APA Council Reports

The Council has worked closely with the APA Administration on the development of legislative strategies to prepare for Congressional action on mental health reform this year, in particular H.R. 2646, the Helping Families in Mental Health Crisis Act, and S. 2680, the Mental Health Reform Act. The Council prioritized policy recommendations to inform APA Administration advocacy during the markup and floor consideration of H.R. 2646. In July, the House of Representatives overwhelmingly passed the bill with provisions addressing the critical psychiatric workforce shortage, stronger enforcement of mental health parity, and improvements in the coordination of mental health resources at the federal level. APA was strongly supportive of H.R. 2646. The Council has now turned its focus to S. 2680, which may be considered by the full U.S. Senate in September.

With the 2016 state legislative sessions largely behind us, it is important to gain a sense of what was done well and what can be improved moving into 2017. The 2016 state legislative sessions brought new resources to the district branches for dealing with psychologists’ scope of practice battles in the states, including the APA regional state government affairs team and the creation of the Unsafe Prescribing toolkit. On the legislative front, sessions kicked off with major bills being introduced in Hawaii, Iowa, New Jersey, New York, and Ohio.

The APA Administration, working closely with the Council and APA membership, brought a new sense of urgency to defeating inappropriate scope of practice measures sought by psychologists. With less than half of the year remaining, it is important to note the major progress made in Hawaii and Iowa. With the help from APA membership, legislation was defeated on the last day of the session in Hawaii, and in Iowa, a compromise was reached that would include the strictest licensure requirements for states with prescribing authority for psychologists.

Nationwide, the legislative trend has continued to focus on allowing psychologists to gain prescriptive authority while short-cutting the education and training necessary to maintain patient safety. APA has continued to broaden the conversation to promote evidence-based alternatives to pervasive mental health access challenges (e.g., expansion of collaborative care models in states with rural health challenges, telepsychiatry implementation, and parity enforcement). The district branches in both Illinois and Iowa will be participating in the rulemaking process, a result of the passage of prescriptive authority bills in Illinois (2014) and Iowa (2016). We expect that the American Psychological Association will continue their efforts to gain such authority in many states, and APA expects active legislation in numerous states in 2017.

The Council has continued their work in amending APA’s 1996 endorsement of the Principles for the Provision of Mental Health and Substance Abuse Treatment Services. The original document was developed by nine major mental health professional organizations, including the American Psychiatric Association, American Nurses Association, American Psychological Association, and National Association of Social Workers. The group’s objective was to define patients’ bill of rights, inclusive of the right to know: benefits available, extent of professional expertise, treatment options, contractual limitations, appeals and grievance procedures, and guaranteed confidentiality. In conjunction with the Council of Healthcare Systems and Financing, the Council has been assigned the responsibility for updating this significant policy model, providing substantive work for consideration by the Joint Reference Committee. The updated position statement is being designed to be a useful resource for patient advocacy.

This spring, the Centers for Medicare and Medicaid Services issued a lengthy proposed rule covering implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The APA-supported passage of MACRA was the culmination of over a decade of lobbying from APA and organized medicine to replace the flawed Medicare Sustainable Growth Rate formula. In summary, MACRA merges current Medicare incentive and penalty programs into one payment system, and it provides incentives for physician participation in alternative payment models. The Council continues to work cross-functionally with APA Administration and other APA components to review written comments and provided strategic lobbying guidance and recommendations. More recently, the Council has identified practical challenges, opportunities, and implications for regulatory advocacy on behalf of psychiatry within the Centers for Medicare and Medicaid Services so that our members can better work within the evolving system’s requirements.

Originally created in 2002 and re-established in 2009, the Committee on Advocacy and Litigation Funding (Jeff Akaka, M.D., Chairperson) is charged with reviewing requests that involve legislation, litigation, and advocacy. The committee serves as a mechanism to evaluate requests for financial assistance to district branches and state associations and to make recommendations regarding funding through the Council on Advocacy and Government Relations and the Joint Reference Committee to the Board of Trustees. With increased legislative activity and greater focus on state government responsibilities in the changing environment of health care reform, the Council has worked with APA in ensuring support to eligible and approved district branches and state associations as they seek to bolster their advocacy apparatus.

APAPAC (Charles Price, M.D., Chairperson) is governed by a board of directors that is comprised of 13 APA members. APAPAC is the bipartisan political voice of the APA and enables APA to invigorate its patient and professional advocacy activities by supporting candidates for federal office. The PAC works to ensure the election of members of Congress who share mutual principles and goals with APA and who stand up for psychiatry’s position during the legislative process. Another extremely important role of the PAC is to educate other members of Congress as to why they should support positions that are vital to our patients and our profession.

