APA Works on Many Fronts For Members, Patients

Throughout the year, Psychiatric News provides regular and comprehensive coverage of APA's many advocacy activities in both the public and private sector, including government relations, public affairs, business initiatives, and psychiatric practice. I applaud that coverage and want to highlight some of our activities from 2005 and our plans for 2006 as part of our efforts to provide you with more information on how APA is working on your behalf.

As you may recall, the Division of Advocacy is composed of the Department of Government Relations, the Office of Healthcare Systems and Financing, and the Office of Communications and Public Affairs. Many—if not most—of our activities are a result of group efforts, not only within the division but also through communication and participation with APA's components, leadership, and other staff and divisions including, of course, our medical director and CEO, James H. Scully Jr., M.D.

A major initiative in 2005 was the “Healthy Minds, Healthy Lives” public information campaign that led our efforts to reduce the stigma associated with mental illness and put a new and positive face on mental health and psychiatry. Implemented by the Office of Communications and Public Affairs, the campaign provided both electronic and written communications to the public, as well as useful information for our members and our district branches/state associations (DB/SAs). We launched our consumer Web site,<www.HealthyMinds.org>; developed a new series of “Let's Talk Facts” brochures and fact sheets, which are available in English and Spanish; created a new public service announcement; and posted ParentsMedGuide.org in English and Spanish to assist parents who are concerned about their children's mental health, specifically depression.

As a first-time endeavor, we produced a video on the Mental Illness Awareness Week Congressional Symposium, cosponsored by APA and NAMI, to help raise awareness in Congress of posttraumatic stress disorder suffered by returning soldiers and survivors of natural disasters such as Hurricane Katrina.

This year we are launching our second year of the “Healthy Minds, Healthy Lives” campaign, which remains very timely, given the increase in media and public attention to mental illnesses and psychiatry over the past year. In addition to our key messages, the public has had to sort through many perspectives on mental health from a range of sources including celebrities, the media, physicians, government officials, and mental health providers, to name a few. To ensure that APA continues to understand which messages are most meaningful to the public, as part of the 2006 campaign, we will conduct new consumer research to help gauge public understanding of mental disorders and psychiatry. From this research, we will be able to provide our members and the public with information to help counter misinformation about psychiatric illnesses and treatment. Other important aspects of our Healthy Minds campaign will include an array of national and local media and advertising placements and several new “Let's Talk Facts” brochures, with topics ranging from obsessive-compulsive disorder and substance use disorders to mental health in various minority communities.

Implementation of Medicare Part D, the new Medicare prescription drug benefit, has been beset by significant problems in enrollment and communications between the Centers for Medicare and Medicaid Services (CMS), the health plans, and pharmacies, resulting in reports of patients not receiving their medications. APA, partnering with the National Mental Health Association, National Alliance on Mental Illness, American Association for Geriatric Psychiatry, American Association of Community Psychiatrists, National Association of State Mental Health Program Directors, National Council for Community Behavioral Health Care, and Treatment Effectiveness Now, has developed a Web site at<www.MentalHealthPartD.org> to assist our members, patients, families, and providers in transitioning to Part D.

APA and other partners met with CMS numerous times in 2005 detailing our concerns focusing on the Medicare/Medicaid (dual-eligible) patient population, drug formularies and administrative processes. We have increased our activities this year as implementation has hit some major snags. We have established an ongoing relationship with CMS staff through meetings, e-mails, and phone calls, sometimes on a daily basis, in an effort to resolve issues. APA has broadened its efforts including meeting with members of Congress and working with the AMA and national medical specialty societies to urge strongly that the problems be fixed.

We have also provided APA DB/SAs with letters and articles detailing the new Part D program and issues that might arise for physicians and continue to hold a weekly conference call with DB/SA executive staff to provide regular updates and to hear how the implementation is going in the various states. Please share your experience with Part D—the good, the bad, and the ugly—through APA's Medicare Part D Help Line at (866) 882-6227 or by e-mail at [email protected] (see box on page 1). We want to hear from you.

