BULLETIN STATE PSYCHIATRIC ASSOCIATION Winter 2008, Vol. 51, #1 • Bringing New York State Psychiatrists Together President's Message: Psychiatry and Medicare Fees Reduction - A Pharma Problem for Patients As Well As By C. Deborah Cross, M.D. Physicians very day seems to bring a developed, a market is created By Barry B. Perlman, M.D. and Seth P.Stein, Esq. new story about the and the product is sold, and E interaction of the phar- sold, and sold! nce again physicians are facing a equal concern for patients covered by maceutical companies and psy- I was at a Grand Rounds substantial reduction in Medicare Medicare Part B and their families. Patients chiatry, a story which usually recently where the speaker O fees for 2008. The Medicare conver- who are enrolled in the Medicare program appears to paint us and our quoted a statistic saying that sion factor for 2008 will decrease by 10% should be rightfully concerned about having profession in a negative light. unless Congress once again takes action to adequate access to psychiatrists and other With the explosion of new by the time a young physician (any discipline) is out of prevent this reduction. Last year, Congress mental health professionals in the years to drugs in our field has come a averted a 5% decrease for 2007, but granted come. The impact of Medicare fee reductions his/her training for 6 years deluge of marketing—to us and no increase in the Medicare conversion fac- will inevitably adversely impact access to their practice patterns are no to our patients. It often seems tor. At the same time, Congress mandated care for both the aged and those under 65 as if we are all struggling just to C. Deborah Cross, M.D. longer recognizable as to that the entire 5% decrease mandated for years of age with disabilities, including those try to stay aware of all the new where they trained. In other 2007 should be implemented in 2008 in suffering with serious and persistent mental pharmacological advances. And how better words, 2 residents from the same graduating addition to the 5% decrease mandated for illness, who are enrolled in the Medicare to do this than to invite the drug rep into class, taught by the same attendings, will, 2008. The culprit is the Medicare program. our offices, or go to a drug company spon- within 6 years, have diverged significantly Sustainable Growth Rate (SGR) formula The problem of Medicare fee reductions will sored dinner/talk. At least, we reason, we’ll from their original standards of practice on used to update the Medicare conversion fac- also exacerbate the nationally recognized get some information. And we tell ourselves graduation. How does this happen? How tor. The SGR was enacted precisely to pre- need for geriatricians and geriatric psychia- that we know it will be slanted toward the do we, as psychiatrists, develop our stan- vent Medicare fee increases due to increases trists at a time when the population is rapid- drug company’s side, but, hey, since we in the Medical Economic Index (MEI). ly aging with the enrollment in Medicare of know this we can factor it in, and, besides, it dards of care? I would really like to believe the “baby boom” generation rapidly won’t really change the way we prescribe that all of us practice “evidence based medi- Every fall for the past several years, Congress approaching. Demographic data and projec- medications for our patients! cine”—but I know this isn’t really true. debates whether the automatically mandated When we decide to give a specific patient a decreases in Medicare Part B conversion fac- tions make the trend clear. In 2005, 12.4% And yet, research seems to say that such tor will take effect. Each year Congress has of the population was over 65 years of age. exposure does influence us. In the 11/25/07 specific medication we tap into a lot of dif- ferent areas of learning—and most of it is acted at the last moment, or even after the That percentage is expected to increase to New York Times magazine section, Daniel 20% by 2025 and even then will not have not “evidence based”, and for a very good new calendar year had begun, to avert the Carlat, MD (a psychiatrist) detailed how his mandated reductions and sometimes grant a reached its peak. This data explains the basis reason. Our patients are not subjects in year as a paid speaker for a pharmaceutical small increase that is much less than the of the call by national political and health- company changed the way he dealt with col- research protocols. They have multiple ill- increase in the cost of living. For 2007, care leaders for more doctors, including psy- leagues and patients. His description of the nesses and comorbid conditions, both med- Congress granted no increase at all. chiatrists, with specialty training in the care ways in which psychiatrists are targeted and ical and psychiatric, and we also have devel- of this population with its special needs. wooed by the drug companies to increase Although it is quite clear why psychiatrists oped our own likes and dislikes. As Carlat The projected 10% decrease in the 2008 the number of prescriptions written for a and other physicians are concerned about said in his article, he had tried the specific Medicare conversion factor follows a 10% specific drug should not surprise us. This the continual and steady erosion in is capitalism in action. A product is [See President on page 2] Medicare Part B fees, this issue should be of [See Medicare Fees on page 6] Fall 2007 Area II Council Meeting By Rachel A. Fernbach, Esq.

