BULLETIN NEW YORK STATE PSYCHIATRIC ASSOCIATION WInter 2010,Vol. 53, #1 • Bringing New York State Psychiatrists Together President's Message: Fall Area II Council Meeting The Assembly and Board of Trustees By Rachel A. Fernbach, Esq. By C. Deborah Cross, MD he New York State Psychiatric September 2009 with a comparison for Association held its annual Fall the same period for 2008 and 2007. irst off, I want to gates to the AMA). In T Area II Council Meeting on In addition, Edward Gordon, M.D., thank those members many instances AMA dele- Saturday, October 24, 2009 at the New Chair of the NYSPA Political Action F who responded to gates have their expenses York LaGuardia Airport Marriott in Committee, presented the PAC finan- NYSPA’s request to contact paid and other organiza- East Elmhurst, New York. NYSPA cial statements for January-October, the Board of Trustees tions reimburse their mem- President C. Deborah Cross, M.D., 2009, and a list of 2009 contributors regarding the Assembly’s bers in various ways. The called the meeting to order and invited to date. budget for 2010. Your email also raised questions all those attending their first Council response was extremely about whether the Assembly William Sorum Award important and effective. In Assembly needs to be as meeting to introduce themselves. Dr. Cross presented the Assembly fact, at its meeting in large as it is and whether it Introductions were followed with William Sorum Award to the Queens reports from NYSPA officers. December 2009, the Board C. Deborah Cross, MD needs to meet twice a year. District Branch, the Brooklyn District agreed that there would be The size of the Assembly is As part of her President's Report, Dr. Branch and the New York County no further reduction of the Assembly’s certainly a debatable point, depending Cross reported on three new work- District Branch for sponsoring annual 2010 budget from the originally request- on one's opinion of the function of the groups created by Assembly Speaker scientific research paper contests for ed $200,000. Drs. Schatzberg and Assembly. As you have heard from me Gary Weinstein, M.D.: (i) Model residents. The Assembly William Bernstein’s response to many of those many times over the last few years, I District Branch Work Group, (ii) Sorum Award was created in honor of who wrote to the Board very clearly believe the Assembly is essential to a Communications Work Group and William Sorum, M.D., Past Speaker of spelled out the financial difficulties fac- well informed, well represented, psychi- (iii) Leadership Training Work Group. ing the APA at this time. What was not atric professional organization. In com- the Assembly, to recognize members- Seeth Vivek, M.D., a member of the in-training and district branches that made clear in the email, I felt, was that parison to the AMA, there are (to quote Communications Work Group, spoke the financial difficulties facing the APA the AMA’s web site) “well over 500 dele- have made notable progress in MIT briefly about the group's activities. could very well be a somewhat short gates” to the AMA’s House of Delegates. activities, involvement and participa- term problem since the publication of They meet twice a year and are the Dr. Vivek, NYSPA Secretary, also pre- tion. Herbert Peyser, M.D., Seeth DSM V may result in a significant “principle policy making body of the sented minutes from the May 15-17, Vivek, M.D, Jeffrey Borenstein, M.D., increase in revenues. Additionally, AMA.” It is characterized as a “demo- 2009, Area II Council Meeting at the Lenore Engel, M.D., Vivian Pender, points were made about other profes- cratic forum” which “represents the Spring APA Assembly Meeting. NYSPA M.D., Henry Weinstein, M.D., and sional organizations and financial reim- views and interests of a diverse group of Treasurer, Darvin Varon, M.D., present- Kenneth Ashley, M.D., accepted the bursement of representatives (e.g., dele- [See President’s Message on page 2] ed the financial statements for January- [See Area II Meeting on page 5] NYSPA Makes A Difference: Legislative Brunches Disciplinary “Catch 22” – An Update By Rachel A. Fernbach, Esq. By Rachel A. Fernbach, Esq. From time to time, The Bulletin plans to and the psychiatrist had entered into publish articles detailing how NYSPA psychotherapy, as was required. The makes a difference in the professional lives individual's license was restored with of its members and the patients they serve. the contingency that the psychiatrist The below article is an example of NYSPA's could only practice under supervision advocacy and efforts on behalf of a psychia- in a licensed facility. The psychiatrist's trist caught between the conflicting agendas application for reinstatement to the of two state agencies. Medicare program had already been approved. n early 2009, the Bulletin reported However, the New York State OMIG on a puzzling situation involving a refused to reinstate the psychiatrist in I conflict between the work of the the Medicaid program as a result of the NYS Office of Professional Medical finding of professional misconduct. Conduct (OPMC) in rehabilitating OMIG's final determination did not physicians brought up on charges and take into account the fact that the the work of the NYS Office of the underlying professional misconduct did Medicaid Inspector General (OMIG) in not involve any wrongdoing with Richard Gallo and Barry Perlman, MD preventing fraud and abuse in the respect to the Medicaid program and he New York City District physician licensing requirements. Medicaid program. Physicians caught that the psychiatrist had already been Branches of the APA hosted their Dr. Perlman also discussed issues of in this bureaucratic "tug of war," are reinstated in Medicare. No state T Eleventh Annual Citywide federal concern, including an increase often unable to work towards rehabili- licensed facility that participates in the Legislative Breakfast on December 6, in physicians opting out of Medicare tation, even in a proscribed supervised Medicaid program can hire the services 2009, at the New York Academy of and fewer graduating medical students