Our Medicare Part D efforts have been led by the Office for Healthcare Systems and Financing. Other initiatives this year include continuing high-quality and responsive membership service through the managed care help line, providing key technical assistance and advocacy on CPT coding and practice management, as well as reaching out and working with the business community addressing employee mental health. Our business outreach also includes our renewed cosponsorship of the Second World Congress Leadership Summit scheduled for May.

The first session of the 109th Congress was challenging for APA and the rest of medicine, as advocacy goals for our patients and the profession were buffeted by budget deficit actions by Congress directed at Medicaid and Medicare. The budget deficit conference agreement passed by the Senate and the House and signed by President Bush includes reductions in Medicare and Medicaid spending of roughly $40 billion over the next five years.

The conference agreement grants the states the flexibility to redesign their Medicaid program and impose copayments and is certainly of concern to APA and many other mental health advocacy organizations. APA strongly opposed these Medicaid reductions (see page 16).

Despite strong interest by some members of Congress in the inclusion of pay-for-performance legislation for physicians in the provisions of the conference agreement, such language was successfully not included. Instead of permitting a 4.4 percent decrease in the Medicare fee schedule, which APA and all of medicine strongly opposed, the conferees agreed to a one-year freeze. A provision permitting marriage and family therapists to bill Medicare independently was successfully removed.

Your DGR staff was successful in having legislation passed by Congress and signed by President Bush that removes the 30-patient group-practice limit on buprenorphine treatment. Implementation of this law will significantly increase access to these treatments.

For 2006, the second session of the 109th Congress, we will be seeking passage of legislation to phase out Medicare's discriminatory 50 percent outpatient coinsurance, mental health parity legislation, legislation to eliminate the statutory ban on Medicare coverage of benzodiazepines, psychiatry workforce legislation, increased NIH and VA funding, legislation protecting patient privacy, Medicaid improvements, and many other important initiatives.

To further these activities, APA will be convening major events on Capitol Hill, such as the Advocacy Day Conference and the Academic Consortium, designed for APA members and partners to meet with their members of Congress and staff and advocate for the above-noted priorities. Participants at these events will receive health policy briefings and instruction to sharpen their lobbying skills.

Throughout 2005, APA continued to provide important financial and staff support to our DB/SAs in states facing strong challenges from psychologists to win prescribing authority by legislative fiat. Despite the 2005 implementation of prescribing laws in New Mexico and Louisiana, no new laws were approved, and psychologist-prescribing bills were defeated in Hawaii, Wyoming, Oregon, Connecticut, Missouri, and Illinois. New Mexico defeated legislation to expand the psychologist prescribing formulary, and New Hampshire defeated legislation to establish an independent board of psychology, seen as a precursor to a prescribing bill. Without question, there will be additional legislative challenges in 2006. Bills have already been introduced in Hawaii and Missouri and carried over from 2005 in Georgia and Tennessee (see page 17).

I want to acknowledge the important role of our APAPAC in providing support for our Congressional activities. In 2005 our membership has grown by nearly 250 members, to a total of 1,693 members, and our PAC member contributions increased significantly! APAPAC hosted or cohosted events for 64 members of Congress, and our members in their home districts had many opportunities to meet and discuss psychiatry's issues with their House and Senate members.

I want to offer my thanks to our many APA members who participate and support our APAPAC.

As you can see, the Division of Advocacy has a full complement of activities and programs under way on your behalf. We plan to communicate our efforts on a regular basis through Psychiatric News, APA's Member Update newsetter, Government Relations Action Alerts, and member broadcast e-mails.

In all that we do, our ultimate goal is to support your ability to provide the best possible care to your patients. I am very hopeful that our advocacy efforts in 2006 will build positively upon our now solid foundation, and we invite your comments on how we can best communicate with you and continue to add value to your profession, practice, and patient success. ▪