The PAC raised an estimated $325,000 from APA members during the 2014 election cycle. APAPAC has currently raised $449,678 so far in the 2016 election cycle, which is already a 38% increase. Increasing this number is the top priority of APAPAC. Strengthening our political voice is vital to the APA’s advocacy efforts and crucial to the future of our specialty and our patients. APA is near the bottom of physician specialties in money raised. APAPAC has recently introduced the APAPAC Congressional Advocacy Network (CAN) to bring an even greater voice to psychiatry’s advocacy efforts. APA’s CAN program is designed to match a least one APA member to every member of Congress to increase the profession of psychiatry’s impact on the U.S. Congress and advance the cause of mental health in America. APA CAN is designed to help develop, train, and energize a national network of psychiatrists who will commit to communicate and build personal relationships with members of Congress and speak on behalf of the APA on issues facing mental health.

Protecting the value of APA communications assets and member information is of paramount importance and a major focus of the forthcoming communications policies document. This can be accomplished by setting clear guidelines for internal and external communication.

Assets like the APA member e-mail list should not be sold or shared with any outside parties. This is one of the most valuable communications assets the APA has, and protecting it serves the organization and our members alike. Direct access to the list within the organization should be restricted to preserve the integrity of the list. It should be regularly maintained and have a clear approval process for outgoing messages established. Guidelines for appropriate use of the e-mail to members must be clearly defined.

Communications to members needs to have a clear, meaningful purpose so that it is most effective and contributes to an overall positive member experience. This issue is being addressed by establishing guidelines for targeted and personalized communication to members. Targeted communications result in more engagement, better retention, and an overall better experience for members.

Members seeking guidance from APA should have easy access to an updated organizational chart, including contact information, to establish means of direct communication from members to the leadership or staff who can best address their concerns.

Keeping the APA governing bodies apprised of APA communications efforts is very important. The forthcoming communications policies document will provide for the regular presentation of communications plans to the APA Board of Trustees and Assembly.

One goal of the communications policies document is to address the need for interactive open communication between APA staff and members. One way this could be addressed is through electronic town halls.

The communications policies document will provide for specific training in communication skills at the time of on-boarding for all national-level leadership at the APA. It will also provide for online training to be available for members in topics like social media, public speaking, and writing for media.

The policies document will seek to unify internal communications at APA by mandating standardized document formats and templates to be used by all departments.

The communications policies document will ensure that APA’s external communications, i.e., those with the media and the general public, are managed so that our messaging is clear and decisive and easy to interpret by the lay public. Accordingly, the communications policies document will lay down several guidelines to maximize the effectiveness of APA’s external communications.

As outlined in the APA Operations Manual, the President of the APA and the CEO and Medical Director are the designated spokespersons on official APA positions. In press matters relating directly to the persons holding those positions, other spokespersons may be designated by the APA Office of Corporate Communications and Public Affairs (CCPA). The CCPA maintains a database of APA experts to respond to media inquiries on general mental health topics.

All communications with media members should be considered “on the record,” and official APA spokespersons should act accordingly. Individual APA members speaking to media members are encouraged to adopt the same policy and avoid “off-the-record” conversations.

All requests from media outlets should be directed to the CCPA media relations team, specifically the senior media relations specialist. The CCPA, charged with maintaining relations with members of the press, will decide who should respond and how. The CCPA is also charged with determining whether press releases and media advisories are issued. The CCPA is responsible for crafting media messages, including talking points, press releases, statements, and media advisories. The CCPA is required to respond rapidly to breaking news events as they occur.

The APA uses social media to enhance the image of the APA in support of its mission, vision, values, and strategic goals. Use of social media as a means of official APA communications will be limited to authorized Communications and Marketing personnel who are directly responsible for the various communications, marketing, and outreach efforts of the organization. As outlined in the APA’s policy manual for employees, if an employee identifies her/himself as an employee of the APA on her/his personal social media account or blog, she/he should not post any profane, offensive, or illegal content. The employee is also expected to make it clear that views expressed on social media are personal views and not those of the APA.

The CCPA is charged with developing and maintaining the patient information section of the website as a means of communicating to patients, families, and the general public the latest scientific information on mental disorders and treatment options. The office works with other APA business units, such as the Department of Government Relations, to establish means of ongoing communication with lawmakers, advocacy groups, and other stakeholders.