setting, because the OMIG refuses to of a physician who has been excluded Medicine in New York, New York. choosing a specialty in psychiatry due reinstate them as a Medicaid provider. from the Medicaid program. Thus, One week later, the Psychiatric Society to concerns about reimbursement for of Westchester hosted its 23rd Annual NYSPA is proud to report that its advo- OMIG’s denial of reinstatement effec- services. In addition, he cautioned Legislative Brunch on December 13, cacy on behalf of a particular psychia- tively prevented this particular psychia- against over-reliance on the use of cer- 2009, at the Crowne Plaza Hotel in trist caught in just such a "Catch 22" trist from complying with the terms of tain guidelines as a basis for pay-for- White Plains, New York. performance and liability relief. has resulted in the psychiatrist's full their probation and completing the Barry Perlman, M.D., NYSPA Past- Finally, at the Westchester event, Dr. reinstatement in the Medicaid program, OPMC program of rehabilitation. President and current Chair of the Perlman expressed NYSPA's support permitting the psychiatrist to resume In an effort to bring this issue to the NYSPA Committee on Legislation, for the continuation of Grant Mitchell, forefront, NYSPA contacted the Office employment at a community psychi- kicked off both events by providing an M.D., in his role as Commissioner of of Governor David Paterson and atric hospital as part of an OPMC overview of current legislative issues the Westchester County Department of supervised program of rehabilitation. Medicaid Inspector General James G. affecting New York psychiatrists, Community Mental Health under new NYSPA became aware of this unique sit- Sheehan, to address the apparent con- including implementation of the new county leadership. flict between the activities of OPMC uation when a member was asked to federal parity law, proposed budget The New York City event was moderat- consider employing a psychiatrist who and OMIG. Following an unsatisfactory cuts for mental health services, pay- ed by Marvin Nierenberg, M.D., a had entered into a settlement agree- response from OMIG, the psychiatrist, ment for atypical antipsychotics, con- member of the New York County ment with OPMC for rehabilitation and with NYSPA's assistance, initiated an cerns with the sexually violent predator District Branch Committee on resumed practice under supervision at a Article 78 proceeding in the Supreme civil confinement program, pending Legislation. Dr. Nierenberg welcomed licensed facility. As part of the settle- Court of the State of New York to chal- legislation that conflicts with the cor- those in attendance and introduced ment agreement, the psychiatrist's porate practice of medicine doctrine license had been suspended for a year [See “Catch 22” on last page] and recently proposed changes to [See Legislative Brunches on page 3] THE BULLETIN FROM THE EDITOR’S DESK... By Jeffrey Borenstein, MD NEW YORK STATE his edition of the report about how to Area II Council meeting. We have a new PSYCHIATRIC Bulletin has informa- improve reimbursements column, which will appear from time to ASSOCIATION T tion about issues from managed care. The time, entitled: NYSPA Makes a which impact the practice of President’s message reviews Difference. As we begin a new decade, I psychiatry in New York. We key issues about APA gover- urge each of you to become more active Editorial Board Jeffrey Borenstein, MD report on the Legislative nance and the Area II members of our organization. Each of Editor-in-Chief Brunches in which our mem- Trustee Report provides an us can make a difference as we advocate Holliswood Hospital bers have an opportunity to update about the recent for our patients and profession. ■ 87-37 Palermo Street interact with local political Board meeting. We also Queens, NY 11423 leaders. We also have a Jeffrey Borenstein, MD have a report on the Fall Tel: (718) 776-8181 ext. 321 Fax: (718) 776-8551 e-mail: [email protected] http://www.nyspsych.org/web- President’s Message continued from page 1 pages/bulletin.asp member physicians.” the Assembly. (This may well mean a cial constraints, serious consideration Manoj Shah, MD Ann Sullivan, MD A number of you, I am sure, have significant financial hardship on this should be given by the Board to imple- already heard the outcome of the group, particularly the residents, which menting such a streamlined, but demo- Rachel A. Fernbach, Esq. November Assembly’s discussions NYSPA will look at in light of our own cratic, form of organization. Assistant Editor regarding how to implement the budget. As I have said many times, our NYSPA’s Area 2 Council will now begin Robert J. Campbell III, MD $200,000 cut in 2010. The cuts were residents are the future of the APA and work on how to implement the reduc- Editor-in-Chief Emeritus made with much debate and extensive NYSPA!) tion in representation while at the same Leslie Citrome, MD, M.P.H. testimony from numerous Assembly The Assembly indicated its strong wish time preserving the very important work Editor-in-Chief Emeritus members. Various proposals were pre- to have the Board look at overall of all our District Branches. A very sented and ultimately the Assembly remodeling of the entire APA organiza- important piece of this restructuring is PLEASE NOTE: NEW ADDRESS voted to preserve the twice-a-year meet- tion. In that regard, Dr. Carol Bernstein that the internal structure and function- New York State Psychiatric ing schedule, but to reduce the total (President Elect of the APA) and Dr. ing of NYSPA does not have to be Association number of representatives. This affect- Ann Sullivan (Speaker Elect of the changed. We have approximately 4,500 400 Garden City Plaza, Suite 202 Garden City, NY 11530 ed New York the most drastically in Assembly) are co-chairing a members in NYSPA and every member (516) 542-0077; Fax: (516) 542-0094 that we (Area 2) will be reduced from Remodeling Committee which is to is vital and important to our work. e-mail: [email protected] 19 representatives to the Assembly to report back to the Board next year. It Strong and