American Psychiatric Association Assembly Meeting

By John P.D. Shemo, MD, DLFAPA
Medical Director,
Psychiatric Alliance of the Blue Ridge
Associate Clinical Professor,
University of Virginia 

The 100th meeting of the APA Assembly was held in New York City prior to the annual CME meeting.  As a meeting site, New York City has the advantage of being about the best draw for attendance, especially from overseas, but has the disadvantage of being so expensive, the lower airline fares being rapidly offset by the higher cost of everything else.  Almost all professional organizations face this same conundrum – that the best “draw” sites are also the most expensive.

The APA is struggling with economics.  As you may be aware, there was an embezzlement problem that occurred, but we are told that the funds were recovered.  The economic problem seems largely driven by the combination of reduced book sales and less attendance at the annual CME meetings.  It is not clear if and how these will change.  Consequently, more meetings, such as Area meetings, will be virtual or non-reimbursed at the APA level.  Unfortunately, a lot is lost in terms of productivity with virtual meetings, especially if there are a lot of attendees.

One issue that was addressed to some degree at this Assembly meeting was the recent use by Medicare of the “151 code.”  This was, to my understanding, first instituted by Medicare in 2017, but I have not been aware of it being used until just very recently.  Medicare, it seems, does not want to deny a lot of care to patients “up front.”  I assume they don’t want people angry at the government, which is why they made Medicare Part D, prescriptive medication coverage, a program administered by a variety of proprietary insurance entities.  With Medicare 151, they do not deny the patient coverage for care up front, but rather deny payment to the practitioner after charges have been coded and submitted.  Use of this code signifies that Medicare believes that the patient is being seen too frequently or for too long a visit and they, therefore, do not pay for the services provided.  I assume that since the patient cannot then be charged for the service, Medicare expects that the practitioner will be financially forced to provide less care to the patients.  They do state that “Payment adjusted because the payer deems the information submitted does not support this many/frequency of services,” but the only information they have is the diagnosis codes and patient demographics such as age, sex, and address.  This issue is being addressed by the APA through their Division of Reimbursement Policy and Quality/Advocacy, Policy, and Practice Advancements.  I have also had the opportunity to discuss this issue with the APA legal department.

There were 22 Position Statements and 17 Action Papers reviewed by the Reference Committees and voted on by the Assembly.

Included among the Position Statements proposed or revised were the following:

1. Substance Use Disorders in Older Adults.
2. Role of Psychiatrists in Palliative Care.
3. Physician Identification:  Consumer Transparency.
4. Arrest of Psychiatric Inpatients for Violence.
5. Mass Incarceration.
6. Weapons Use in Hospitals and Patient Safety.
7. Inquiries About Diagnosis and Treatment of Mental Disorders in Connection with Professional Credentialing and Licensing.
8. Air Pollution and Psychiatric Health.
9. The Mental Health Impact of People Displaced by Climate Change.
10. Proposed Position Statement on Transcranial Magnetic Stimulation.
11. Tobacco Use Disorder.
12. Research with Involuntarily Hospitalized Psychiatric Patients.
13. Conversion Therapy and LGBTQ+ Patients.
14. Human Trafficking.
15. Police Brutality and Black Men and Boys.
16. Mental Health Equity and the Social and Structural Determinants of Mental Health.
17. Racism and Racial Discrimination and Their Adverse Impact on Mental Health.
18. The Use of Psychiatric Institutions for the Commitment of Political Dissenters.
19. Academic Freedom of Psychiatrists.
20. Neuroscience Training in Psychiatric Residency Training.
21. Consistent Treatment of All Applicants for State Medical Licensure.
22. Child Poverty and Mental Health.

Action Papers passed by the Assembly included:

1. Guidelines for Psychiatrists in a Supervisory Role for Non-Physician Practitioners, which asks that the APA create a work group to draft a resource document for practicing psychiatrists to better understand, navigate, and manage their supervisory responsibilities, malpractice and liability concerns when working with non-physician practitioners.
2. Advancement of New Research:  Triple Blind Peer Review in APA Publications.
3. Two Decades Post FDA’s Box Warning on SSRIs:  Call for Review.
4. Increasing Access to Naltrexone for Treatment of Alcohol Use Disorder.
5. Supporting Safety Training for All Psychiatry Resident Physicians.
6. Promoting Harm Reduction – Informed Policy Making and Education Regarding Kratom.
7. Promoting Public Education About Tianeptine.
8. Psychiatry Core:  A New Educational Experience for Primary Care Doctors.
9. Need to Collect Sexual Orientation, Gender Identity, and Gender Expression Information at Inpatient Psychiatric Facilities.
10. Coordination to Reduce Burden of Prior Authorization (which would allow physicians to bill for time used to obtain prior authorization for treatment of patients).
11. End Binding Arbitration for Denied Medical Claims.
12. Making Assembly Representation More Equitable.
13. Votes by Strength and a Task Force to Look at Assembly Representation.

Action Papers not passed by the Assembly included the following:

1. Banning Stigma Against People Living with Mental Illness: Beyond Health Insurance Parity.
2. Improving Regulation of Controlled Substances.
3. Incorporating Medical Marijuana Information into Controlled Substance Databases.
4. Distinguishing Medical Aid in Dying (MAiD) or Physician-Assisted Death (PAD) from Suicide.

Copies of these newly proposed and revised Position Statements and the Action Papers are available on the APA website for those wishing to review more of the details of these actions.

As usual, I end this report with the reminder that Drs. Kaul, Moideen, and I, as your representatives to the APA Assembly, are always open to input on issues and concerns you would like to see addressed by the Assembly and/or APA administration.