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Texas Society of Psychiatric Physicians EWSLETTER N FEBRUARY / MARCH 2002 a Crisis of Capacity George D

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Texas Society of Psychiatric Physicians EWSLETTER N FEBRUARY / MARCH 2002 a Crisis of Capacity George D Texas Society of Psychiatric Physicians EWSLETTER N FEBRUARY / MARCH 2002 A Crisis of Capacity George D. Santos, MD, Chairman, Public Affairs Committee ometimes it is difficult to know where to at the loss of psychiatric beds since 1996. It on the availability of psychiatric beds. In SSbegin. We as psychiatrists are faced with highlights a disturbing trend of erosion in the January 2000, 82% of Texas, counties encom- so many challenges in our efforts to provide ability to serve the mental health needs of our passing a population in excess of 5 million basic good medical care, it is particularly frus- communities. As this process of diminishing Texans, had no psychiatric beds. The number of trating when other factors can have such a beds continues, it is helpful to review a few of psychiatric physicians actually increased by negative impact. We spend a great deal of time the study’s findings to get a clearer picture of 2.4% from 1996 to 2000. In January of 2000, training and refining our skills and informa- the problem we face today. psychiatric physicians made up 5.4% of the tion base. We have all striven to decrease the The TSPP report cites another study, the Hay physician workforce. The bad news, however, stigma of psychiatric illness that stems from an report, which examined health care delivery was a loss of 4,826 psychiatric beds in 71 hos- inexperienced general public. In many ways nationally from 1988 through 1997. This review pitals in 36 Texas counties. This represented a these efforts have met with significant success. highlighted some of the factors which had dis- 29% reduction of available psychiatric beds GEORGE D. SANTOS,MD There are more people seeking care, and the proportionately affected the mental health sys- during the 1996 to 2000 period of time. There treatment options we have to offer are varied tem of service delivery. It showed that was a 36% drop in the number of hospitals and effective. We are however faced with a behavioral health care benefit costs were cut which had psychiatric beds. These reductions closures since the completion of the study, the growing problem in Texas. We have a crisis of 54% during the period, significantly more than were most prevalent in the general medical-sur- numbers would be even worse. capacity. the 7% cut in general healthcare benefits. The gical hospitals. As we are all aware, there have It is difficult to put your finger on any one Because of a variety of influences over the decline in psychiatric services were due to been more hospital closures in most of our factor as being most responsible for this trend. last several years, the availability of inpatient healthcare benefit plans’ reduction in expendi- large cities since the time of this study. The TSPP study identified several factors noted psychiatric services has been seriously tures for behavioral health. This reduction in Every part of the State has been affected. by the psychiatrists who responded to a TSPP impacted. This is true in both the public and insured dollars providing coverage for mental Harris County had a 52.9% decrease in psychi- survey. These factors included: declining admis- private sectors, and has impact in both inpa- healthcare services is only one of many factors atric beds. Counties around the State had simi- sion rates (despite growing populations), tient and outpatient levels of services. The TSPP that contribute to the decline in psychiatric ser- lar findings: El Paso a 76.3% decline, Dallas a declining patient days, and declining reimburse- conducted research into this issue, which was vices we now face. 29.3% decrease, Bexar County a 34.4% loss. If ments from public and private payors. Most psy- published in January of 2000. This study looked Let me summarize some of the TSPP findings we included the hospital and psychiatric bed continued on page 5 A Call to Action Quality Care Under Attack! John R. Bush, Executive Director uality psychiatric care is under attack to become active participants in organized their scope of practice. Texans must not allow QQfrom many different directions... psychiatry so that TSPP can position itself to further degradation in the quality of psychiatric continuing managed care limitations on be an even more effective advocate for the care for patients to occur. Psychiatric patients access and reimbursements; State regulatory profession and the patients served by the deserve and expect the highest quality of care to restrictions; inadequate funding for public profession. be delivered. This is the core of TSPPs Mission mental health; availability and rising costs of At press time, the Governor of New Mexico Statement: “TSPP is dedicated to developing the malpractice insurance; dangerous encroach- was considering signing into law a bill passed highest quality of comprehensive psychiatric ment into medical practice by unqualified by the New Mexico legislature which