The communications policies document will mandate use of the APA name and logo for all internal APA entities and lay down rules or guidelines for prohibited use of the APA name and logo as well. It will establish guidelines and an approval process for modification of the logo, use of the APA seal, and use of the APA logo by district branches and state associations.

The policies document providing for a means of measuring outcomes (e.g., open rates, click rates, views, number of comments submitted, or contacts made) that will be tracked over time to measure effectiveness of APA communications strategies. This will make APA communications plans adaptable and dynamic in a complex and evolving media landscape.

Regular reassessment of the communications policies document by a subcommittee of the Communications Council, using data-based outcome metrics as a guide, will occur at a defined time period. An updated version of the policies document will be presented to the Joint Reference Council each time an amendment is made to the document.

Collaboration of staff and membership on the communications policy document is an example of the ideal symbiosis we should strive for with our members. It is in the APA’s interest for communications to be member focused, so it was prudent to ask the Council members how APA staff could best serve them and their colleagues. The drafting and eventual adoption of this communications policies document will do much to protect the integrity of APA communications, facilitate member communications, and promote the national of voice of psychiatrists in America.

The Council on Communications also plans to discuss how to further integrate innovative new methods of communicating, such as Twitter, Instagram, Snapchat, and Facebook, into APA’s public communications. As these platforms gain an ever-increasing role in society, they have begun to supplant many forms of traditional media as the preferred method of getting information to the general public. The APA is currently active on a number of these platforms already, but new technology and trends are constantly evolving in this space. With this in mind, the Council seeks to understand how the APA can best tailor its message to the unique audiences of these new communication platforms, with the ultimate goal of using them to engage the public in a meaningful, modern dialogue about issues related to mental health and substance use disorders.

The Council has collaborated with the Council on Psychosomatic Medicine to draft a position statement on the role of psychiatrists in palliative care. A workgroup consisting of volunteers from both the councils is working on the statement. The workgroup is planning to submit the final draft to the Joint Reference Committee (JRC) for approval in the fall of 2016.

The JRC asked the Council to review an existing position statement entitled “Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with Dementia.” The Council suggested retiring this position statement but strongly supported the need for a statement emphasizing the importance of high-quality mental health care services in the long-term care (LTC) setting. The Council is developing a new statement focusing on the specific role of psychiatrists in systems where LTC services are provided by multidisciplinary teams in which psychiatrists may serve principally as consultants or supervisors. The statement is expected to be ready in September 2016 for submission to the JRC.

The Council reviewed the draft guidelines and provided feedback to the Practice Guidelines Steering Committee. The Council was impressed by the effort made by the guidelines group to create a document built on the foundation of the existing evidence and adherent to the IOM rules. The input of the Council focused on ensuring that the guidelines would prove useful to our members in the field.

This year the Council continued its collaboration with the AAGP on various issues of common interest to the members of both organizations. Council members and the AAGP representatives agreed to continue the conversations on potential collaborative advocacy efforts and connect via regular conference calls. The Council has proposed that the President-Elect of the AAGP be appointed a corresponding member of the Council on an ex officio basis. This will improve the collaboration between the Council and the AAGP and increase the impact of both the APA and the AAGP.

The Council is considering three topics for presentation at the 2017 Annual Meeting. These topics include collaborative care in geriatrics, the role of psychiatrists in palliative care (to be developed in collaboration with the Council on Psychosomatic Medicine), and forensic issues in geriatric psychiatry (including assessing capacity for physical intimacy among persons with dementia). One or more of these may be presented in association with the AAGP.

The Council responded to the requests below for comments on policy documents.

The Council is charged with recommending honorees for APA Geriatric Awards: the Jack Weinberg Award in Geriatric Psychiatry and Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. The Jack Weinberg Award recognizes psychiatrists who have made noteworthy contributions to geriatric psychiatry as researchers, mentors, leaders, and clinicians over the course of their careers. The 2016 award recipient was Dr. Constantine G. Lyketsos. The recently established Hartford Jeste Award recognizes an early-career geriatric psychiatrist who has made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service and has demonstrated the potential to develop into a future leader in the field. The 2016 awardee was Dr. Ilse Weichers.

The Council continues to identify and support opportunities for the development of quality abstracts on global mental health and international topics for presentation at the APA Annual Meeting and other international psychiatric meetings. The Council coordinates efforts with national psychiatric organizations outside the United States and with U.S.-based psychiatric organizations for ethnic groups and international medical graduates, and through APA components such as the Caucus on Global Mental Health and Psychiatry.

