorado, and Wyoming signed parity language into law this spring.Collaborative care and other legislation: state associations are beginning to pursue legislation to implement the Collaborative Care Model (CoCM). APA has developed model legislation that requires private insurance to cover CoCM codes. Illinois became the first state to enact APA’s legislation. Delaware and New Jersey are likely to see introduction of the legislation soon, with several other states interested in 2020 introduction. In states like Ohio, the APA is working closely with district branches/state associations to expand telemedicine.APA Urges Senators and HHS to Limit Family DetentionAPA was one of the first organizations to join efforts opposing potential legislation that would authorize extended immigrant family detention. This was in response to an announcement that the Trump Administration intended to modify the 1997 Flores Settlement Agreement, which limits the government’s ability to keep children in immigration detention. APA signed onto a coalition letter to the Senate Homeland Security and Governmental Affairs Committee, detailing how extended immigrant family detention exacerbates child traumatization and is harmful, costly, and unnecessary. The letter urges Congress to reject any efforts to expand family detention and overturn current child protection principles and instead encourages Congress to invest in more sensible and humane alternatives. Other signatories included the American Civil Liberties Union, the American Psychological Association, the American Academy of Pediatrics, and a host of other organizations.Trauma-Informed CareThe ongoing conflict and discussion about immigration at the southern border and the Administration’s policy regarding the separation of children and families has resulted in a heightened Congressional interest on the topic of trauma and its lasting impact. To date, several Congressional Committees (Judiciary, Oversight, Energy, and Commerce) have convened hearings to discuss the impact of the separation policies, and we anticipate additional activity moving forward. APA’s work with congressional appropriators led to an invitation for Altha Stewart, M.D., APA’s President, to testify before the Labor-HHS-Education subcommittee on February 27, 2019. Dr. Stewart was asked to help the subcommittee understand the long-term impact and costs of the resulting trauma on the affected children, families, and society.In addition, the concept of trauma-informed care overall is gaining momentum. Provisions from a broad trauma-informed care bill, led by Sen. Richard Durbin (D-IL) and Rep. Danny Davis (D-IL), were added to the comprehensive opioid bill (H.R. 6) last year, and the APA is working with bill sponsors to identify potential additions for this Congress’ version. As part of this process, Dr. Stewart met with Rep. Danny Davis in February to discuss the bill, as well as broader opportunities to raise awareness about the importance of trauma-informed care.Congressional BriefingsIn May 2018, Dr. Stewart also participated in a Hill briefing on the “Innovations and Challenges in Providing Mental Health Services to Prisoners and Returning Citizens.” Dr. Stewart was joined by leaders from the American Psychological Association, the Legal Action Center, the Association of State Corrections Administrators, and the National Association of Social Workers.In July, Eric Yarbrough, M.D., participated in a Hill briefing by providing a clinical perspective on “Demystifying Gender Dysphoria.” The APA was joined by the American Psychological Association and Beverly Fisher, M.D., a plastic surgeon.In November 2018, APA hosted a Hill briefing entitled, “Mental Health Parity through the lens of the Opioid and Suicide Epidemics,” which was moderated by Bruce Schwartz, M.D., APA President-Elect. The Hill briefing provided an overview of the parity law and a clinical perspective on the importance of parity and how lack of enforcement affects patients. Senator Bill Cassidy (R-LA) joined the briefing, made remarks, and answered questions.In December 2018, APA participated in a Hill briefing entitled, “Racial Disparity in Mental Health: the Need for Inclusion in Research and Resources.” William B. Lawson, M.D., represented APA on a panel that also included researchers from major universities and the National Institutes of Health.Food and Drug Administration (FDA) Reclassification of ECTThe FDA has proposed to reclassify ECT from a class III (high risk) medical device to class II (low risk) for use in treating severe major depressive episode (MDE) associated with major depressive disorder or bipolar disorder in patients whose symptoms are treatment resistant or who require a rapid response due to the severity of their psychiatric or medical condition. This is a change that is largely supported by APA, although there are some concerns for the FDA to address to ensure that there are not unintended consequences of adopting this proposal.Supporting ResearchAPA Mental Health Registry (PsychPRO)PsychPRO has successfully completed 2018 MIPS reporting for close to 600 clinicians who participate in the registry as solo practitioners, small and large group practices, and community and hospital systems. The majority achieved MIPS scores of 70% or higher, which puts them in the range for bonuses on their 2020 Medicare reimbursements. All these practices participated through full PsychPRO integration with their EHR, which provided for an efficient and effective system for reporting. PsychPRO staff are currently putting together the Data Validation Plan for 2018, which is required by CMS to ensure the quality of data that was reported to the program. This is one among many requirements to remain a certified QCDR throughout the year. Other requirements include monthly support calls held by CMS that must be attended by PsychPRO staff.CMS Quality Measures Development GrantResearch and Registry staff and our subrecipient, NCQA, have successfully recruited experts to serve on the Technical Expert Panel (TEP) and the Consumer and Family Panel (CFP) to assist in advising the development, refinement, and testing of the proposed quality measures. Separate informational webinars were held in January and February to orient TEP and CFP members to the goals of the measure development initiative and their roles in the process. These webinars were followed by all-day in-person CFP (March 21, 2019) and TEP (March 28, 2019) meetings, where panel members were able to engage in discussions about the proposed measure concepts and associated standardized assessment tools. Both sessions provided invaluable information that is being used to refine the descriptions and specifications of the measures.Research Colloquium for Junior Psychiatrist InvestigatorsThe