vibrant representation by the http://www.nyspsych.org 14. Additionally, New York, California still remains to be seen whether the Area 2 Council is essential to our ongo- and Missouri (all state associations) Board would consider a proposal to ing work in New York State. Again, I Executive Committee 2008-2010 lost their Deputy Reps. Another change modify the current “bicameral” struc- was very impressed by the thoughtful C. Deborah Cross, MD, President is that there will be no Deputy Reps ture to something that would be more responses from you, the NYSPA mem- Glenn Martin, MD, Vice President (for those District Branches who still streamlined, efficient, and cost effective bers, in this time of crisis. Your repre- Seeth Vivek, MD, Secretary have them) seated at the November and which would continue to have a sentatives to NYSPA work extremely Darvin Varon, MD, Treasurer Assembly meeting. Additionally, broad democratic base. Area 2/NYSPA hard to make sure that your concerns James Nininger, MD, Area II Trustee though the MITs (residents), ECPs has put forth such a proposal in the are heard and that we represent you Seth Stein, Esq., Executive Director (Early Career Psychiatrists) and MURs past and has strongly supported this both in New York State and in the Barry Perlman, MD, Past President (minority and underrepresented type of reorganization. The financial national APA. As always, I encourage groups) will keep their Deputy Reps savings would be significant. If the you to email me any thoughts or ques- Information for Contributors they will be “unfunded” members of APA continues to face significant finan- tions about this topic or any others. ■ The Bulletin welcomes articles and letters that NYSPA members will find timely, relevant, and compel- ling. Articles should be between Area II Trustee’s Report by James Nininger, MD 750 and 1500 words (three to five double-spaced manuscript pages) he APA Board of Trustees met of the Membership Committee that on developing cultural formulations, December 5–6, 2009. The main new general members who have been Axis 2 is being moved to Axis 1, Axis 3 and letters no more than 750 focus of the meeting was to pass out of training for at least six years be is being reevaluated, Axis 4 is being words. All submissions must be T the 2010 budget. This process involved charged 50% of the full GM rate for the examined for possible use of ICD-3 made electronically, preferably by reviewing and discussing recommenda- first year when joining and then be codes and Axis 5 is being looked at to email to the editor. All authors are tions from the Finance and Budget increased to the full amount of GM develop new global impairment scales. encouraged to also provide a pho- Committee and then voting on the dues the following year. Genetic issues are being studied for tograph of themselves which will final product. The end result spared Dr. Robert Cabaj, Chair of the Council incorporation into the manual, and a be printed alongside their article. the Assembly from any cuts beyond the on Advocacy and Government request is being made to delay the pub- Information for Advertisers $200,000 increment hammered out at Relations, provided the Board with an lication date from 2012 to 2013 to per- the November Assembly meeting. The mit more extensive field trials. A Board The Bulletin welcomes advertise- update on the rapidly changing Federal Board worked effectively and collabora- workgroup is providing overview for ments from both NYSPA members health care proposals and discussed tively to make hard decisions finalizing scope of practice issues prominent in the DSM-V process including a review and commercial enterprises. Total a budget in a continuing time of finan- several states. APA priorities in health of the DSM budget. The cost of devel- circulation averages 5,500 copies cial hardship and uncertainty. A few reform for 2009/10 include that parity oping the document is great, but the per issue. The Bulletin is received by facts: 2009 revenues are projected at requirements be applied broadly and eventual revenues should be a great members of the American $7.8M below those projected, primarily that mental illness and substance abuse help to the organization’s fiscal status. Psychiatric Association who belong due to an abrupt decline in advertising coverage be included and enforced in Interim reports by two ad hoc work- to a district branch in New York which is expected to continue. As you any basic plan requirements. groups active on the Board are of note: State. The Bulletin is also sent to the know, the components were markedly Additional priorities include ending the the Ad Hoc Workgroup on Preparing leadership of other district branch- cut and consolidated this past year and two year waiting period for SSDI recipi- Members for the Future, chaired by Dr. es across the United States and to various internal grants (litigation fund- ents to receive Medicare, fixing the SGR Nada Stotland, is charged with identify- New York State legislators, medical ing, DB infrastructure, DB competitive) permanently, providing better coordina- ing trends within the profession. This libraries, and science writers. The were significantly diminished. Dr. tion and/or integration of primary care workgroup liaisons with a similar Bulletin is published quarterly. Scully and his staff have worked hard to and psychiatric services, expanding the group from the American College of Both classified advertisements and decrease expenditures (down $6.5M use of telemedicine, and minimizing Psychiatrists and is identifying a variety display advertisements are avail- expected for 2009) but in November, potential for scope of practice conflicts. of trends expected to affect psychiatric able. Please contact the editor for 18 full time positions were eliminated. Psychologist prescribing bills this past practice during the next 5 to 10 years. current rates and media require- At the end of December, the staff will year were defeated in Arizona, Hawaii, The group also consults with a focus ments. NYSPA members receive a be down 15% from the high in 2005. Illinois, Mississippi, Missouri, Montana, group