xxAACP Newsletter, Volume 12,
Number 3, Summer 1998
Letters and Notes
Dear Editor:
I would like to object to the Postion Paper on Standards for Quality Management in Implementing Public Sector Managed Care Systems which was published in the Spring issue of the newsletter ( Vol. 12-2 ). The statement that managed care controls costs without compromising quality is open to serious question. Also, that managed care has been successful in the private sector is a statement that I would challenge. Managed care may have cut costs, but has also diverted large sums of money to its coffers, thus enabling the CEOs of such organizations to give themselves huge salaries, thus cutting drastically monies which should have gone for patient care.
We have come to accept the inevitability of the inroads of managed care, but it doesn't mean that we can't be honest as to how this has crippled good psychiatric treatment. How else can we justify or rationalize being given 6 or 8 sessions to treat a disturbed depressed individual?
The guidelines for Public Sector Managed Care (PSMC) simply creates another layer of hierarchy to scrutinize and critique the work of community psychiatrists. Our licensure, our credentials lose their meaning when scavengers are sent out to search for garbage. We already have laws, standards, accrediation requirements, and quality controls. Why then do we need more, "measurable indicators", "comprehensive quality monitoring", and "independent program evaluation"? I see all of this as diverting the direct work with patients, since it is obvious that the sparse budgets for mental care will then be invaded for pay for all these inspectors of policies and care givers.
I believe that an association of community psychiatrists should be more active in resisting the inroads of (mis)managed care, providing the support for good care for patients, and the security of the psychiatric providers.
Leo H. Berman, M.D.
Westport, CT
Ortho Update
Ortho's 75th Annual Meeting took place in Arlington, Virginia April 17-19, 1998. Ezra E. H. Griffith, the 1997-1998 President, presided at a spirited plenary session, "Looking Ahead: The Shape of Mental Health Practice in the 21st Century". AACP cosponsored a full day program on "Advances in Treatment of Severe and Persistent Mental Illness", presented by Joel Feiner MD and William McFarlane MD.
At the organization's business meeting, Dr. E. H. Griffith handed the presidental gavel to President-Elect Ira S. Lourie, MD, child psychiatrist and noted expert on policy and programs for children's mental health. The results of the 1998 ballot include the election of Kenneth S. Thompson, MD, an AACP member, to a three year Board term. Dr. Jane Knitzer, Ed.D. became President-Elect. Lorna Hines-Cunningham, MSW was elected Treasurer. Luis Zayas, Ph.D., Elaine Yatzkan, Ph.D., and James Dobbins, Ph.D. were elected to three year Board terms.
Ortho's next Annual Meeting will take place April 9-11, 1999, again in Arlington, Virgina. The "Call" for proposal brochures can be obtained from the Ortho office by calling (212) 564-5930, by faxing (212) 564-6180, or by e-mailing amerortho@aol.com. If you are interested in further information about the American Orthopsychiatric Association (Ortho), please contact Gale Siegel, MSW, Executive Director.
The Moffic Award for Ethical Practice in Public Sector
Managed Behavorial Health Care
As managed behavorial healthcare has entered the public sector and community mental health, we are all becoming familiar with the ethical challenges that have become apparent in the public sector; the escalation of "business ethics", gatekeeping, the interpretation of medical necessity, alterations in informed consent, decreased confidentiality, authroization for payment, and unlicensed utiliztion review, among others. To try to address these issues, one of our Founding Board Members, H. Steven Moffic, MD, wrote The Ethical Way: Challenges and Solutions For Managed Behavioral Healthcare ( Jossey-Bass, 1997 ).
Associated with his presentations on the topic, Dr. Moffic began to become more familiar with the real-life struggles to address these issues. Unrecognized courage, succes, and models of ethical practice could be glimpsed.
In order to stimulate national recognition of high ethical practice in such settings, Dr. Moffic and the AACP enthuysiastically decided to establish The Moffic Award For Ethical Practice In Public Sector Managed Behavioral Healthcare. The award will include at least $1,000 and recognition at the annual Psychiatric Services meeting.
Any clinician, administrator, or organization is eligible. And don't be modest about nominating yourself.
Send any nominations to:
H. Steven Moffic, MD
Froedtert Hospital
8S, FE
9200 W. Wisconsin Avenue
Milwaukee, WI 53226
Fax (414) 257-5241
Back to Summer 1998 Table of Contents