Council and Caucus members developed and coordinated presentations focused on training American psychiatrists as global mental health investigators, implementers, and collaborators, as well as reviewing models of education and training on global mental health. The Council and Caucus will continue to expand on these topics and others, including migrant and cultural issues, for upcoming meetings.

The research colloquium for junior investigators held during the 2016 APA Annual Meeting in Atlanta featured the inaugural participation of young researchers from Brazil, Colombia, France, and Mexico. Additional slots are being reserved for international participation at the 2017 APA Annual Meeting in San Diego to foster greater participation. Participation in the international poster session and the scientific program continues to include hundreds of psychiatrists and trainees from over 50 countries. The Council and Caucus will continue to promote participation in these opportunities for professional growth by international psychiatrists.

The Council is also coordinating abstract submissions for relevant international meetings, including international congresses of the World Psychiatric Association and the upcoming 2017 World Congress of Psychiatry, which features the theme “Psychiatry of the 21st Century: Context, Controversies and Commitment.”

The Council is connecting with U.S.-based ethnic group psychiatric organizations to identify opportunities for collaboration and foster closer relationships with the APA. The organizations contacted include the American Society of Hispanic Psychiatry, the Arab American Psychiatric Association, the Association of Chinese American Psychiatrists, the Association of Korean American Psychiatrists, the Haitian American Psychiatric Association, the Hellenic American Psychiatric Association, the Indo American Psychiatric Association, the Nigerian American Psychiatrists Association, the Philippine Psychiatrists in America, the Society of Iranian Psychiatrists in North America, the Turkish American Neuropsychiatric Association, and the Viet-American Mental Health Network.

A new membership category for psychiatric trainees outside of the U.S. and Canada was approved and finalized during the 2016 APA Annual Meeting. A membership category for international medical students is being reviewed and finalized. APA will connect and coordinate with psychiatric organizations outside the U.S. and Canada to share the benefits and opportunities associated with these new membership categories.

The Council reviews APA position statements and Assembly action papers addressing a range of issues affecting psychiatry. Over the course of the past year, they have reviewed and provided updates and feedback on topics such as the abuse and misuse of psychiatry, human rights, and migrant and refugee mental health. The following are position statements (PS) and action papers (AP) reviewed and under review by the Council in coordination with several other APA components:

The Council nominated former U.S. Surgeon General Dr. David Satcher to receive the 2016 APA Human Rights Award in recognition of his efforts to promote and support the human rights of populations with mental health needs through the release of the first U.S. Surgeon General’s report addressing mental health, Mental Health: A Report of the Surgeon General, and his efforts to eliminate racial and ethnic disparities. Dr. Satcher was presented with the award by APA President Dr. Maria Oquendo during the 2016 APA Annual Meeting in Atlanta.

The Council continues to explore opportunities for global mental health education and training, opportunities to foster exchange and bilateral learning between American and international psychiatrists, identifying issues that affect international medical graduate psychiatrists in the United States, and addressing mental health care and treatment of diverse populations.

The Council continued its initiative to advance education and training of psychiatrists for new roles in collaboration with primary care:

An APA Education Summit was convened by the Council in Fall 2015: Focus on Faculty Development. The summit provided a forum for discussion of barriers to faculty development of the newer skills needed in a resource-limited environment. Allied education organizations reported on their faculty development activities. Discussion centered on issues of improving faculty content knowledge and pedagogic skill, recruiting faculty into teaching, and resources.

The Council is frequently called on to provide opinion on actions and issues related to education. The Council supported APA testimony to the Department of Veterans Affairs Commission on Care regarding the shortage of psychiatrists and the need to strengthen recruitment and training efforts. The Council reviewed recommended action steps in the 2015 Board of Trustees Workgroup on Training and Education Report. The Council weighed in regarding ABPN’s current requirement that individuals be required to maintain general certification in order to maintain subspecialty certification.

The Council monitored and provided comments on the following GME issues:

The Council serves as consultant to the CME activities of APA and to the overall CME program. The Council is involved in shaping APA education, in assisting with needs assessment for CME activities, and in identifying psychiatrist knowledge gaps. At the request of the Board of Trustees, the Council provided input with regard to the Division of Education’s creation of a pilot program that would increase APA’s educational offerings by partnering with non-ACCME accredited district branches and affiliates to develop live and enduring education through joint sponsorship of CME credit. The program will be expanded to include provision of credit to live meetings of allied organizations and online education of district branches and allied psychiatric groups. The Joint Sponsorship Program expansion will provide added value to education initiatives affecting psychiatry and enhance professional reputations of district branches and APA affiliates.