of early career psychiatrists and So, all have sacrificed. discount of 50% off the basic clas- North Dakota, Tennessee, and Texas. A members-in-training. A brief on-line sified ad rate. Membership, while not growing, has study bill was passed in Oregon, and a survey was returned by 2700 members remained level, and hopefully the bill was introduced this past November and the results are being analyzed. The opinions expressed in the arti- recent increase in dues will lead to in the Virgin Islands. Preliminary analysis suggests that neu- cles or letters are the sole responsi- greater financial returns in the coming Dr. David Kupfer reviewed progress in roscience, evidence-based practice, bility of the individual authors, year. In New York, MITs have been the development of DSM-V. Proposed reimbursement policies, new informa- and may not necessarily represent attempting to get a “point person” in criteria will be placed on line for public tion technologies and prevention are the views of NYSPA, its members, each residency training program, and comment to provide feedback inform- the topics receiving the highest priority or its officers. this should be pursued and perhaps ing pilot testing and phase I field trials ratings from the respondents. then serve as a model for the rest of the for 30 to 35 disorders. Feedback will The ad hoc workgroup on Future Graphic Design & Production country. The Guidelines for Elections be requested on how to determine level Relationships with Industry, chaired by Lydia Dmitrieff to Distinguished Fellowship have been of severity, and plans also include using Dr. Sidney Weissman is working on a A to Z Design Group revised and will weigh more heavily on the PRN (APA Physician Research proposed model for pharmaceutical
The following is a transcript of Dr. Perlman's remarks at the 2009 Legislative Brunches: able savings could be realized now and in the future by revisiting the legislation At Legislative Brunches dating back almost two decades, the array of issues which and pressing for appropriately long and indefinite sentences for those convicted. have made up NYSPA’s agenda have covered a wide array of topics. However, there Corporate Practice of Medicine has always been a core set of concerns. The central matters have been: equity in We wish to acknowledge the role played this past year in blocking a dangerous access to mental health services, adequacy of accessible psychiatric practitioners, change in New York State’s corporate practice of medicine law, brought about as a child, adult and geriatric, to meet the needs of persons seeking or requiring care, by product of proposed changes to the education law in order to permit recogni- quality of care, adequate funding for those services, and respect for our field and tion of supervision of social workers in non-licensed settings. However arcane this those served by it. issue may seem, it is raised in order to protect against large corporations becoming Parity sponsors of medical practices, which is legally limited to licensed practitioners Over the past several years, several of our goals have been largely realized while only. This issue is really a matter of public health policy meant to protect New others remain elusive. For example, Timothy’s Law, the NYS mental health parity Yorkers. bill, was signed in 2006 and implemented beginning in 2007. The Paul Wellstone National Health Reform and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 became Among the goals of national health system reform is to insure as many uninsured law just over a year ago. While we await the accompanying federal regulations, we Americans as possible. We share that goal. However, there is much in the complex recognize that the nexus of these laws will provide New Yorkers with among the bills being debated which greatly concerns us. We remain concerned about the most comprehensive mental health and addiction coverage in the country. This proposed cuts to Medicare, including physician providers. Medicare rates for New year we were pleased that Timothy’s Law was made permanent. York City area psychiatrists remain low. Increasingly, given the yearly uncertainty Nevertheless, significant gaps remain. Healthy NY, the plan for individuals, sole about draconian Medicare fee cuts due to the Sustained Growth Rate methodology proprietors and small businesses lacks any mental health or addiction benefit and and the increases in practice costs including liability premiums, many medical its pharmacy plan does not allow for the prescription of medications to treat psy- school graduates who complete their educations with a heavy debt burden are chiatric disorders. New York’s Family Health Plus and Child Health Plus plans choosing specialties other than psychiatry & especially geriatric psychiatry. In addi- have only very limited benefits for those conditions. As our country struggles tion, many practicing psychiatrists are opting out of Medicare. (NYS DOH in its towards national health system reform, it is critical that “parity” be realized in all periodic inquiry of doctors gathers data on insurance participation by specialty but plans for all Americans and that the gains of recent years not be diminished. does not make the information publicly available.) Budget This direction is especially worrisome as we are on the cusp of the retirement of We are all aware of the fiscal crisis facing New York State. Without belaboring the the baby boom generation. Let us not turn our wish to cover more persons into point, we ask that budgets for the care of persons with serious and persistent men- an access problem for seniors in many areas of the country, especially large cities. tal illness be spared to the extent possible. We remind you that the population of Rather, let us foster a system which will attract younger practitioners who want to concern is not only cared for in clinics and hospitals licensed solely by OMH. To a participate in our system of public health insurance. In keeping with this concern, large measure they receive their care in institutions jointly licensed by both DOH we