Reports to the Membership

The Board at its March 2015 Meeting adopted a 5-year strategic plan for the APA that focuses on the integration of psychiatry into all care settings and support for our members in this transition, education, research, and diversity. The Board said its goal was to determine how best to meet the challenges and opportunities ahead, internally and externally, and have a multiyear focus. The adopted plan was informed by the most extensive all-member survey in APA’s recent history, which drew over 2,200 member responses.

The Strategic Initiatives are:

These strategies will be achieved through increased advocacy, effective communication, strengthened member services, a well-structured organization and association, and collaboration with other medical as well as mental health organizations.

In keeping with a formal request from the Assembly Executive Committee, Dr. Boyer brought forward a motion about part IV of the American Board of Psychiatry and Neurology (ABPN) MOC requirement.

At the March 2014 Board of Trustees Meeting, the Board, acting on the recommendation of the Assembly Executive Committee, and representing over 36,000 psychiatrists, voted to support the elimination of part IV of MOC.

Therefore, the Board of Trustees recommends to the ABPN that they lobby and advocate the American Board of Medical Specialties to eliminate part IV of the MOC, that the APA reaffirms its commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice and that the APA will establish a joint Board and Assembly Work Group with the charge to evaluate the broad issue of MOC for psychiatry and its relationship to maintenance of state licensure and other accrediting bodies. The goal of the work group is to return timely reports to the Board and Assembly, including recommendations, if appropriate, for any positions the APA should take regarding any and all parts of MOC.

Following the Board vote, Drs. Summergrad and Levin sent a letter to ABPN President and CEO Larry Faulkner expressing the Board’s concern.

The Board approved the Practice Guidelines for Psychiatric Evaluation of Adults at its December 2014 Meeting. The Guidelines were passed by the APA Assembly at its November 2014 meeting. The Guidelines are composed of the following sections:

Position statements can be found on the American Psychiatric Association’s website: www.psychiatry.org in the “Learn Section,” Library & Archives under APA documents. The APA Board of Trustees addressed several position statements throughout the year. Five new position statements were approved, 20 position statements were reaffirmed, and seven position statements were retired.

The Board Ad Hoc Work Group on Healthcare Reform examined issues and opportunities for psychiatry in the era of new healthcare systems deliveries. The report makes recommendations in six areas of APA activities. It includes the development of initiatives and resources by components and the Administration for the purpose of educating federal and state policy makers, regulatory agencies, and payers regarding the role of psychiatrists in organized systems of care.

The work group will meet during the September 2015 Component Meetings to review the Administration implementation plan and consider each of the recommendations as contained within the ad hoc work group report. The work group will report back to the Board of Trustees at its October 2015 meeting.

The Research Review Ad Hoc Work Group determined appropriate scope and priority areas for research of the APA as appropriate to the fields of psychiatric medicine and mental healthcare and as a professional society given its size and within its resource capacity. The work group considered six primary objectives for the Research office: 1) shaping the research agenda, 2) increasing research capacity, 3) addressing practice needs, 4) improving practice quality, 5) improving care delivery, and 6) addressing the value of psychiatry.

The work group selected shaping the research agenda as the primary objective for the office, which means to shape the agenda policies, priorities, and activities of research funders across the spectrum. The APA through the Division of Research is addressing the needs of psychiatrists, patients, care givers, and other stakeholders in the research agenda.

The Ad Hoc Work Group on Education and Training presented a comprehensive report that was approved by the Board of Trustees. The report includes several overarching recommendations including: 1) The APA must take a leadership role in advocating for the necessary changes in residency education to prepare the psychiatrists of the future to meet the public health needs of Americans with psychiatric illness. 2) The APA should vigorously advocate for maintaining and increasing funding for graduate medical education, including funding for training in innovative care delivery systems. 3) General psychiatry training programs remain 4 years in length. This is more than warranted due to the need to learn the greater volume of clinical knowledge in the areas of neuroscience, ethnic/social diversity and systems of integrated healthcare that are required of a generalist psychiatrist. 4) The areas that must be covered during the 4 years of general psychiatry training include psychosomatic medicine, geriatric medicine, child and adolescent psychiatry, forensic psychiatry, and substance abuse/addiction. Increased clinical exposure to these areas during general residency training will be required to ensure that generalist practitioners will be able to meet the clinical demands of the future. 5) The increase in clinically applicable neuroscience knowledge has created a need for residency curricular development.

The report renews the APA commitment to an educational advocacy agenda that focuses on supporting GME funding and maintaining psychiatry’s designation as a primary care specialty.

The Board of Trustees approved the adoption of a new brand for the APA at its December meeting. The Board noted many competing marks, fonts, and colors evident in APA’s then-current approach to branding and voted unanimously to support a rebranding initiative. The newly adopted brand (Figure 1) will help the APA and related entities move forward in conveying a consistent look and message and demonstrate clear value to members. The APA Administration is in the process of rolling out the new brand to our many audiences. The Benjamin Rush mark will continue to serve as the seal of the APA for certain formal documents and events. The APA successfully launched its new brand on May 16, at the Opening Session of the 2015 Annual Meeting.