he New York State Psychiatric minutes from the last Area II Council Association held its annual Fall Area Meeting as well as the last Executive T II Council Meeting on Saturday, Committee conference call. In addition, October 20, 2007, at The New York Dr. Vivek provided an update on the NYSPA LaGuardia Airport Marriott in East Scientific Paper Contest. An initial mailing Elmhurst, New York. C. Deborah Cross, about the contest has been sent out to all M.D., NYSPA President, called the meeting training directors, psychiatry department to order and introduced several Council chairs, district branch presidents and district guests including Jeffrey Akaka, M.D., branch executive directors in the state. Assembly Speaker, Michael Blumenfield, Entries are expected by the third week of M.D., Immediate Past Speaker, Jim January 2008 and an independent panel of Nininger, M.D., Past Speaker, Gary judges will select a winner and two honor- Weinstein, M.D., Assembly Recorder, Nada able mentions. The winner will make a Stotland, M.D., APA President-Elect, Frank presentation of his or her paper at the Lu, M.D., APA Trustee-at-Large, and Sam March 2008 Area II Council meeting. Dr. Musczynski, Director, APA Healthcare Vivek hopes the contest will further the aca- Systems and Finance. demic accomplishments of NYSPA's mem- After the introductions, Dr. Cross presented bers-in-training and promote increased APA Richard Gallo received the NYSPA Distinguished Service Award. He is pictured here with Barry the President's Report. She reported that membership among psychiatric residents. Perlman, M.D., and C. Deborah Cross, M.D. NYSPA will be participating in a newly Darvin Varon, M.D., NYSPA Treasurer, pre- formed work group to address the required sented the financial statements for January- changes to the rate structure for New York September 2007 with a comparison for the State COPS funding for outpatient clinic same period for 2006. A member of the services. New York State has determined Assembly Nominating Committee, Dr. that the current COPS reimbursement Varon also reported that the Committee is methodology is in violation of federal currently seeking nominations for the posi- Medicaid regulations. Dr. Cross also tions of Speaker-Elect and Recorder. announced that she has created a new NYSPA Vice-President, Glenn Martin, M.D., NYSPA Membership Committee that will be provided an update on the NYS Medicaid chaired by Karen Gennaro, M.D. The Pharmacy Preferred Drug Program. In gen- Committee will be looking into ways to eral, if a drug is on the preferred list, there improve membership recruitment and is no requirement for prior approval and retention. Finally, Dr. Cross, a member of even if a drug is not on the preferred list, the New York State Board of Professional the statute still includes a physician-over- Medical Conduct, reported that the BPMC ride that will permit the patient to fill the is seeking additional psychiatrist members, prescription. Atypical anti-psychotics and particularly in the upstate region. Please antidepressants are currently exempt from contact her if you or someone you know is the Preferred Drug List (PDL). Dr. Martin interested in participating. discussed issues regarding sedative hyp- After the President's Report, other members notics and central nervous system stimu- of the Council provided reports. NYSPA lants and thanked those members of the Secretary Seeth Vivek, M.D., presented the Michael Scimeca, M.D., and Aaron Satloff, M.D., awarded the inaugural Harvey Bluestone Award to [See Area II on page 4] Seeth Vivek, M.D. THE BULLETIN FROM THE EDITOR’S DESK... By Jeffrey Borenstein, M.D. NEW YORK STATE his edition of the Bulletin psychiatry. We also have an throughout New York State. We have a report PSYCHIATRIC reports on the Fall Area II article which looks at the about the new NYSPA Committee on ASSOCIATION T Council Meeting; at the important issue of Medicare Membership Recruitment and Retention. meeting Richard Gallo received fee reductions and the impact The Area II Trustees Report provides infor- the NYSPA Distinguished Service of these reductions on access mation about the APA Board Meeting. We Editorial Board Award and Seeth Vivick, M.D. to care for Medicare benefici- also have statements from the two candidates Jeffrey Borenstein, M.D. received the Harvey Bluestone aries. for Area II Trustee: James E. Nininger, M.D. Editor-in-Chief Award. The President’s Message We provide information and Seeth Vivek, M.D. I urge all members to Holliswood Hospital provides an overview of the issue about the Healthy Minds make their voices heard, on behalf of our 87-37 Palermo Street of the interaction between the public program patients and our profession, by voting in the Queens, NY 11423 pharmaceutical companies and which can now be viewed upcoming election. ■ Tel: (718) 776-8181 ext. 321 Jeffrey Borenstein, M.D. Fax: (718) 776-8551 e-mail: [email protected] http://www.nyspsych.org/web- pages/bulletin.asp President’s Message continued from page 1 Manoj Shah, M.D. drug he was being asked to talk about and venues. Hard choices! On the DB level spokesperson for Pharma, or that we should Ann Sullivan, M.D. he actually felt it worked and helped many have taken the approach that they be the conduit for information directly from Rachel A. Fernbach, Esq. patients. So if we have a good experience will not accept drug company money for pharmaceutical companies with no safe- Assistant Editor with a medication, we are more apt to use it programs, while others continue to make guards or disclaimers. But if you have ever again. How else can you account for the use of unrestricted grants for CME pro- Robert J. Campbell III, M.D. tried to get into one of the drug dinners at fact that a large number of psychiatrists still grams. DB officers state that they find it Editor-in-Chief Emeritus the Annual Meeting you know that they are prescribe Neurontin as a mood stabilizing very difficult to get members out for pro- without a doubt one of the most popular Leslie Citrome, M.D., M.P.H. agent when clinical trials have shown it is grams where members either have to pay or offerings at the meeting! And I don’t really Editor-in-Chief Emeritus no better than a placebo? When we attend the meeting is not being held in a fancy believe that every person there immediately PLEASE NOTE: NEW ADDRESS a symposium on a medication and are told restaurant! Creative approaches have to be goes back home and prescribes nothing but New York State Psychiatric that the speaker (always a famous psy- developed to keep the DB members active that particular drug for the next 30 days Association choparmacologist!) uses this specific drug and involved at the