oppose the creation of an independent Medicare board to set fees. Without the and OMH, that is the Article 28 facilities. Many of these are inner city safety net intercession of our representatives, many more would have already opted out of institutions which find themselves in evermore precarious financial situations. Medicare and the access issue would have reached crisis proportion years ago. As much as what we would not like to see happen, we have suggestions for cost We also are concerned with plans to use so called “evidence based medicine” and savings as well. Several years ago, NYSPA adopted a policy which we believe “best practices” as the basis for pay for performance and liability relief. As doctors would save the state considerable monies spent on psychotropic medications. well know, these reified concepts are not nearly as clear as presented. They are Pharmaceutical companies do not seem to compete on the basis of cost. We rec- compromises among experts. Patients most often don’t neatly fit the matter ommended that the Medicaid formulary adopt a policy of seeking first trials of addressed. As Professor Jerome Groopman, M.D., of Harvard Medical School has costly atypical antipsychotics based on cost. New York State spending on just this recently written, “A recent analysis of more than a hundred evidenced-based con- class of medications has reached almost $500 million, so what we are talking clusions about clinical practice reported that after two years more than a quarter of about is real money. This policy now seems even more doable than it did even sev- the conclusions were contradicted by new data, and that nearly half of the ‘best eral years ago as a prominent member of that drug class is now available as a practices’ were overturned at five years. This shows that guidelines are not gospel generic. Our adopted policy presents an approach which we believe can be adopt- from a scientific point of view.” We believe guidelines should be just that. ed without harming fragile patients. Other As in the past, we continue to raise serious questions about the state’s Sexually These few minutes allow us to present only a few of the most important of our Violent Predator program – an expensive and expanding balloon which we have concerns. There are many other important matters which will arise and as they do opposed for more than a decade not only because of its yearly cost (between we shall be in touch. But for now, I’ve spoken long enough. We would like to $200,000 and $400,000 per individual if one includes security costs as compared invite you, our legislators, to address us and to please make an effort to respond to to only $30,000 for prison), but because of the violence it does to the mental the questions we’ve asked rather than to speak in broad generalities. Thank you health system by usurping the mental health system to solve what is truly a prob- for your participation in this brunch and your attention. ■ lem of the criminal justice system. In ten years, it is projected that this program Barry Perlman, M.D., is a NYSPA Past-President and current Chair of the NYSPA may cost as much as $400 million. However one views the SVP program, consider- Committee on Legislation.
Winter 2010 New York State Psychiatric Association • THE BULLETIN Page 3 Legislative Brunches continued from page 3 smoking. This informa- practice of medicine tion is being collected issue. in an attempt to address Next, Assemblyman the serious health prob- Adam Bradley announced lems that disproportion- that this is the last year ately affect individuals he will be attending the with serious and persist- legislative brunch as a ent mental illness. legislator because he is The New York City about to become the next event was concluded Mayor of the City of with remarks from staff White Plains. He con- members from the gratulated the group on offices of Representative NYC Council Member Gale the permanency of Carolyn Maloney, Senator Brewer Timothy's Law and indi- Shirley Huntley, Senator Kevin Parker, cated his support for adding mental Assemblyman Peter Rivera, and health benefits to the existing Healthy Assemblyman Felix Ortiz. NY program. Assemblyman Bradley The Westchester brunch, which took addressed the civil confinement pro- place the following gram for sexually violent week, was moderated by predators and agreed that Edward Herman, M.D., the focus should be on Legislative treatment for offenders Westchester County Legislators William Burton and Kenneth Jenkins Representative for the within the corrections Psychiatric Society of system rather than place- Assemblyman George Latimer stated state budget crisis and the need for Westchester. He wel- ment within the mental that he appreciates attending events like enhanced mental health services in comed New York State health system. Finally, he the legislative brunch because it pro- New York State prisons. The Assembly Members discussed the lack of vides him with an opportunity to be Westchester event was concluded with Adam Bradley (D-White treatment and services for educated about issues of concern to his remarks from Grant Mitchell, M.D., a Plains), Sandy Galef (D- those suffering from constituents. He discussed the state psychiatrist who serves as the Ossining), George PTSD and recognized budget crisis and noted that mental Commissioner of the Westchester Latimer (D- Assemblyman Nick Spano NYSPA's advocacy work health services are an excellent illustra- County Department of Community Mamaroneck), Amy Paulin on behalf of veterans and tion of the important distinction that Mental Health. Dr. Mitchell provided (D-Scarsdale), Mike Spano others. should be made between the cost of an update on the Care Coordination (D-Yonkers) and Westchester County Assemblywoman Sandy Galef spoke certain services and the value of those Project, a pilot program aimed at the Legislators William Burton and next, discussing state budget issues, her services. Assemblyman Latimer top users of Medicaid services within Kenneth Jenkins. Grant Mitchell, M.D., support for legislation addressing announced that he is hosting a public the county