On February 12, President Obama signed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act into law. The SAV Act will increase access to much-needed mental healthcare for America’s veterans by improving the ability of the Veterans Health Administration to attract and retain psychiatrists. The legislation was named in honor of Clay Hunt, an Iraq and Afghanistan War veteran and suicide prevention advocate who tragically took his own life in 2011.

APA was very supportive of this measure and instrumental in its passage. The legislation would establish a pilot project encouraging more psychiatrists to choose a career with the VHA by offering medical school loan repayments on par with other government agencies and private practices. Both Immediate Past President Paul Summergrad, M.D., and I were present for the White House bill signing ceremony.

Over the last year, the APA has formed and strengthened numerous partnerships with our allied professional and consumer organizations. Partnership is an essential component of the work we do in our programmatic and advocacy activities. Some specific activities include:

The APA Administration met with the American Association of Community Psychiatrists (AACP), the Academy of Psychosomatic Medicine (APM), the American Association of Directors of Psychiatry Residency Training (AADPRT), the American Board of Psychiatry and Neurology (ABPN), the American Medical Association (AMA), Morehouse School of Medicine, Research!America, ecoAmerica, the Council of Medical Specialty Societies (CMSS), the American College of Neuropsychopharmacology (ACNP), NAMI, Mental Health America (MHA), the American Brain Coalition, the American Psychiatric Nurses Association (APNA), and the Kennedy Forum, just to name a few, regarding future collaborative initiatives.

In July 2014, the APA application to become a nongovernmental organization with Special Consultative Status to the United Nations was approved. This action stemmed from an Assembly Action Paper approved by the Board and provides the APA the opportunity to join over 4,000 nongovernmental organizations working with the economic and social branch of the United Nations in the development of international policy and working together to raise awareness on various issues.

After years of advocacy with the Department of Health and Human Services (HHS) on expanding mental health parity to our most vulnerable population and expressing the need for full disclosure from insurance plans, Centers for Medicare and Medicaid Services (CMS) released its proposed rule on how the Mental Health Parity Act applies to the majority of Medicaid plans and the Children's Health Insurance Program (CHIP). The rule broadly extends the parity requirements to the 50 plus different Medicaid systems with a wide diversity of treatment of MH/SUD benefits, including those that have carved out mental health benefits in unique ways. This creates greater consistency between the commercial and Medicaid markets and would help ensure that beneficiaries who receive services through Medicaid or CHIP will have access to mental health and substance use disorder benefits. States are required to make publically available their documentation for Mental Health Parity and Addiction Equity Act (MHPAEA) compliance requirements as well as include this in their contracts with third parties. The APA reviewed the proposed rule in detail and submitted comments.

The flawed Medicare Sustainable Growth Rate (SGR) was a budget cap that was passed into law in 1997 as an attempt to control federal spending on physician services. Since 2003, Congress routinely delayed devastating cuts that would have jeopardized beneficiary access to psychiatric services in the Medicare program through “patches” to scheduled SGR reductions, causing significant instability and administrative burden for physician practices. In March and April 2015, Congressional leadership conducted breakthrough negotiations based on recent bipartisan work to bring an end to the flawed Medicare SGR formula once and for all. They have laid the groundwork for significant changes to Medicare physician reimbursement over the next decade and beyond with the passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA).

The APA proactively lobbied on repeal and replacement of SGR for over a decade with the assistance of thousands of APA members, and passage of H.R. 2 is a historic action that will stabilize payment and improve access to psychiatric care for Medicare beneficiaries.

The APA sent a strong letter in support of the bipartisan comprehensive mental health reform legislation known as the “Helping Families in Mental Health Crisis Act.” This legislation, also known as the Murphy-Johnson Bill, was recently reintroduced in the U.S. House of Representatives. It builds on last year’s bill, which was already widely considered the most pro-psychiatry legislation to be introduced in many years and which was unanimously supported by the Board in December 2014. The new version of the bill contains very helpful new language on parity enforcement and on increasing the psychiatric workforce, as well as other changes to some of the provisions in last year’s bill.

The next steps in the comprehensive reform debate will include Reps. Murphy and Johnson working with the leadership of the House Energy & Commerce Committee to move the bill toward a Committee vote, while they also continue to collaborate with Senators Chris Murphy (D-CT) and Bill Cassidy, M.D. (R-LA) on the quickly developing Senate version. The APA will remain deeply engaged in lobbying both bodies as they work toward possible votes in Committee followed by House and possible Senate Floor votes in the coming months or beyond.

I want to especially thank the Board, which has made many vital decisions over the past year and has worked to elevate the APA. I also want to thank the Assembly Executive Committee, Assembly, and all of the DB/SAs and their leadership (elected leadership and executive directors) for their concerted effort to engage membership and make a noticeably positive impact on patients and our members.

I look forward to another year of the APA growing and strengthening its position in the healthcare discussion. I also look forward to our continued journey together.