local level. (until the next dinner by another drug 400 Garden City Plaza, Suite 202 for this specific illness and gets good results, Another approach to try to regulate the company!). Garden City, NY 11530 we are much more likely to think of using involvement of Pharma with APA has been Our APA is made up of thousands of psychi- (516) 542-0077; Fax: (516) 542-0094 that drug the next time we see a patient like to require Conflict of Interest statements atrists, some of whom work for pharmaceu- e-mail: [email protected] the one presented! And when we ask a col- from members involved in a variety of activ- tical companies full time doing research, http://www.nyspsych.org league what he or she does in a particular ities within the APA. Members of the Board some who give talks for drug companies, situation, we usually follow their advice. Executive Committee 2006-2008 of Trustees have to fill them out, as do and some who never write a prescription! members of committees, etc. Recently, there C. Deborah Cross, M.D., President What should we do? Can we, as a profes- In many ways, the furor over whether the has been a lot of controversy about the Glenn Martin, M.D., Vice President sion, rid ourselves entirely of the influence APA is too involved with Pharma reminds selection of the Work Groups for the DSM V Seeth Vivek, M.D., Secretary of Pharma? Every year at the APA Annual me of the arguments (which still continue) and the need to get highly qualified experts Darvin Varon, M.D., Treasurer Meeting, there is hand wringing over the that APA is “soft” on managed care! The in the various fields, but ones who are not Ann M. Sullivan, M.D., Area II Trustee very visible presence of Pharma, from the APA is a big “umbrella” and we must find too tied in to Pharma! The development of Seth Stein, Esq., Executive Director drug sponsored dinners, to the exhibition room for all of our psychiatrists without the specific Conflict of Interest statement to Barry Perlman, M.D., Past President booths, to the extra-curricular trips. There demonizing any one group. At the same have been significant changes over the last be used by those asked to be on the Work time, we must all be true to our ethical core Information for Contributors 10 years in APA’s oversight of Pharma’s Groups was a major undertaking. However, and try always to deliver the best care possi- The Bulletin welcomes articles and involvement in the Annual Meeting and there are a number of APA members who ble to our patients—without direct financial letters that NYSPA members will every effort is made by the Scientific say the statements don’t go far enough; that gain to ourselves beyond reasonable reim- find timely, relevant, and compel- Program Committee to monitor that the just asking for a set number of years of bursement for our clinical efforts. As our ling. Articles should be between educational presentations are as free from information, or just focusing on Pharma field develops more “hard” evidence about 750 and 1500 words (three to five bias as possible. However, some members involvement is missing the point. The push exactly which treatments work best in real double-spaced manuscript pages) still express the belief that we (the APA) are is now to ask for a lifetime of disclosure of life for every day patients, we can all strive and letters no more than 750 too in bed with Pharma. At every Assembly conflicts and to include much more than to incorporate this into our daily practice. words. All submissions must be meeting we listen to the Treasurer’s report just conflicts focused on pharmaceutical made electronically, preferably by and hear how much of our income is companies. Hopefully, I have raised some questions for email to the editor. All authors are dependent in one way or another on While I think it is helpful for all of us to NYSPA members to think about. If you encouraged to also provide a pho- Pharma and the basic fact is that our dues know what biases others may or may not have any ideas, solutions, or even more tograph of themselves which will would have to increase by at least 20-30% if have, perhaps we are trying to over-control questions, on this topic or others, I’d like to be printed alongside their article. we significantly restricted Pharma’s involve- the entire issue. Obviously, I am not advo- hear from you. Email me at debo- ■ Information for Advertisers ment in the Annual Meeting and in other cating that the APA should be the [email protected] The Bulletin welcomes advertise- ments from both NYSPA members and commercial enterprises. Total circulation averages 5,500 copies per issue. The Bulletin is received by members of the American Psychiatric Association who belong Healthy Minds on Public Television’s to a district branch in New York State. The Bulletin is also sent to the leadership of other district branch- Thinkbright Stations es across the and to Healthy Minds, the public television series focusing on mental health, hosted by Jeffrey Borenstein, M.D. is New York State legislators, medical now airing on New York State Public Television Thinkbright’s “Health & Wellness” night. libraries, and science writers. The Bulletin is published quarterly. The series airs Mondays at 10 p.m. on the following stations: Both classified advertisements and display advertisements are avail- WNED – Buffalo – Digital: 43.3, Time Warner Channel 21 able. Please contact the editor for WXXI – Rochester – Digital: 21.3, Time Warner Channel 433 current rates and media require- WCNY – Syracuse – Digital: 24.2, Time Warner Channel 851 ments. NYSPA members receive a WSKG – Binghamton – Digital: 66.1 in Binghamton; 30.1 in Corning, Timer Warner Channel 750 discount of 50% off the basic clas- sified ad rate. WPBS and WNPI – Watertown – Digital 16.2 and 18.2 The opinions expressed in the arti- Mountain Lakes PBS – Plattsburgh – Digital 57.3 cles or letters are the sole responsi- WMHT – Albany – Digital: 17.3 bility of the individual authors, and may not necessarily represent The series has already aired in the NYC Metropolitan area on WLIW 21 and has received four Telly Awards. As the views of NYSPA, its members, Dr. Borenstein explains, “Everyone is touched by psychiatric conditions, either themselves or a loved one. Our or its officers. goal is to share cutting edge information from experts along with personal experiences from people who have Graphic Design & Production overcome psychiatric conditions. I want people to know that with help, there is hope.” Lydia Dmitrieff A to Z Design Group The series can also be viewed on line at www.wliw.org/healthyminds.

Page 2 New York State Psychiatric Association • THE BULLETIN Winter 2008 AREA II TRUSTEE’S REPORT By Ann Sullivan, M.D.