to provide coordination of Commissioner of the Westchester improper treatment of prisoners, and hearing on state budget issues on care in an attempt to improve outcomes County Department of Community lack of available services for returning Thursday, February 18, 2010 at the and reduce Medicaid expenditures. To Mental Health, also attended the event. veterans and their families. Next, Osborn, a senior living community in date, the program, which costs only The first legislator to address the group Assemblyman Mike Spano discussed Rye, and encouraged anyone interested $170,000 to operate, has saved $1.8 was Assemblywoman Amy Paulin, who state budget concerns and expressed his to attend. million in incarceration costs, state discussed the Medicaid formulary issue, support for NYSPA's position regarding Next, Westchester County Legislators hospital costs and Medicaid costs. the sexually violent predator civil con- the sexually violent predator civil con- William Burton and Kenneth Jenkins Because of its marked successes, the finement program and the corporate finement program. addressed the group, discussing the Department will be expanding the program for 2010. ■
MediComment: How To Get Managed Care to Pay You More by Edward Gordon, MD lder readers of the Bulletin will payments are subject to an interest pay- be filed with the Insurance Department requests and follow up periodically. remember prior columns with ment. online at http://www.ins.state.ny.us 4. Repeat for each insurer with which Othis name. When CPT intro- What’s wrong with this scenario? There /complhow.htm. you are contracted. duced the E/M codes over 15 years ago, is almost no incentive for the insurer to Negotiating Overall, when I received increases, most I wrote a series of columns to teach the increase its fee schedule. In addition, Here’s how to proceed: were in the range of 25-30%, depend- proper use of the codes to members inertia on the part of the psychiatrist 1. Review your fee schedules in light of ing on the variance from reasonable billing for their services. With all the helps the insurer to maintain its level of your expenses and draft a “wish list” - fees and the length of time since the recent coding issues and changes in underpayment. I discovered that some what fees would you like to be paid for last increase. state and federal laws, I decided to of the fee schedules in my files hadn’t your standard services. What is the What results can you expect? That come out of hibernation and offer been changed in many years. Although minimum which will allow you to depends on your volume of service, the some new advice. patient copayments and deductibles accept new patients from this insurer? availability of others in your neighbor- This column will review my recent have been increased, often at an alarm- 2. Call the 800 number for your insurer hood who are willing to accept paltry experiences with managed care and my ing rate, almost none of these funds and speak to your “Provider fees, whether you treat a high priority efforts, mostly successful, to obtain fee have gone to pay for physician services. Representative.” This is harder than it group (e.g., children), as well as the increases from managed care compa- One tendency would be to decide not sounds, as these individuals can be dif- nature of the company you are dealing nies. If you never bill insurers, you to accept patients covered by these ficult to reach and often fail to return with. won’t benefit from this column, plans. Most psychiatrists will, however, telephone calls and emails. Request a Some Examples although you might get some ideas. continue to treat old patients, and often copy of the insurer's most recent fee From Company A, I received an Fee Schedules end up building a stable of underpay- schedule. Speak to the Provider increase to 110% of their highest pub- Managed care companies operate with ing patients. Representative and explain that you lished fee schedule, as well as agree- “standard” fee schedules. On signing a As the active network shrinks, insurers want your fees increased or you won’t ment to reimburse me at this increased contract with insurers or their mental are left with “phantom networks.” be able to accept and treat their fee schedule, even for their lowball fee health contractors, such as Patients unable to obtain care frequent- insured. You will likely be told to schedules (PPO, etc). ValueOptions or Magellan, the psychia- ly complain to the New York State make a list of the codes you want From Company B, I received an trist agrees to accept the attached fee Insurance Department, which publishes increased and where to send it. Don’t increase of fees to “reasonable fees,” schedule, among other requirements. an annual table of insurance company yell at the Reps. It’s not their fault. comparable to those paid to other Be aware that Magellan and complaints, often printed in newspa- Besides, you need them to navigate the physicians for E/M codes. ValueOptions fee schedules are among pers. Employers paying for insurance fee process. Company C declined to raise my fees. the lowest around. Review your policies expect their employees to be 3. Prepare a standard letter, keep it sim- I will follow up again soon. options carefully before signing up with able to get care. Insurers are thus under ple and polite, explaining your fee Good luck! such mental health contractors, as other some pressure to increase fees, in order requirements, listed by CPT code. Ask Keep NYSPA informed of any problems insurers you contract with may lower to provide enough care to reduce com- for any increase to be retroactive to the you may have in getting your fees your payments if they buy into those plaints and negative press. date of the request. Since the approval reviewed and increased, and the out- networks and their corresponding lower How to get your fees increased? It's process may take six months, this is come of your efforts, successful or oth- fee schedules. simple. Just ask. If your patients are important. Mail or fax it on and keep erwise. ■ Thereafter, if things go right, bills are upset by their insurer failing to pay for copies and request receipts, either from sent to the insurer, and the contracted their care, as you must then bill them the post office or from your fax fee, minus coinsurance and/or directly, encourage them to call their machine. Follow up every couple of Edward Gordon, M.D., a NYSPA Past- deductibles, is received within 30 days, employer, their union, or whoever is weeks. They are slow. Keep a file on President, is currently a member of the according to New York law. Delayed paying for the policy. Complaints can your desk on the progress of the Committee on Economic Affairs.