There were significant recruitment and retention activities in 2014, and the total membership is growing. Membership gains were higher in 2014 than the previous year in all membership categories except Resident-Fellow Members. Membership losses offset some of the gains. The net result of all membership activity was the third year of membership growth with an overall increase of 3.9% (1,371 members) from January 2014 (35,003 total) to January 2015 (36,374 total).The total number of members in dues-paying categories increased by 2.3% during the same time period.

The committee agreed to use $150K of the $180K approved for the District Branch Grant process for expedited grant requests for initiatives. A total of 55 grant requests were awarded in the amount of $2,727 for membership recruitment and retention initiatives (N=20), healthcare reform educational sessions (N=15), CME event (N=12), and other educational sessions (N=8). There were seven submissions for innovative grants; four were awarded for $5K each and one for $10K.

Two years ago, the Membership office formalized an initiative to provide district branch/state associations (DB/SAs) a variety of APA print resources to display at their local meetings. Membership contacts DB/SA staff in advance to learn about the meeting dates and assembles a schedule. The Membership contact then contacts each DB in advance of the meeting to find out which resources they’d like to have for the upcoming meeting. In 2014, nearly 40 DB/SAs were sent materials such as membership applications and brochures, flyers on member benefits, educational opportunities, etc.

The Membership Committee sponsored a special meeting for district branch membership chairs during the Annual Meeting for a third year. Representatives from 38 DB/SAs attended, including 28 staff and 20 members. Information was shared about upcoming membership promotions by the national office and how the DB/SAs can get involved. Most of the meeting was an open forum for attendees to discuss and share ideas about membership recruitment and retention. A summary of the meeting will be posted on the DB Membership Chairs listserv.

For the second year, the Membership Committee and BOT WG on International Psychiatrists cohosted a New International Member Welcome Reception on Monday morning during the Annual Meeting. There was a very good turnout with well over 100 people from at least 25 countries in attendance, including several Presidents of International Psychiatry organizations. Drs. Summergrad, Levin, Amiel, Riba, and McIntyre all gave welcoming remarks. The reception was very much appreciated by the new international members/fellows/distinguished fellows in attendance.

The idea of allowing international members to pay one fee to cover their lifetime of membership was introduced a few years ago for the Membership Committee to explore. The lump sum dues rates for U.S. and Canadian members are determined by a complex set of factors using actuarial and other data that vary from one country to another. The Membership Committee agreed to move forward with a recommendation to the Board of Trustees that a lump sum dues option be offered to international members and suggested that the Finance & Budget Committee recommend proposed amounts for approval. The Board approved the action item, and promotion of the new program began in 2015.

The Membership Committee considered a series of ideas to streamline the dues payment policies that, if implemented, would improve membership processing, create more clarity for members, and remove barriers for those who want to reinstate. Overall, the Committee anticipates that with the establishment of a reasonable final dues payment deadline and a process that no longer requires the management of dues amnesty, there will be improvements in member retention. The following recommendations were approved by the Board of Trustees for implementation in 2016.

The APA Membership Department finalized logistics with the 71 psychiatry residency training programs that qualified for the 100% Club in 2014–2015. All qualified programs have received their confirmations, certificates or plaques, and special gifts for each resident (platinum and gold level). Membership is also working with Psychiatric News and APA Headlines to promote the 100% Club programs in APA publications and newsletters throughout the year.

The Rebate Program is being expanded in 2015 to include residents/fellows and international psychiatrists, in addition to fully trained U.S./Canadian psychiatrists who pay the Full-Program or Resident Non-Member Annual Meeting registration fee. Membership applications must be completed on-site at the Annual Meeting to be eligible for the Rebate Program. Promotion will begin after the Advanced Registration deadline in mid-April.

Membership is updating a series of house ads to run on a space-available basis in Psychiatric News educating members and nonmembers alike to the benefits of membership. The ads focus on specific APA resources relating to Annual Meeting member registration discounts, research, practice management, educational and CME opportunities, and advocacy.

The International Membership Ambassador program is continuing in 2015 with members from several countries agreeing to recruit their colleagues for APA membership. The Membership Department is working with members from Argentina, Australia, Brazil, India, Japan, the Netherlands, Spain, and the United Kingdom.

Membership staff exhibited at the Royal College of Psychiatrists’ (RCP) annual International Congress in London on June 24–27, World Psychiatric Association’s (WPA) World Congress of Psychiatry on September 14–18, in Madrid, American Academy of Child & Adolescent Psychiatry Annual Meeting in San Diego on October 20–24, and the APA Institute of Psychiatric Services meeting in San Francisco on October 30–November 2.

Throughout the year, the Membership Department continued to send recruitment mailings and e-mail blasts to nonmembers who attended the 2014 APA Annual Meeting in New York City, lapsed members 5 years or less promoting APA dues amnesty, medical student members of AMSA, and others.

In 2014, 1,057 applications for fellowship and 282 for international fellowship were approved. Additionally, 128 distinguished fellowship and one international distinguished fellowship nomination were approved.