By John P.D. Shemo, MD, DLFAPA
Medical Director, Psychiatric Alliance of the Blue Ridge
Associate Clinical Professor, University of Virginia
May 19-21, 2023
San Francisco, California
As always, the spring Assembly meeting was held prior to the scientific meeting held in San Francisco this year.
As I have mentioned in recent past reports, more of the review and revision of Action Papers is being done by Reference Committees prior to the Assembly meeting and then put on a consent calendar. The consent calendar is then approved by the Assembly in its entirety except that any member can have any item removed from the consent calendar for individual discussion on the floor. This does oblige Assembly members to have reviewed Position Statements and the Reference Committee revisions of Action Papers prior to the first plenary session of the Assembly. If the Reference Committee had elected to not support an Action Paper, or had made revisions that had “gutted” the author’s intent in the paper, the author can move that their original paper be presented rather than the Reference Committee revision and this option is then voted on by the Assembly.
Those items removed from the consent calendar will then be discussed/revised and then voted on by the full Assembly.
Proposed Position Statements developed by APA committees are subject to a yes or no vote with no revisions. If not approved by the Assembly, the Position Statement goes back to the authoring committee for reconsideration. I personally believe that it would be useful if the result of the discussion that led to the “no” vote was also sent, but enough APA staff are at the meeting that this information probably most often does get “unofficially” back to the authoring committee.
In addition to this “legislative” function, the Assembly also has a series of reports and presentations at the Assembly. This typically includes reports from Saul Levin, MD, the Medical Director and CEO of the APA, the treasurer, the APA President, Chairs of the APA PAC and the APA Foundation, etc.
At this meeting, there was also a presentation by the incoming head of the American Board of Psychiatry and Neurology regarding issues of ABPN certification and recertification.
As I have mentioned in the past, I am concerned about this shift in Assembly meeting time away from our legislative role, which the Board already labels as being “consultation” to the oral presentations of “reports” that are already available in the Assembly packet, especially since the “question and answer” aspect of the reports has recently been largely eliminated.
In his address, Dr. Levin did outline the top challenges facing psychiatry as being:
- Prior authorization.
- Preserving the physician/patient relationship.
- Payment for services.
- Maintenance of certification.
- Safe prescribing/Scope of practice.
In the Legislative Report, the following positive aspects of the Congressional Consolidated Appropriations Act (CAA) of 2023 were outlined:
- CAA allocated 200 new graduate medical education slots with 100 going to psychiatry.
- Grants and technical assistance provided for the “Collaborative Care Model” (COCM), integrating behavioral health into primary care.
- Addressing of “hidden equity.” Re-authorizing the Minority Fellowship Program for five years with increased funding. Authorizing grants to states to help enforce the Federal Parity Law.
- Mitigating Medicare cuts. CAA restored 6.5 percent of the planned 8.5 percent cut to Medicare payments to all physicians.
- Increased access to Telehealth. Medicare telemedicine flexibilities that were part of the COVID- 19 “public health emergency” were extended until the end of 2024.
Briefly, some of the Position Statements (PS) and Action Papers (AP) passed by the Assembly are outlined below. To go into detail would require a report of at least 40 to 50 pages. The actual documents are available to any APA member on the APA website:
- PS – Physician Identification/Consumer Transparency.
- PS – Capital Punishment.
- PS – Restrictive Housing of Incarcerated Adults with Serious Mental Illness.
- PS – Lengthy Sentences Without Parole for Juveniles.
- PS – Protecting Vulnerable Populations from Social Media and Online Harms.
- PS – Studying the Decriminalization of Illicit Substance Possession and Use.
- PS – Assessing the Risk for Violence.
- PS – Addressing Discriminatory Policies that Prevent Access to Housing and Employment.
- PS – Regulatory Oversight of Data, Apps, and Novel Technologies in Mental Health.
- AP – Incorporation of Medications for the Treatment for Opioid Use Disorder by Opioid Treatment Programs into Controlled Substance Databases. While all controlled substances prescribed by practitioners are automatically included in these databases, opioid treatment programs do not need to similarly report – this is an effort to correct this.
- AP – Interference With Psychiatry Resident Physicians in Training, that psychiatric residents need to be trained as/by psychiatrists.
- AP – That the APA Support the Development of “Overdose Prevention Centers.”
- AP – Improving the Public and Healthcare Professionals’ Perception of Psychiatry and Psychiatrists. (This Action Paper was very extensive and complex.)
- AP – Expanding Post Graduate Opportunities for Unmatched Psychiatry Residency Applicants.
This is only a partial list of the issues addressed by the Assembly and being addressed by the APA.
While I do see areas in which I think the APA could be improved, including a governance model more similar to that of the AMA, this is no way lessens my appreciation of the value that we and our patients derive from the work of the APA.
As always, Adam Kaul, Sherin Moideen, and I are most open to the concerns, and ideas about options for improvement, of our PSV colleagues and how these could be addressed by the APA Assembly.