Page 4 New York State Psychiatric Association • THE BULLETIN Winter 2010 Area II Meeting continued from page 1 award on behalf of the three district branches. Dr. Cross also recognized Dr. Vivek for his work in establishing the NYSPA Annual Resident Paper Contest which accepts submissions from resi- dents throughout the state. Legislative Report Richard Gallo, NYSPA Government Relations Advocate, reported on the Veterans' Mental Health Training Initiative (VMHTI), a new program jointly sponsored by NYSPA, the National Association of Social Workers (NYS Chapter) and the Medical Society of the State of New York. VMHTI is conducting training sessions for mental health providers on mental health issues affecting returning veterans and their families. Upcoming training ses- sions will be held at Fordham University in New York City on April 23, 2010, and at SUNY New Paltz, on May 21, 2010. (from left) Herbert Peyser, MD; Seeth Vivek,MD; Jeffrey Borenstein, MD; Lenore Engel, MD;Vivian Pender, MD; Henry Weinstein, MD; Kenneth Mr. Gallo provided an update on Ashley, MD Timothy's Law, New York's mental health mandate which became perma- Force. NYSPA and other members of deficit, which will be offset by with- Committee and encouraged any NYSPA nent this past summer. The New York the Task Force provided comments on drawals from the reserve fund. In members who may be interested in pro- State Insurance Department recently draft regulations and a revised version 2010, the APA expects a $1.4 million viding volunteer evaluation services to issued a Circular Letter addressing how is now being reviewed by the deficit. In addition, APA central office contact him. Timothy's Law will be impacted by the Governor's Office of Regulatory Reform. plans to lay off new federal parity law. NYSPA expects Healthy Minds In addition, a draft was submitted to all some employees in Jeffrey Borenstein, significant improvements in mental members of the Council for comment an attempt to reduce health and substance use disorders ben- M.D., provided an and feedback. costs. Finally, Dr. update on the efits for many New Yorkers. Nininger presented Finally, Mr. Gallo provided an update Executive Director's Report Healthy Minds tele- Rachel Fernbach, Esq., NYSPA Associate the Draft Report of vision program, on NYSPA's efforts to ensure that pri- the APA Workgroup vate insurance carriers process claims Executive Director, provided an update which he hosts. on significant changes to the HIPAA on Relationships Public response to from psychiatrists for outpatient evalua- between tion & management services. In privacy and security rules that go into the program has effect on February 17, 2010. No later Psychiatrists and the been extremely pos- response to NYSPA's advocacy, the Pharmaceutical and Insurance Department announced that than February 17, all providers that are itive and the show subject to HIPAA will need to revise Medical Device is now being dis- it plans to issue a Circular Letter on the Industries. topic. NYSPA will provide members their HIPAA Business Associate tributed nationally. Assembly Update Healthy Minds is Gary Weinstein, currently broadcast M.D., Assembly in the NYC metro- Jeffrey Selzer, MD Speaker, and Bruce politan area on Hershfield, M.D., Channel 13 on Assembly Speaker-Elect, both provided Saturdays at 7:00 a.m. and on WLIW 21 updates on Assembly activities and sev- on Sundays at 9:30 a.m. and Tuesdays eral cost-reduction and restructuring at 11:30 p.m. In addition, the proposals currently being considered by ThinkBright digital public television the Assembly. Assembly Recorder Ann stations in New York State are broad- Sullivan, M.D., discussed the restructur- casting the series on Tuesdays at 2:00 ing proposals and their potential effect p.m. and 8:30 p.m. on the functioning of the APA as well Committee Reports as member activity and involvement. Barry Perlman, M.D., Chair of the Following the reports, the Council dis- NYSPA Nominating Committee, report- cussed issues relating to APA gover- ed that NYSPA will be holding its regu- nance. lar biennial elections for the offices of OMH Report NYSPA President, Vice-President, (from left) Gary Weinstein, MD;Ann Sullivan, MD; Bruce Hershfield, MD Lloyd Sederer, M.D., OMH Medical Secretary and Treasurer in May 2010. Director, provided an update on OMH Council members interested in holding with information regarding the Circular Agreement, HIPAA Notice of Privacy activities, including the clinic reform an office are encouraged to contact the Letter as soon as it is made available. Practices and HIPAA Policies and project, the OMH psychiatrist work- Nominating Committee. A proposed Barry Perlman, M.D., Chair of the Procedures. In addition, as of force, prescription of antipsychotics, slate of officers will be presented at the NYSPA Committee on Legislation, pro- September 23, 2009, HIPAA providers and proposed budget cuts to clinic and March 2010 Area II Council Meeting. will need to provide written notice to vided an update on recent OMH guide- other mental health services. The meeting was concluded with lines on use of ECT in youth and ado- any individuals whose unsecured pro- Committee on Physician Health reports from the following NYSPA lescents. In response to the guidelines, tected health information is breached Jeffrey Selzer, M.D., Medical Director Committees: Addiction Psychiatry, NYSPA drafted a letter to by an unauthorized third party. To for the Committee on Physician Health, Children and Adolescents, Economic