included a care for patients, families and communities.” non-physician providers; discriminatory provision that will grant prescribing privileges While TSPP will continue to craft winning coverage in private insurance and public to psychologists effective July 1, 2002. If this bill legislative strategies, the ultimate key to JOHN R. BUSH programs; closure of psychiatric hospital becomes law in New Mexico, the dangerous legislative success rests with members building beds; growing restrictions in workers’ consequences for patients in their State will be relationships with legislators: RELATIONSHIPS... compensation coverage; disruptive utilization considerable. RELATIONSHIPS... RELATIONSHIPS! I NSIDE... review hassles; invasions into the patient- TSPP, along with its allies and friends in If you are a member, contact your Chapter APA Launches Political physician relationship and patient privacy, to medicine, patient advocacy organizations and leadership or the TSPP Office and volunteer to Action Committee . .6 help in TSPPs Political Action Task Force, a APA President Visits Houston . .4 TSPP, along with its allies and friends in medicine, patient advocacy program designed to encourage the formation Calendar . .8 of relationships between psychiatrists and Congratulations . .3 organizations and many Texas psychologists, soundly defeated a members of/candidates for the Texas Editors . .8 [Psychologist Prescribing Bill] filed in the Texas Legislature in 2001. Legislature prior to the convening of the next Executive Council Actions . .3 Legislative Session in January 2003. If you are Executive Council . .2 not a member, please contact the TSPP Office Heart of Texas Chapter . .4 mention a few. Individually and collectively, many Texas psychologists, soundly defeated a for a membership application and become In Memoriam . .2 these attacks are detrimental to patients seek- similar bill filed in the Texas Legislature in active in organized psychiatry’s many activities Looking Forward . .8 ing needed psychiatric care. More and more, 2001. It is expected that organized psychology advocating for the profession and psychiatric Medicaid Fee Increases Approved . .7 these challenges must be resolved at the State will again attempt to gain prescribing privileges patients. Membership Changes . .4 level. TSPP works vigorously and effectively by legislative fiat when the Texas Legislature Psychiatrists in Texas cannot afford to be Political Action . .3 on these and many other challenges 24/7 for convenes in January 2003. Needless to say, if passive or apathetic. There are too many chal- President’s Message . .2 the benefit of patients and all psychiatrists, the New Mexico bill becomes law, it poses a lenges that need to be continuously and effec- The Ethics Corner . .5 regardless of practice setting (private prac- serious threat to our legislative strategies and tively addressed. Active membership TMA Section on Psychiatry . .6 tice, public sector and academic). About 75% ultimately to patients in Texas, as well as involvement allows our organization to be a TSPP Committee/Council Schedule . .6 of Texas psychiatrists participate in this patients in other States. This is not a “turf issue” strong and united voice for psychiatry and for Unequal Protection . .4 ongoing effort through their membership in between medicine and psychology; rather it is a patients. Quality psychiatric care for Who Will Tell the Story? . .7 TSPP. TSPP invites and encourages the 25% of quality of care issue. Even a majority of psy- patients in our State is at stake. Your Committees at Work . .3 Texas psychiatrists who are not yet members chologists oppose such an unwise expansion in Together, we DO make a difference. TEXAS SOCIETY OF PSYCHIATRIC PHYSICIANS P RESIDENT’ S M ESSAGE A District Branch of the American Psychiatric Association EXECUTIVE COUNCIL 2001-2002 Practice of Psychiatry Circa 2002 EXECUTIVE COMMITTEE (*) President. Charles L. Bowden, MD oth in my role of serving as your population growth that exceed the national President-Elect . R. Sanford Kiser, MD BBPresident, and as a result of the opportu- average, every large city in Texas has from 5 to Vice President . Karen Dineen Wagner, MD, PhD nities I have to speak on aspects of mood dis- 10% fewer psychiatrists in full-time practice Secretary-Treasurer. J. Clay Sawyer, MD Immediate Past President . Deborah C. Peel, MD order throughout the U.S and other parts of now than they did a decade ago. Because of the world, I am able to meet many psychia- demographic patterns, and the numbers of COUNCILORS (*) trists in all walks of professional practice. physicians in residency training, it seems likely A. David Axelrad, MD Jefferson E. Nelson, MD This column draws from those experiences, as that this real relative shortage will continue. Gary L. Etter, MD Deborah C. Peel, MD Alex K. Munson, MD Margo K. Restrepo, MD well as my experiences as Chair of a large One might think that a perceived shortage Department of Psychiatry at the University of would encourage more graduating medical stu- REPRESENTATIVES TO THE APA ASSEMBLY (*) CHARLES L. BOWDEN,MD Texas Health Science Center at San Antonio.
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