Parity or disparity
Network inadequacy can make all the difference
Maureen Bailey, Associate Director for Policy &
Practice Advocacy, American Psychiatric Association
Recent studies continue to show that patients needing mental health
care spend countless hours and face significant delays and hassles
when trying to find a psychiatrist who participates in their health
plans’ network. The primary culprit for this is that the provider
directories are inaccurate, often listing psychiatrists that have
moved, died, retired, resigned or are not taking new patients.
Lack of enforcement
With little to no enforcement of requirements (where they exist) that insurance companies
keep these directories accurate and up to date, patients spend hours paging through them
and making repeated and unsuccessful phone calls to find a psychiatrist a reasonable
distance away who can see them in a reasonable amount of time. In fact, the problem is
that the network represented is inadequate to meet the demand. Ultimately many give up
seeking care all together, or pay out of pocket for their care. This shifts the burden from
the insurance plan to the patient who
must seek care on less favorable terms.
And, the plan wins.
Who’s to blame?
Regrettably, insurance companies blame
you – the psychiatrist—for inaccuracies
in directories saying that psychiatrists
fail to report when they are leaving the
network or their schedules are full. This
argument should not stand because the
plans have the ability to know which psychiatrists in their directories are filing claims
in reasonable numbers and which are not. However, they don’t check on that because it
benefits them to have robust directories, even if the doctors listed in them are not taking
patients.
Smoke and mirrors
They don’t check and report on who is “really” seeing patients because it allows them
to represent to regulators that their network is adequate to care for the patient population
and thus to qualify for licensing in the state. Further, a robust number of psychiatrists in
a directory draws consumers in need of psychiatric care and employers to that company
to purchase a plan. The plan then never has to pay for the service because it turns out
that those listed as “participating” in the plan, in fact are not participating at all or are
seeing only a small number of plan patients. Inaccuracies in directories benefit the plans,
hurt the patients, and ultimately hurt you, the psychiatrist. As long as plans can represent
that the names in the directory are available to patients, they have no incentive to attract
psychiatrists to their network or to provide the care that patients need.
You can help to change all of this; in fact it will not change without your help!
The American Psychiatric Association has explained to state attorney generals, the
Department of Labor, state insurance commissioners, large employers and legislators
See Parity on page 14
Volume 40 Number 2
Summer 2015
Editor’s note —
“Doctor, can you write me a letter so
I can have my dog in my apartment?”
If you’re like me, you’ve had this request
asked of you numerous times. What was your Victoria Kelly, MD
answer? I was confused and had no idea what
I would need to write, let alone whether I should.
There are many types of animals incorporated into therapy – dogs, cats, fish,
hamsters, and the most popular forms including canines, dolphins, and equines.
Earlier this month, a news story made headlines when a man walked into a
Nixa, Missouri restaurant with a snake around his neck. When another patron
complained, the man allegedly reported that his snake was a service animal that
helped with his depression!
Using animals to improve hospitalized patients’ mental well-being dates back to
the 18th century, and it wasn't until the late 1980’s that the first articles appeared in
the medical literature regarding the benefits of service dogs in helping those that
are physically disabled. Even Sigmund Freud and Florence Nightingale recognized
that involving pets in treatment reduced patient’s depression and anxiety. Formal
use of animals in therapy is credited to psychologist Boris Levinson whose 1969
book described how his dog helped troubled children communicate. Even a recent
study indicated that dog-owner gaze elicited an increase in oxytocin, a response
similar to a mother-child gaze that encourages bonding. Since the 1990’s with
the passage of Title III of the Americans with Disabilities Act, service animals
(specifically dogs) have been accepted in public places – called having “access
protection.” There
are also “Assistance
Animals” defined under
the Fair Housing Act,
and “Service Animal”
defined under the Air
Carrier Access Act. Not
confusing at all, is it?!
“Pet therapy” is a broad
term that can mean
various things, ranging
from simply owning a
pet, to using a highly
trained service animal (which is usually a dog but can be many other kinds of
creatures). By all means, owning a pet can be very rewarding on many levels, but
a pet is significantly different than a service animal - like the difference between a
real physician and the actor who plays one on TV!