APA BOARD MEETING OCTOBER 14-15, 2007

award $300,000 in DB/SA competitive services for our returning veterans and should take! grants, from a total of $490,800 in their families. REPORTS FROM WORKGROUPS/TASK requests. Area 2 did well with awards to FINANCE: FORCES/PROJECTS: the following DB’s: Brooklyn $5,000; The Board adopted a balanced budget for The Board approved an excellent work Greater Long Island $4,860; Mid-Hudson 2008 that based on assumed revenue, group report : RECOMMENDATIONS OF $l,800; New York County $12,400; NY would be in the black by about $200,000. THE TASK FORCE ON THE BIOPSY- State Capital District $21,900; This may be conservative, as depending on CHOSICIAL ASPECTS OF CHILDHOOD Ann Sullivan, M.D. Westchester $5,842; and West Hudson the annual meeting revenue we may have VIOLENCE. This report outlines the $1,200 for a total of $53,000. a higher surplus. A major expense this issues, treatment and advocacy needs on Previous awardees will be requested to year is the development of the DSM V, for the critical issue of childhood violence, appy Holidays to all! The APA report on progress of the initiatives this which 2.4 million is budgeted. The total and is available on the APA website. has been extremely busy and fiscal year. cost of the DSM V is estimated at 18.5 mil- In addition, due to the importance of this H effective in advocating for parity, Some District Branches have urgent issues. lion to completion. work, the Board approved a adequate Medicare reimbursement, pre- Dr. Rubin, Chair of the Membership We currently have reserves of 18.2 million Corresponding Committee to address the venting psychologist prescribing and in Committee, will be working closely with in the APA ( c ) ( 6) and if we are to have issue of Childhood Violence , under the funding for services for our returning vet- our District Branch in Puerto Rico on one year’s unrestricted expenses in the Component Committee on Child and erans. At the Board meeting the progress issues affecting the serious decline in their bank we need about 35 million. So we are Adolescent Services. of the DSM, membership retention and membership, and hopefully develop an half way there! We are still in much better Pedro Ruiz presented an update on his grants for District Branch initiatives were effective plan to address their concerns. shape than 7 years ago when we had no presidential project, a book focused on the also key items on the agenda. Highlights INSTITUTE ON PSYCHIATRIC SERVICES: reserves at all!! important topic of disparities in Mental of the October meeting include: The Institute on Psychiatric Services was The Board approved one change to the Health and Chemical Dependency treat- ADVOCACY: held in New Orleans October 11 to 14 and proposed budget that we in NY can appre- ment and services. It will include a wide The APA Division of Government had a total registration of 1118 , a very ciate. Dr. Ed Gordon has for many years range of contributors across the country Relations has had a hectic, and productive good turnout! The only city that has ensured that the APA stay on top of the and is expected to be published in 2009. several months! Federal Parity has been attracted more registrants recently is NY myriad of coding issues that Medicare Finally, the Executive Committee had passed by both houses and is now in con- (as expected!!) at 1728. While there may often uses to pay us less. The Board voted on 9-19-07 to sign onto the Amicus ference deliberations. APA has been close- be a slight financial loss due to less specifically added $25,000 to the budget Brief of the American Psychological ly involved and is trying to ensure that exhibitors, as an attendee at the conference for a consultant requested by Ed’s coding Association that supports a challenge in state mandates are not weakened. We also I can attest to its excellent program, and workgroup, to ensure that we maximize the California Supreme Court to came the closest we ever did to repealing the large number of interested MIT mem- our influence in this convoluted process! California’s limitation of marriage to only the 50% Medicare co-pay. It was in the bers who attended. There were a series of CONFLICT OF INTEREST/ DISCLO- opposite sex couples. It is critical that the SCHIP legislation that President Bush excellent sessions focused on post Katrina SURES APA be a clear voice on this issue as it vetoed, and was not able to be overridden recovery in New Orleans and the Gulf As with the rest of medicine, the APA’s makes its way through state courts across by the House. However, since it has been the country. Coast. The American Association of relationship to the pharmaceutical compa- backed by both houses, it gives us a better Community Psychiatrists worked closely NEW APPOINTEES: chance for future bills. The APA has been nies and industry is under the microscope. with the APA on the program, and has Dr. Altha Stewart has completed her tenure active with NAMI and MHA in advocating The DSM V Task Force on Disclosures that been a great advocate for the Institute over as President of the American Psychiatric for comprehensive mental health services I am a member of continues to carefully the years. Foundation. As President she transformed for our returning veterans, with good suc- review all nominated appointments to the NAMI: the American Psychiatric Foundation into cess. And once again psychologist pre- DSM V. The Board guidelines for example an effective fund raising and granting scribing was halted in several states includ- Dr. Anand Pandya is the new President of restrict direct industry income per year to institution focused on key issues in psychi- ing Hawaii and California! NAMI! Many of us know Anand from his $10,000 or less while serving on the DSMV work with Disaster Psychiatry and in the Workgroups or Steering Committee. The atry, often those affecting our underserved MEMBERSHIP: NY County District Branch. He is now APA is in the process of reviewing the dis- patients. She has been a strong advocate Overall national membership continues located in California, and is doing great closure and conflict guidelines for the for our patients and our profession. to grow in all categories. However, some work with NAMI. Dr. Pandya met with other consultants or participants in the Dr. Richard Harding has been chosen as District Branches are still decreasing in the Board and described the new NAMI DSMV, as well as the components, practice the new President of the APF and will con- numbers, while others are growing. The national initiative to set up NAMI guidelines, publications, etc. While the tinue the growth and effectiveness of the largest growth is in members in training, Connections, a support group nationwide requirements may not always be the same, foundation. A new Executive Director, Mr. although general members are also slightly that would be available to the mentally ill, it is important to review and see if some Michael Burke has also been chosen to increased. much as AA nationally is available to all common ground is possible and to be join the team. Supporting our District Branches is critical alcoholics. It would provide open, easy careful to ensure reasonable disclosure and Finally, as 2007 comes to a close, once for the APA’s future. The Board approved access to group support for our most vul- management of conflict. All members again Happy Holidays to you and your the recommendation of the Council on nerable patients. NAMI is also in a coali- need to be involved in this critical discus- family, and may we all enjoy peace in the Member and District Branch Relations to tion with the APA to lobby for funding for sion and in the direction our association New Year! ■ [email protected]