With the financial support of the National Institute on Drug Abuse, the Council on Addiction Psychiatry and the Council on Medical Education have been working to identify, evaluate, and make widely available open source resources for a curriculum on substance use disorders that can be used to guide and augment the didactics curriculum of general psychiatry residency training programs in accordance with ACGME program requirements.

The Council approved the selection of APA’s education awards. The 2016 Vestermark Psychiatry Educator Award recognizes excellence, leadership, and creativity in the field of psychiatric education. The winners are John Howard Coverdale, M.D., and Robert E. Hales, M.D., M.B.A. The Council approved nominations for the Irma Bland Award for Excellence in Teaching Residents and The Nancy C.A. Roeske, M.D., Certificate of Excellence in Medical Student Education.

The Councils on Research, Quality Care, and Healthcare Systems and Financing continued their strategic discussions with the APA Board of Trustees (BOT) on an APA-supported registry during the July 2015, December 2015, and March 2016 BOT meetings. Stemming from the Council-charged workgroup formalized in May 2014, the work presented included a report of recommendations outlining how the APA should move forward with an APA-supported registry (July 2015). As a result of this presentation, the BOT requested the workgroup outline business cases or scenarios in which a mental health registry would be most beneficial to psychiatrists and their patients. In a follow-up presentation during the December 2015 BOT meeting, the workgroup presented potential options for registries the APA might support. Following the business case report, the Board of Trustees requested the development of a formal business plan. During the March 2016 BOT meeting, it was voted to approve funding for a 2-year pilot program of an APA-supported mental health registry. Dr. Greg Dalack, Chair of the Registry Workgroup and a member of the Council on Quality Care, presented at all three of these meetings.

The Committee continues to focus on developing evidence-based practice guidelines to assist psychiatrists in clinical decision making. The newest guideline, Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia, was approved by the APA Board of Trustees in December 2015 and was published in May 2016. This and other guidelines are available for free on psychiatryonline.org: http://psychiatryonline.org/guidelines. Other dementia guideline-related products that will be available soon include an executive summary in the American Journal of Psychiatry, articles in Psychiatric News and Psychopharmacology Update, a CME vignette, family/care provider information, and teaching slides.

The Guideline Writing Group is currently working on a guideline that will address the pharmacological treatment of alcohol use disorder. Following the completion of this guideline, the group will then begin work on a new guideline for treatment of bipolar disorder based on an AHRQ systematic review that should be completed in December 2016.

A second writing group, chaired by Dr. Linda Worley, was formed and is working on a new guideline for treatment of eating disorders. Once the work on this guideline is complete, the group will begin work on a guideline for treatment of delirium following an in-house systematic review on the topic.

A third writing group is also being formed to work on a new guideline for treatment of people with schizophrenia. This guideline will be based on an AHRQ systematic review on the topic that is expected to be available in January 2017.

An update to the 2010 Practice Guideline for the Treatment of Patients with Major Depressive Disorder is currently in progress and should be completed by the end of 2016.

The Committee on Mental Health Information Technology (CMHIT) continued work on a number of topics, such as technical data standards, health information exchanges, and telemedicine. The group convenes monthly by conference call to oversee its various activities. This year the group responded to a call for public comment on the 2016 proposed rule for the Medicare Access and CHIP Reauthorization Act (MACRA), specifically providing feedback on the Advancing Care Information (ACI) quality reporting category of the Merit-Based Incentive Payment System (MIPS). For several months, the group explored the feasibility of developing an EHR comparison database tool to be hosted by the APA on psychiatry.org, including providing project-level details for moving forward. After careful consideration of APA’s current membership needs and other factors, the JRC decided against moving forward with this project.

Within the CMHIT, the Apps Workgroup has developed a process for reviewing behavioral and mental health applications (“apps”) and is working with the APA Administration to develop a website that will host product reviews of these apps.

In addition, CMHIT and the APA Administration have developed a frequently asked questions (FAQs) resource to be available on psychiatry.org for members. The FAQs include questions commonly submitted to APA through e-mail or fielded through the Practice Management Help Line or the Customer Service line. The FAQs will be available on the Practice Management section of psychiatry.org and are intended to be updated frequently, with new questions and answers being added to the document quarterly based on what is submitted to APA staff.