Types of service animals
• Service animals – Perform highly skilled tasks for disabled person that
they cannot do themselves (cerebral palsy, multiple sclerosis, stroke, seizure
alert, diabetic alert); have access protections (meaning they cannot be
See Editor’s note on page 12
2
Ohio Psychiatric
Physicians Association
3510 Snouffer Rd., Suite 101
Columbus, OH 43235
E-Mail [email protected]
www.ohiopsychiatry.org
OFFICERS
President
Steven Jewell, MD
President-elect
Alan Levy, MD
Immediate Past President
Stephen Pariser, MD
Secretary
Tamara Campbell, MD
Treasurer
William Resch, DO
APA Representatives
Brien Dyer, MD
Karen Jacobs, DO
Eileen McGee, MD
Past President
Suzanne Sampang, MD
Government Relations Representative
Alan Levy, MD
Newsletter Editor
Victoria Kelly, MD
Jeanne Lackamp, MD — Vice-Editor
Resident-Fellow Representative
Todd Jamrose, DO
ECP Representative
Megan Testa, MD
Ohio State Medical Association Delegate
Suzanne Brodbeck, MD
COMMITTEE CHAIRS
Addiction & Pain Control Issues Committee
Jason Jerry, MD
Child & Adolescent Committee
Mackenzie Varkula, DO
Early Career Psychiatrists Committee
Megan Testa, MD
Ethics Committee
Susan Stagno, MD
Forensics Committee
Ryan Peirson, MD
Government Relations Committee
Alan Levy, MD
Integrated Care Committee
Douglas Smith, MD
Membership Committee
William Resch, DO and
Eileen McGee, MD
Nominating Committee
Stephen Pariser, MD
Practice Issues Committee
Brooke Wolf, MD
Program & Continuing Education Committee
Mark Munetz, MD
Public Information & Liaison Committee
Ryan Peirson, MD
Public Mental Health Committee
Ann Morrison, MD
Resident-Fellow Member Committee
Todd Jamrose, DO
Veterans and Military Committee
James Wasserman, MD
OPPA - INSIGHT MATTERS - SUMMER 2015
Psychiatry takes flight
Caring for those who serve
On Thursday, July 16th I was privileged to represent OPPA at the Ohio
National Guard (ONG) Healthcare Provider Orientation Flight at
Rickenbacker Air National Guard base in Columbus. This occurred
in the context of TRICARE Awareness Week,
which is an annual celebration of the health care
program dedicated to supporting active duty
service members, National Guard and Reserve
members and their families.
Steve Jewell, MD
President
While the primary goal of the day-long experience was to
familiarize the participants (a total of about 20 physicians
and behavioral healthcare providers) with the role and
mission of the ONG, and inform us about the ongoing
need for healthcare providers to care for TRICARE
beneficiaries, the real highlight of the day was the chance
to observe a mid air refueling of a military aircraft. We all
boarded a tanker plane and took off to meet the aircraft.
After a two-hour flight to our destination, the refueling
took place somewhere over Oklahoma.
The real excitement of the day was that we were
observing the refueling of a B-2 stealth bomber (an
aircraft valued at $1 billion, which is so top-secret that it
only flies in and out of one airbase in the country—hence
the need for mid-air refueling) something that even the
ONG airmen were excited about! As you can see from the
pictures (which I took laying down in the tail of the plane,
next to the boom operator who was doing the refueling)
we were ‘up close and personal’ with this amazing
aircraft!
We all came away with a deep appreciation for the role
of the ONG, not only in Ohio, but also on the national
stage. The experience also reinforced the importance of
healthcare providers agreeing to accept TRICARE to
ensure continuity of care for service members and their
families (something that I am proud to say I have done
for well over 30 years). If you are interested in becoming
a TRICARE provider, go to the related July 13, 2015
story in OPPA’s e-Insight electronic update for links to
further information: (http://ohiopsychiatry.org/aws/OPPA/
pt/sd/news_article/109161/_PARENT/layout_details/
false#sthash.7cd9ozeu.dpuf).
OPPA - INSIGHT MATTERS - SUMMER 2015
3
The pitfalls of productivity
Ethical and legal implications of copy forward,
templates and pre-populated entries
J.P. Shand, MD, Ethics Committee RFM Rep and
Mark Abramowitz, Esq, Associate, DiCello Law Firm
The current trends in medicine have put time constraints on providers to see more patients
in less time. This has led clinicians to find ways to be more productive and efficient. In
an effort to maximize the time they spend with patients, providers have learned to utilize
computer assistance for note writing. However, increasing use of electronic health record
(EHR) documentation can lead to several pitfalls.
Ethical issues
Being sloppy is noticed! Many providers are unaware
that Federal Law requires all EHRs to keep track of the
meta-data of the creation of a patient’s notes. This includes
tracking when any part of a note was made, edited, viewed,
or deleted1. Often EHRs go far above this, and keep track of
every word that is copied, changed, or not changed.