The Newly Created NYSPA Committee on Membership Recruitment and Retention By Karen G. Gennaro, M.D. am very pleased to accept the challenge non-member colleagues in this effort. responsibility of the Secretary or the NY district branches. Our APA immediate of heading up the newly formed NYSPA A group of us accepted our mission from President-Elect, or sometimes under a Past Speaker of the APA Assembly, Michael I Committee on Membership Dr. Cross and met at the inaugural meeting Committee on Membership. But we are now Blumenfield, M.D., has graciously agreed to Recruitment and Retention (COMRR) and for this new NYSPA Committee at the Area asking each of the district branches to con- lend his name to the yearly recognition I’d like to thank NYSPA President Deborah 2 Council meeting on 10/20/07. I am sider establishing a special Committee on award for the district branch with the high- Cross, M.D. for creating a focus on member- pleased to recognize Vanessa Hiraldo, M.D Membership Recruitment and Retention est percentage of new members. ship in NY. I’d also like to thank APA (COMRR) and naming a chair to work with of Westchester, Berney Goodman, M.D. of We need you to personally participate in Membership Chairman Joseph Rubin, M.D. the new NYSPA committee. Some district New York County, and Mahendra Singh our membership recruitment and retention and APA Membership Recruitment and branches may choose to have the same per- Airen, M.D. of Queens for their time and efforts. Each district branch would benefit Retention Task Force Chairman James son responsible for membership administra- contribution in launching this committee. Nininger, M.D. for helping lay the ground- tion as well as recruitment and retention. from having a strong group of members This newly formed committee is in the work for the rejuvenation of membership In order to accomplish our ambitious goals, come forth who are willing to focus just a energy at the APA. process of constructing a plan to collectively our expectation is that most district branch- bit of their time reaching out to encourage boost APA membership, a plan that will non-members to join the APA. We will pro- Expansion of our membership base will es will name a second person to focus on include collaboration and competition vide you with a list of non-member leads help provide the necessary resources to meet recruitment and retention. between district branches as well as finan- and talking points so that you will feel com- the challenges of our ever changing profes- Our new committee will meet twice yearly cial incentives funded by NYSPA and recog- sion. In this age of managed care, encroach- at the Area 2 meetings as well as several fortable making these contacts. Please call nition awards to district branches. ment by paraprofessionals, and lack of times via telephone conference calls. Our your district branch President if you are access to care by our patients, our collective In the past, most district branches have lim- motivation will be to compete with each willing to help with membership recruit- membership in a group much larger than ited their membership function to approv- other to have our respective district branch ment. Your effort will help your district any of our individual voices is critical. The ing membership actions and encouraging achieve the highest percent of new members branch earn financial incentives as well as a APA is working hard to protect our profes- members to apply for fellowship classifica- to earn financial incentives provided by chance of winning the yearly Michael sional turf and to improve our patients’ tion. This important administrative func- NYSPA for each new member recruited and Blumenfield Membership Recruitment access to care. Our challenge is to enlist our tion has typically been subsumed under the to earn a relative ranking among our fellow Award. ■

Winter 2008 New York State Psychiatric Association • THE BULLETIN Page 3 Area II Council Meeting continued from page 1

including ERISA exempt plans. Richard Gall, provided an update on Timothy’s Law implementation. Mr. Gallo plans to participate in a series of meetings to be held by the New York State Department of Insurance to address open issues, includ- ing the inclusion of PTSD as a covered disor- der and the restructuring of the methodolo- gy for funding of licensed clinics. In addi- tion, Mr. Gallo reported that he has been invited to participate in a legislative round- Jeffrey Akaka, M.D., APA Assembly Speaker table discussion on the critical shortage of child psychiatrists. Over one hundred indi- Council who recently testified before the viduals are expected to participate. Finally, PDL Committee. In addition, Dr. Martin NYSPA will be reviewing the possibility of reported that the NYSPA Information applying for New York State grants to address Technology Committee has now initiated a the shortage. Google group, which allows all members of Executive Director's Report (from left to right) Darvin Varon, M.D., Seeth Vivek, M.D., Deborah the group to communicate via an online Seth Stein, NYSPA Executive Director, report- Cross, M.D., Seth Stein, Esq., and Glenn Martin, M.D. message board. Anyone interested in ed that NYSPA's Executive Committee has ing this problem. Mr. Stein also noted that Gary Weinstein, M.D., APA Recorder becoming a member of the Google group is authorized the commencement of a lawsuit psychiatrists and institutions have been addressed the Council and answered ques- by NYSPA against the New York State using E&M codes for reimbursement for psy- tions about Assembly and APA activities. Department of Health in connection with chiatric services. He recommends using the Medicaid’s failure to pay the full coinsurance Committee Reports E&M documentation templates