The Council discussed issues and priorities facing the Association with regard to performance measure development and implementation, as well as providing education to members about these increasingly important topics. Included in these topics are: MACRA [Medicare Access and CHIP Reauthorization Act] and its associated Merit-Based Incentive Payment System (MIPS) proposed rule. The Council acknowledged APA collaborations with other entities through national initiatives such as the AMA-supported Physician Consortium for Performance Improvement (PCPI) and considers measure concepts internally through the practice guideline development process. Pressure is building for psychiatry to define quality measures for the diagnosis and treatment of mental health and substance use disorders, as the entire health care system is moving toward a pay-for-quality approach. It is critical for the APA to be involved in defining these quality measures, otherwise crucial measures pertaining to psychiatry will be defined by payers, other groups of clinicians (particularly psychology), as well as patient advocates. There are different approaches to measure development such as developing focused measures on specific psychiatric disorders versus measures that are global to psychiatry (e.g., psychiatric evaluation) or to all of health care (e.g., care coordination, medication reconciliation). In support of this effort, the BOT approved a proposal to develop a Committee on Performance Measurement. This Committee held its inaugural teleconference in August 2015 and identified two goals to focus its efforts: 1) publication of a white paper that outlines the APA’s position on performance measure development and the organization’s place within the National Quality Enterprise, and 2) completion of a systematic performance measurement gap review. Both of these projects will position the APA to become a major voice in how psychiatrists are reimbursed by the public and (eventually) private payers.

Several other workgroups developed under the Council are active or have received approval to continue to convene. The Patient Safety Workgroup focuses on a variety of patient safety issues such as transitions of care that occur when patients are discharged from inpatient care. The Standards and Survey Procedures Workgroup continues to address policies related to institutional surveys, as well as development of standards in collaboration with national organizations (e.g., the Joint Commission). The Gender Dysphoria Workgroup’s commission has been extended and plans to continue developing resource documents focusing on treatment of those with gender dysphoria. Most recently, a resource document entitled “Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists” was approved by the BOT. The next step will be to gain approval for publication in the American Journal of Psychiatry of a condensed version of this resource document. The third meeting of the Caucus on Psychotherapy occurred at the APA Annual Meeting in May 2016, with a growing membership of 174 APA members who have interest in this area. This group convenes psychiatrists interested in advancing psychotherapy and psychosocial treatment.

The APA Patient Registry Work Group drafted and presented a report summarizing their activities and discussions. The APA approved moving forward with registry development and selected FIGmd as the vendor to assist in its creation. FIGmd has a great deal of experience in registry development and extracting data from existing electronic health records (EHR).

The registry will serve a number of significant purposes and is anticipated to help clinicians in several important ways. Among these is its ability to enable psychiatrists to easily meet quality care reporting requirements imposed by the Affordable Care Act, such as those involving submission of quality care reports to the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS). Failure to report on quality care will result in reimbursement payment penalties, and participation in the registry will allow psychiatrists to avoid these deductions. The registry also will assist with psychiatrists’ submissions of Maintenance of Certification Part 4 requirements and will result in a large research database that could be used to conduct studies, as well as for benchmarking purposes.

The APA’s registry team is working closely with FIGmd to determine how to use existing EHRs to fulfill PQRS reporting requirements in order to help psychiatrists avoid potential penalties imposed by CMS, if a significant number of quality measures are met. The registry could also potentially qualify psychiatrists to achieve CMS’ high performer bonus. During the Council’s gathering at the APA’s 2016 Annual Meeting, the Council endorsed the process of moving forward with the registry and recommended that the Division of Research work with the Council and any stakeholders to further refine the final content.

The FDA proposed that ECT devices be reclassified from class III to class II and that some specific warnings should apply to ECT devices. With this reclassification, ECT devices could continue to be used to treat severe depression in adults who require a rapid treatment response or who are not responding to other therapies. However, the FDA proposed that additional clinical research studies would be needed before using ECT to treat other conditions, including manic episodes (in bipolar disorder), schizophrenia, schizoaffective disorder, or catatonia. The FDA also proposed that the use of ECT devices in children and adolescents up to age 17 years would not be approved without further research. Finally, the FDA proposed that patients be given a number of warnings about ECT, including a warning that continuation and maintenance ECT have not been shown to be effective. Under the proposal, it was not clear what would happen to patients who are receiving ECT if the regulations were to go into effect.

Council on Research ECT experts and a group of about 30 global ECT experts came together and held multiple conference calls to prepare a response, which was sent by the APA to provide guidance to the FDA on this proposed rule, including data to support the use of ECT in conditions other than depression and the use of ECT for maintenance therapy.