application deadline for this year’s Research Colloquium was December 31, 2018. Of the sixty applications we received, 47 awardees were selected following a thorough review process. Forty-one of the awardees are from the United States and Canada, while six international awardees were selected from Brazil (N=2), Colombia (N=1), France (N=2), and Japan (N=1). Currently, three precolloquium webinars are scheduled throughout the month of April to facilitate early engagement between mentors and mentees prior to the 2-day Colloquium at the APA Annual Meeting. Both the American College of Neuropsychopharmacology and Society of Biological Psychiatry have continued their partnership with APA Foundation (APAF) on this important mentoring initiative.Proposals for Changes to DSM-5Currently, there are six proposals for major revisions in various stages of the review process, including text changes and removal of a disorder. Three proposals are under review by their relevant Review Committees, who have recently submitted recommendations to the Steering Committee. Four new proposals have been received and are under consideration by the Steering Committee for referral to the appropriate Review Committees. One proposal for a minor change was approved by the Steering Committee and is currently posted for public comment (April 1st–30th). In addition to these active proposals, a consensus workshop is being planned for after the Annual Meeting (summer 2019) to determine the agreement on the inclusion of a set of diagnostic criteria for grief in Section II (https://www.psychiatry.org/psychiatrists/practice/dsm/submit-proposals).Education and Annual MeetingWork Group on Physician Well-being and BurnoutThe standing Committee on Psychiatrist Well-being and Burnout is chaired by Richard Summers, M.D., and continues to survey and collect data focusing specifically on the issue of burnout among minority/underrepresented (MUR) psychiatrists. The work group is drafting a manuscript describing findings from their 18-month survey project and examining factors associated with higher burnout scores among psychiatrists. The work group is also conducting a grounded-theory assessment of burnout in MUR groups, specifically conducing qualitative research interviews, which will inform the development of a survey instrument. Currently, 38 sessions have been accepted for inclusion into the 2019 APA Annual Meeting program in San Francisco on physician well-being and burnout.Substance Abuse EducationIn 2018, the APA hosted seven Providers Clinical Support System (PCSS) webinars highlighting motivational interviewing, medication-assisted treatment (MAT) in the emergency room setting, recovery support for young people with opioid use disorder, and methods for addressing substance use disorder in pregnancy. This initiative offers education on opioid use disorder and medication for addiction treatment to provide up-to-date evidence-based information to psychiatrists and other mental health care providers. Through PCSS, APA is also conducting its second Train the Trainer program, which seeks to create MAT trainers at the district branch level. Additionally, APA serves an important role in the national States Targeted Response-Technical Assistance (STR-TA) project, which provides ECHO-style learning collaboratives to help physicians implement evidence-based care for opioid use disorders. Learning collaboratives have focused on adolescents and medication for addiction treatment, telepsychiatry, “implementing the basics,” and a number of additional topics. Both PCSS and STR-TA are supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).Clinical Support System for Severe Mental Illness (CSS-SMI)In July 2018, APA was awarded a 5-year $14.2 million grant from SAMHSA to establish a Clinical Support System for Serious Mental Illness. The SMI Adviser website (www.SMIadviser.org) was launched in November 2018. Weekly live webinars started in January 2019, as well as virtual e-mail-based consultations to clinicians. Between January and April, nearly 1,500 clinicians participated in an SMI Adviser educational activity. Later in 2019, a chatbot-based “answer engine” will be added to the website to guide users to items in the website’s knowledge base of evidence-based resources, guidelines, and toolkits.APA Annual MeetingThe 2019 Annual Meeting opening and convocation speakers were Valerie Jarrett, Senior Advisor and Assistant to the President for Public Engagement and Intergovernmental Affairs during the Obama Administration, and La June Montgomery Tabron, President and CEO of the W.K. Kellogg Foundation. The scientific program for the 2019 Annual Meeting included more than 650 sessions, with a special track commemorating the history of psychiatry for the 175th anniversary of APA’s founding. There were several interactive learning labs. Notable speakers included Patrice Harris, M.D., President-Elect of the American Medical Association, and Nora Volkow, M.D., Director of the National Institute on Drug Abuse.To commemorate the 175th anniversary of the APA, the APA hosted an anniversary gala at San Francisco City Hall as well as a history track. Within the history track, there were eight workshops dedicated to the seven MUR/s as well as international relationships with APA partners and four symposia dedicated to the following four eras:Era 1: The advent of organized medicine in caring for people with mental illness (Early years of APA)Era 2: The dawn of the modern era: reforms in care and treatment (Deinstitutionalization)Era 3: Advancing diagnosis, treatment, and education (DSM)Era 4: Shaping the future of psychiatry: breakthroughs in research and delivery of clinical care (Looking ahead)In addition, Annual Meeting booths were available, hosted by APA and APAF, offering an opportunity for members to celebrate the 175th Anniversary by contributing their story to a permanent collection held at the Melvin Sabshin, MD Library and Archives. The stories were brief clips (1–3 minutes) in which participants responded to prompts such as, “Why did you become a psychiatrist” and “What is the most meaningful story of successful treatment you can recount?”APA’s CME ProgramIn 2018, the APA accredited 321 activities and delivered 1,752 hours of accredited education to 53,499 learners. The APA’s Joint Sponsorship program allows outside organizations, such as district branches and allied organizations, to apply for CME credit from the APA for their meetings. The joint sponsorship program welcomed six new organizations into the program in 2018: the Group for Advancement of Psychiatry, the Tennessee Psychiatric Association, the Iowa Psychiatric Society, the American Association of Directors of Psychiatric Residency Training, the Regional Council of Child and Adole
Referência(s)