prepared by for services rendered to dually eligible indi- The meeting was concluded with reports NYSPA to ensure proper documentation in viduals as of April 1, 2007. If we are unable from the Chairs of the following NYSPA the event of an audit. to resolve the issue with Committees: Addiction Psychiatry NYSDOH, the lawsuit will Finally, Mr. Stein Committee, MIT Committee, Public Affairs be brought in the name of introduced new Committee, NYSPA Bulletin, Children and NYSPA and individual NYSPA staff member, Adolescent’s Committee, Economic Affairs psychiatrists who have Christina Committee, ECP Committee, Membership received only 20% DiGiovanni, who Committee, Committee on Public Psychiatry, Medicaid copayments for will be working with as well as a report from the MSSNY Darvin Varon, M.D., NYSPA Treasurer claims submitted after Donna Gajda, NYSPA Committee on Addiction & Psychiatric March 31, 2007. Coordinator. Medicine. ■ welcome to sign up via the Google website. Mr. Stein provided an Area II Trustee’s The Committee is currently discussing issues Report pertaining to records of minor children, opt- update on Timothy’s Law in and opt-out issues, and the issue of access implementation issues. Ann Sullivan, M.D., to electronic records. First, NYSPA members Glenn Martin, M.D., NYSPA Vice President Area II Trustee, pro- have reported receiving vided an update on Edward Gordon, M.D., Chair of the NYSPA retroactive payments from Oxford Health advocacy issues. She noted that the U.S. Political Action Committee ("PAC"), pre- Plans, representing additional payment for House of Representatives passed a federal sented the PAC financial statement for psychiatric services rendered. These addi- parity bill and the APA has been very January-September, 2007, compared with the tional payments are required by Timothy’s involved in the process to ensure that state same time period for 2006 and 2005, and Law, which mandates that co-payments for mandates are not weakened. Psychologist the list of contributors to date. He encour- psychiatric services be the same as those prescribing was successfully defeated in both aged all present to contribute if they had not imposed on all other medical conditions. Hawaii and California. The National already done so. Second, an upstate insur- Alliance on Mental NYSPA Nominating Committee ance carrier has been Illness has elected a Seth P. Stein, Esq., NYSPA Executive Director Barry Perlman, M.D., Chair of the NYSPA requiring participating new president, Dr. Nominating Committee, announced that providers to submit Anand Pandya, who Seeth Vivek, M.D., and James Nininger, patient intake forms to met with the APA M.D., are running for Area II Trustee to the ensure proper diagnosis Board at its last APA Board of Trustees. before paying claims in meeting. Finally, the NYSPA Distinguished Service Award connection with the six APA Board has decid- major illnesses required to ed to join an amicus Barry Perlman, M.D., presented the NYSPA be covered under brief being submitted Distinguished Service Award to Richard Timothy’s Law. This prac- by the American Gallo, NYSPA Government Relations tice violates the HIPAA Psychological Advocate. Dr. Perlman noted Mr. Gallo’s 34 minimum necessary stan- Deborah Cross, M.D., NYSPA President Association in sup- years of service to NYSPA and highlighted dard and NYSPA plans to port of a lawsuit chal- some of his many legislative accomplish- work to correct this practice. lenging California’s limitation of marital sta- ments, including the Professions Bill and tus to opposite-sex couples only. Timothy’s Law. Dr. Perlman remarked that Mr. Stein also reported on recent changes to Seeth Vivek, M.D., NYSPA Secretary Mr. Gallo’s work as Chair of the Timothy’s the New York State Social Services Law Dr. Sullivan reported that the APA budget for Law Coalition truly embodied the spirit of regarding reporting of child abuse or mal- 2008 is expected to be $200,000 in the black NYSPA and its mission to improve care and treatment. As of October 1, 2007, all and the APA currently has approximately treatment of persons with mental illness. mandatory reporters, including physicians, $18 million in its reserve fund. She reported must make an individual report of suspected that the Board approved the recommenda- Harvey Bluestone Award child abuse or maltreatment regardless of tions of the Council on Member and District Aaron Satloff, M.D., and Michael Scimeca, whether or not a report of the same circum- Branch Relations regarding DB/SA competi- M.D., awarded the inaugural Harvey stances has already been tive grants. The fol- Bluestone Award to Seeth Vivek, M.D. The reported by another mem- lowing Area II district Harvey Bluestone Award was created jointly ber of the facility staff. branches received by NYSPA and the Bronx District Branch in NYSPA will be seeking grants in the follow- memory of Harvey Bluestone, M.D., a dedi- clarification regarding ing amounts: cated and distinguished long-time member whether a single report Brooklyn - $5,000; of NYSPA. Dr. Scimeca praised Dr. Vivek for can be submitted identify- Greater Long Island - Richard Gallo, NYSPA Legislative Consultant his love of teaching, advocacy for the profes- ing all those who are $4,860; Mid-Hudson sion, his many board certifications and his mandatory reporters - $1,800; New York work in establishing the new NYSPA rather than multiple County - $12,400; Scientific Paper Contest. reports from each mandat- NYS Capital District - Legislative Report ed reporter. $21,900; Westchester Barry Perlman, M.D., Chair of the NYSPA In addition, Mr. Stein stat- Gary Weinstein, M.D., APA Assembly Recorder - $5,842; and West Committee on Legislation, reported that the ed that NYSPA members Hudson - $1,200. U.S. House of Representatives recently have reported that New York State Medicaid Finally, Dr. Sullivan reported that Richard passed a federal mental health parity law. has been disallowing claims submitted Harding, M.D., will be the new President of While original versions of the bill as pro- under code 90862 and is instead applying the American Psychiatric Foundation. posed would have preempted Timothy's Law, code 99231, which is a code for a short hos- Assembly Update pital follow-up visit. Richard Gallo, NYSPA this bill, if enacted into law, will not pre- Nada Stotland, M.D., APA President-Elect , Government Relations Advocate, has agreed empt Timothy's Law. Instead, it will man- Jeffrey Akaka, M.D., Assembly Speaker, and date enhanced coverage for all health plans, to contact the Department of Health regard- Barry B. Perlman, M.D., NYSPA Past President

Page 4 New York State Psychiatric Association • THE BULLETIN Winter 2008 AREA II TRUSTEE CANDIDATES James E. Nininger, M.D. SeethVivek, M.D.