Commissioner Hogan's office express- assist members, NYSPA is preparing addressed the Council. The Committee Affairs, Early Career Psychiatrists, ing its concern over many of the guide- new model HIPAA documents that will on Physician Health is a division of the Members-in-Training, and Public lines and also forwarded the matter to be posted on the NYSPA website. ■ Medical Society of the State of New Psychiatry. the APA ECT Advisory Committee. In Finally, Ms. Fernbach provided a brief York that provides non-disciplinary, addition, NYSPA has asked Laura overview of the new Medicare and confidential assistance to medical pro- Fochtmann, M.D., a NYSPA member Medicaid payment incentive programs fessionals experiencing problems from with expertise in the use of ECT in for providers who adopt health infor- stress and difficult adjustment, emo- youth and adolescents, to prepare a rec- mation technology in their practices. tional, substance abuse and other psy- ommended protocol on the topic to be Area II Trustee’s Report chiatric disorders, including psychiatric submitted to OMH. Area II Trustee James Nininger, M.D., problems that may arise as a result of Finally, Dr. Perlman provided an update provided an update on APA finances. medical illness. Dr. Selzer provided an on the OMH Clinic Restructuring Task In 2009, the APA expects a $1.2 million overview of the activities of the
Winter 2010 New York State Psychiatric Association • THE BULLETIN Page 5 “Catch 22” continued from page 1 Trustee’s Report continued from page 2 lenge OMIG's final determination. An to reinstate petitioner – thus hampering turers’ relationships to psychiatric pro- and recommended role of the subspe- Article 78 proceeding permits a private petitioner's return to such employment fessional associations. This effort dove- cialties within the association. The individual to obtain judicial review of a – was baseless." tails with the draft report by Dr. Board approved a request to publish a determination made by a government The decision of the Court permitted the Appelbaum’s task force on the relation- Task Force report on Complementary ship of individual practitioners with and Alternative Medicine in Major agency or public official. psychiatrist in question to resume full this industry that has been circulated Depressive Disorder: Evidence The Court found wholly in favor of the employment pursuant to the terms of for comment. Some argue that it is not Challenges and Recommendations. psychiatrist, stating that the OMIG's the OPMC settlement agreement. possible to separate marketing activities Finally, a number of members have decision not to reinstate the psychiatrist According to OPMC and the Committee from scientific and educational ones inquired about criteria for the Board in Medicaid was arbitrary and capri- on Physician's Health, this precedent- and others feel that this separation is going into Executive Session as it did in cious and in direct conflict with the set- setting case has already benefited other feasible and essential. I feel the the recent budget discussion, and have tlement agreement that had been New York State physicians caught in the American Psychiatric Foundation, requested roll call votes for non-unani- approved and administered by OPMC. same bind, allowing them to move for- where I serve as a Board member, can mous decisions. Whenever there are The Court chastised OMIG for making a ward with their plans of rehabilitation serve as an important vehicle to help divided votes, a Board member may determination that included no inde- and return to practice. ■ define and maintain an ongoing rela- request a roll call vote. I have done this pendent investigation or analysis and tionship with pharmaceutical compa- in the past and will do so for any divid- stated that "the IG's perfunctory refusal nies focusing on joint educational and ed votes on substantive issues and therapeutic activities benefiting patients request the Secretary include the results and their families. in the minutes. I will request the Board Regarding other actions coming out of review the indications for Executive NYSPA Brain Bowl Challenge the meeting, the Board of Trustees Session and report back to you in my voted to engage in a comprehensive next column. Please contact me with review and assessment of the current any concerns and feedback. ■ The NYSPA Members-in-Training Committee is pleased to announce the results of its inaugural Brain Bowl Challenge, an online contest for psychia- Special Discounts for NYSPA Members! try residents, covering a broad range of topics in psychiatry, neurology and Health Assets Companies general knowledge. Each participating residency program identified two res- “Let us answer your insurance/HIPAA/Medicare…questions.” idents to compete in the contest, which was administered online between Psychiatry Billing & Practice Management September 28, 2009 and October 30, 2009. (Verify Benefits, Get/Track Authorizations & Credentialing included) • Electronic billing with quick turnaround of payments • FIRST PLACE AND A PRIZE OF $300: HIPAA compliant/ User Friendly/ Live Support to answer questions • Low Cost Set up Fee (Special Discounts for NYSPA members) SUNY Upstate Medical University in Syracuse, NY • Accept Credit cards for copays – easy to use, we will help set you up Psychiatry Collections SECOND PLACE AND A PRIZE OF $200: (Collect Delinquent patient & insurance payments) SUNY Downstate Medical Center in Brooklyn, NY • Amazing results with insurance company & patient copay accts. • Easy to use submission forms • Payments go directly to you! THIRD PLACE AND A PRIZE OF $100: NYC Department of Consumer Affairs License # 1260593 St. Vincent's Hospital in New York, NY 845-334-3680 or 866-524-9862 [email protected] www.healthassets.com Eleven residency training programs throughout the state You decide which services you need! competed in the competition. “We take care of the paperwork. You take care of the patient. Together, we make your practice the best it can be.” 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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