DBs Increase Involvement In Legislative Battles

As part of an ongoing program of APA's Board of Trustees to give district branch presidents a direct communication link to APA leaders, President Michelle Riba, M.D., invited the presidents of the Michigan and Minnesota psychiatric societies to brief the Board at its meeting last month in Arlington, Va., on initiatives in their states and challenges the district branch is facing.

She also invited psychiatrist Michael Ebert, M.D., who is APA's representative to the Association of American Medical Colleges' (AAMC) Council of Academic Societies. Medical education issues have been a key component of Riba's agenda during her presidential year.

Michigan Psychiatric Society President Wayne Creelman, M.D., cited the district branch's troubling membership decline, which, he noted, is far worse than that experienced by any of Michigan's neighboring Midwestern states.

“This is putting a tremendous strain on our budget, because we are very much dues dependent,” he said. The district branch has submitted a grant request to APA for funds to enhance membership recruitment and retention efforts.

Shifting to legislative issues, Creelman pointed out that Michigan is one of only 15 states without a law mandating insurance parity for mental health care. This prompted him a couple of years ago to run for a seat in the state legislature, but he lost in the primary, he noted. Psychiatrists and their allies in his state will have to do a better job, he suggested, of getting out the message that psychiatric care is not a budget buster, but is in fact cost-effective—that treating mental illnesses early will save substantial health care dollars in the long run.

He said as well that the state medical society in Michigan is fighting a 2.3 percent tax the legislature has imposed on the “gross billables” of all physicians in the state, though lawmakers are calling it a “billing fee” rather than a tax. It is designed to raise funds to help pay for increases in Michigan's Medicaid budget.

William Dikel, M.D., president of the Minnesota Psychiatric Society, discussed several initiatives in which psychiatrists in his state are working to ensure that Minnesotans have access to quality psychiatric care. Among these projects are the Integrated Care Task Force, which is “working with state government and health insurance companies to structurally support and fund the integration of primary care medicine and psychiatric care.”

One objective is to end the segregation of mental health care into carveouts, “which only give the illusion of cost saving—they are actually more expensive to health plans,” Dikel said. If the powers that be agree to take steps to integrate primary and psychiatric care, primary care physicians will have improved skills in prescribing and managing psychoactive medications, and psychiatric services would become an integral part of care in inpatient and outpatient medical units, he pointed out. It would also dilute the argument by some psychologists that they deserve prescribing privileges because primary care doctors are ill equipped to manage the complexities of psychiatric medications.

Dikel also discussed a district branch initiative in which psychiatrists are conducting educational programs for primary care physicians in both rural and urban areas of Minnesota.

Also on the Minnesota Psychiatric Society's agenda, he said, is a project to have insurance companies use medical-necessity criteria set by Minnesota psychiatrists and one to address the mental health care needs of people incarcerated in jails and prisons.

Ebert, APA's liaison to the AAMC, noted the importance of the relationship between the two organizations since more than one-third of psychiatrists are affiliated with academic medicine. He cited the significant gains that can derive from this relationship—for example, that “the AAMC has the best database of physician salaries” as well as other databases.

One of the AAMC's current themes, Ebert said, is “increasing the quality of medical education without increasing its size.” He cited areas in which APA and the AAMC share overlapping interests, such as“ the humanistic aspects of medicine,” the neurosciences, and promoting minority medical careers.