Distinguished Fellow Member Distinguished Fellow Member Since 1976 Since 1978

Private Practice, 1977-; Clinical Associate Professor of Psychiatry, Cornell University Chair, Departments of Psychiatry and Addiction Services; Jamaica, Brookdale and Medical College, 1989-; Speaker, APA Assembly, 2004-05; President, New York State Flushing Hospitals, NY; Chair, Advanced Center for Psychotherapy, NY; Part-time Private Psychiatric Association, 1998-2002; Member, AP A Board of Trustees, 2003-05; Chair, Practice, Forest Hills, NY; Secretary, New York State Psychiatric Association; Assembly Rep Assembly Committee on Planning, 1999-2002; Member, Executive Committee; Steering & Past President, Queens Psychiatric Society Committee on Practice Guidelines, 2005-; Exemplary Psychiatrist Award, National Alliance for the Mentally III, 2006 Certified: Candidacy Statement The role of Area trustee provides a tremendous opportunity to listen to, educate, General Psychiatry, Addiction Medicine, Addiction Psychiatry, Geriatric Psychiatry, and represent our members on the AP A Board. We are faced with critical chal- Forensic Psychiatry, Psychosomatic Medicine, Administrative Psychiatry lenges. Severe underfunding of services, stigma, managed care restrictions, and increasingly liberal scopes of practice allowing nonphysicians to diagnose and treat Awards: mental illness (including the prescription of medications) all contribute to erosion of proper treatment for our patients and barriers in access to quality care. The American Red Cross Award for service following 9/11 In New York we must remain vigilant in sustaining the gains we have made in First recipient of the Harvey Bluestone Award (Ethics and Service) parity and scope of practice, and speak up on issues such as proper privacy of med- Leo Davidoff Award for Medical Student teaching ical records and appropriate evaluation, diagnosis, and management of sexual offenders that do not deplete our mental health budget for chronic and indigent patients. We must better educate the public, government officials, and our nonpsy- Accomplishments: chiatric colleagues as to the nature, prevalence, and cost -effectiveness of appropri- ate treatment of mental illness. To attain these goals, membership strength and Conceptualized and built a department of psychiatry involvement are crucial in AP A. At the same time we expand and refine our elec- Started a Residency Training Program in 2001, Fellowship in 2007 tronic communication abilities, we need to provide greater personal outreach to Started a Psychiatry Externship in 1996 members in the field and impart to training directors and early career psychiatrists Started a free psychiatric clinic for indigent immigrants, Queens the importance of psychiatrists' active involvement on behalf of our patients. This includes strengthening liaisons with the AMA, state medical societies, and advoca- Initiated Scientific Paper Contest, initially in Queens, now at the NY State level cy groups. In New York, a strong alliance with the medical society has helped us to avoid intrusions into our scope of practice. To foster recruitment, we must contin- Mission /Goals: ue to forge alliances with our allied psychiatric groups, consider shared- dues strate- gies, and be sensitive to the needs of international medical graduates and minority Bringing over 30 years experience in leadership and management to represent representatives, many of whom serve valiantly in the public sector. you in Washington. APA has made progress in the prioritization of goals, removal of redundancy in Using experience in various subspecialties in hospital and private practice set- committee and component functions, and the establishment of financial oversight mechanisms that include Assembly input to ensure fiscal responsibility. We must tings in Board deliberations. strive to improve communication with and between legislative and public affairs Advocating Proactive legislation against Psychologist Prescription and Admitting reps, executive directors, and presidents and presidents-elect of our district branch- privileges. es. Difficulties in establishing a viable information system damaged morale in DBs through lack of an adequate available database and timely reporting of dues Introduce creative ideas in receiving enhanced Value for our Membership Dues billings. Concrete steps have been taken to rectify this. I support having an expert Advocacy for Training and Career development for MITs and ECPs. business and financial advisory panel serve as consultant to the Board. As the Area trustee from New York on the Board, I would make sure these issues are pursued Assisting APA members in all stages of their career (practice management, reci- and that future concerns of NY SPA members receive appropriate attention. I have procity of licensure etc.). lobbied in Albany for NYSPA and in Washington, D.C., for APA and serve on the Board of the APA PAC. At the New York County District Branch, I established the first task Force on In the last 40 years APA voting has dropped to under 30%. Please do vote! Psychiatry and Nursing Homes and chaired the Committee on Aging for 14 years. I was among the first group of psychiatrists to volunteer services to the homeless, volunteered at Pier 94 and ground zero with Disaster Psychiatry Outreach follow- Together we can change our future ing 9/11, in Louisiana following Katrina, and coordinate the Assembly liaison rep- resentatives to the AP A Committee on Psychiatric Dimensions of Disasters. As a member of the Medical Society of the State of New York, I have served on the I will be honored to represent you. Thank you. Committee on Psychiatric Medicine and the Task Force on Psychiatry and Violence, and currently serve on the Task Force on Tobacco. I have demonstrated strength in working well with diverse groups to establish consensus, have represented NYSPA as treasurer, vice president, and two terms as Contact info: 718-206-7165 or [email protected] or www.seethvivek.com president and Area representative, and served on the AP A Board of Trustees as speaker-elect and speaker of the Assembly. I would be honored to serve as your Area 2 trustee. Contact info: 212-212-879-8338 or [email protected]

Winter 2008 New York State Psychiatric Association • THE BULLETIN Page 5 Medicare Fees continued from page 1 decrease in psychiatric fees in 2007 due to charges, but their patients thereby lose all If we are serious about remedying this prob- and not be forced by an economic calculus to the implementation of reductions in the Medicare and other health insurance cover- lem so that broad access is preserved and choose procedure based specialties. The first work value assigned to all Medicare CPT age for treatment provided by an “opt-out” needed medical manpower trained in the task must be identifying a fair alternate to the codes due to the increase granted to certain physician. While many practitioners say necessary fields of geriatric medicine and SGR methodology which includes enhance- evaluation and management codes (99xxx). they will opt out of the system or stop psychiatry are available for Medicare ments for the “cognitive” specialties. Working Because of statutory requirements that the accepting new Medicare patients, it is diffi- patients, we must start to take action now. together, medical and psychiatric professional cost of any increase in Medicare codes be cult to obtain reliable data on their actual Groups advocating for the elderly and for associations and organizations speaking for “budget neutral”, the 2007 increase for E&M practice decisions. Interestingly, it is known those with serious mental illness must advo- the needs of the elderly and those with seri- codes was offset by decreases in the work that psychiatrists more than physicians in cate for the passage of Medicare legislation ous mental illness can begin to shape the values for all Medicare codes. any other specialty have decided to “opt and then raise these broader concerns about debate and make a tangible difference. ■ For 2008, Medicare has approved a 32% out” of Medicare. the issues identified in this piece with their increase in the work values for anesthesiolo- A 1981 study demonstrated that psychiatric members of Congress. If this issue is per- Classifieds gy codes and this increase will be offset by participation in Medicaid was directly corre- ceived as only a problem of physician an approximately 2% reduction in the work lated with reimbursement. The same can be income, then it is unlikely that Congress will Psychiatrists needed for adolescent values for all CPT codes. In sum, psychiatric expected of decisions regarding the inclusion see the need to act. and adult outpatient program. Dream codes (908xx) face a decrease of 20% from of Medicare enrollees in practices today. Once the problem has been identified as a job for retiree or moonlighting - flexible 2007 to 2008 unless Congress takes action What is certain is that the threat of rate cuts problem for access to care for Medicare bene- hrs - evenings, days, weekends. this winter. or flat fees has discouraged medical students ficiaries and their advocacy groups demand Private practice in Albany, NY - full In addition to the challenge posed by fee from pursuing specialties in geriatrics, and change, then we may to find solutions that administrative services provided - decreases, Medicare also imposes fee limita- fellowship programs in geriatric psychiatry will encourage young physicians to pursue pleasant atmosphere. tions on non-participating physicians and have chronic problems in filling their slots. their interest in treating Medicare patients Contact Laura Hunt - 518-330-2699 New York has imposed even more stringent The fill rate for fellowships in geriatric psy- fee restrictions on non-participating physi- chiatry declined to 61% in the years 2001- cians than the federal law. At the same time 2002 from 84% during 1999-2000. While physicians are facing rapidly escalating costs there may be interest in geriatric psychiatry, Notice of Good Faith Estimate of Non-Deductibility of of practicing. For example, liability insur- the decision to seek more lucrative specialties NYSPA 2008 Dues ance rates climbed an astounding 13 % this is understandable when one considers the year in New York State which prompted debt load of graduating medical students. The Omnibus Budget Reconciliation Act of 1993 included certain provisions denying tax Governor Spitzer to a Blue Ribbon Eight percent (8%) of medical school gradu- deductibility for the portion of dues paid to 501(c)(6) professional organizations that is Commission to study the problem which is ates carry significant debt with 41% carrying spent on influencing state or federal legislation. The law requires NYSPA to provide its mem- bers with a good-faith estimate of the portion of their dues which is attributable to lobbying rapidly becoming a crisis in our state. Even debt of more than $150,000. With that bur- and therefore, is non-deductible for federal income tax purposes. if Congress passes major Medicare legisla- den, choosing a specialty like geriatric psy- tion that will postpone the drastic Medicare chiatry whose practitioners are among the For 2008 dues, NYSPA has estimated that 33 1/3% of NYSPA/Area II dues are attributable to fee reductions, this legislation will only con- lowest paid is a difficult one. Gone are the lobbying and cannot be deducted. The schedule below sets forth the calculation of the fer a 0.5% increase in each of the next 2 days when there was an articulated goal of deductible and non-deductible portion assuming payment in full. If only a partial payment years. During this two year period, Congress shoring up reimbursement for so called was made, then 33 1/3% of the amount paid is non-deductible. must find a fix for the Medicare fee setting “cognitive specialties”, such as psychiatry, Membership Category 2008 Dues Deductible Non-Deductible methodology. internal medicine including geriatric medi- General Member/Fellow 150.00 100.00 50.00 Regardless of the outcome of congressional cine, and other lower paid specialties whose Member in Training 15.00 10.00 5.00 efforts, the calculus of the cost of practice practice revenue is not contingent on per- Life Member/Life Fellow (1-5) 100.00 67.00 33.00 may lead some or many physicians, includ- forming well renumerated procedures. Life Member/Life Fellow (6-10) 50.00 33.00 17.00 ing psychiatrists, to formally “opt out” of the Indeed, today Medicare reimbursement pro- Please note that this notification only applies to NYSPA/Area II dues. It does not apply to Medicare program. By opting out of vides a clear disincentive rather than an inducement for those considering training in APA dues or to district branch dues. If you have any questions, please do not hesitate to Medicare, physicians gain the right to charge contact the NYSPA Central Office. Medicare patients usual and customary geriatric psychiatry. New York State Psychiatric Association State Psychiatric York New Association American Psychiatric Area II Council - 400 Garden City Plaza Suite 202 Garden City, NY 11530

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