Some pitfalls to watch for and avoid:
Pitfall 1: Copying forward incorrect information
As in the game “broken telephone,” a well-intended
message can be twisted and lost. If early in a patient’s
record a clinician writes an incorrect observation, this
information easily can be transferred to note after note. If
clinicians fail to review each point that has been copied
forward, incorrect information can be left in that patient’s
chart. This incorrect information can have detrimental
effects on patient care and billing, and potentially may have
medical/legal consequences.
At several Veterans Administration sites, a copy-forward
tracking system has been implemented. This highlights
(in bright yellow) any verbiage that is pasted from another
location. This feature is designed to prompt providers to pay
special attention to an area that should be read/edited before
signing the note.
Pitfall 2: Using incorrect templates and pre-populated
entries
In Psychiatry, several templates may be used to expedite
note writing – these can include risk assessments, mental
status exams, and reviews of systems. If providers aren’t
careful, such templates easily can document points that
were not asked, or elements of patient care which are
blatantly incorrect, such as writing a patient with one leg
had a “normal gait”.
If clinicians rely too heavily on pre-filled data in their notes,
there is a good chance that they will either add something
that is not present in the patient’s exam, or miss something
4
important. Carelessly over-using pre-populated entries can
destroy the integrity of the patient’s medical records.
Pitfall 3: “Stacking” your notes
When adding information to notes becomes as easy as one
or two clicks, a provider must ensure that everything they
are documenting was actually performed and is true. It has
been noted that billing easily can be manipulated with a
few documented but unperformed services. There are many
stories of Medicare and private health insurance companies
auditing and clawing back payments for services not
rendered. This becomes not only a documentation, patient
care, and payment issue - but a medical ethics issue as well.
In conclusion, there is no need to throw the EMR “baby”
out with the documentation “bathwater.” Certainly, EMR
tools can be useful and valuable for all involved. However,
meaningful use of EMR documentation requires mindful
medical practice, thoughtful authorship, and attentive
editing. These strategies will lead to best outcomes
for documentation accuracy and – ultimately – to best
outcomes for patient care.
1
Federal Register, Vol. 77, No. 171 Rules and Regulations - 45 CFR §170
(2012)
OPPA - INSIGHT MATTERS - SUMMER 2015
Life 101: What you may not have learned
in med school, residency or fellowship
But someone should tell you...
Jeanne Lackamp MD
Vice-Editor
As a (relatively) junior attending of seven years’ time, I have been
privileged to work with hundreds of patients, and myriad coworkers. In
addition to the clinical lessons I have learned, I also have learned a lot
about working in an academic medical center, and about personal growth
While I would never claim to be an
expert – nor do I follow the concepts
below perfectly – I hold these tenets
as admirable goals. As we celebrate
the start of another academic year, I
hope you will find them interesting and
applicable as well.
Academic Rules:
#1: Toot your own horn!
As dedicated clinicians, I encourage my
coworkers to be proud of the hard work
they are doing every day. This includes
singing their own praises when given
an opportunity, and being bold about
their accomplishments. Mentors,
supervisors, and administrators may
sing your praises, but get comfortable
with tooting your own horn as well!
#2 When asked to do something,
seriously consider doing it
How many times are we asked to
participate in [morbidity/mortality
rounds, panel discussion, chapter
authoring, committee participation]
and our initial reaction is “Oh no, not
ANOTHER thing to do!” When asked
to do something, seriously consider
doing it. What will this opportunity
offer you? How can your participation
contribute to the activity in a unique
way? What additional work/exposure/
experience might you gain?
#3: Keep a running list of your
accomplishments
In our day-to-day work, we are all
faced with extra activities to do (see
Rule #2 above). If you choose to
engage in extra activities, or if you
are awarded accolades or kudos,
keep track! Keep a running list of
achievements, and update it often.
Then, include all of these things in an
updated CV (update at least twice per
year, or more often as needed).
#4: Go to Grand Rounds
If you’re lucky enough to have access
to an academic center, you likely have
the opportunity to attend regularly
scheduled Grand Rounds activities.
Make them a priority. Grand Rounds
attendance can keep you academically
and mentally challenged, with new
concepts and interesting presenters.
Your attendance also is a good example
to trainees and colleagues. In addition,
Grand Rounds attendance keeps you
involved in an important departmental
activity – something which hearkens
back to years ago, and keeps us mindful
of our medical heritage.
Personal Rules:
#1: Participate in something
extracurricular that gives you joy
Do you enjoy rock climbing,
photography, running, yoga, or
cooking? Does traveling to far-away
lands help give your life perspective?
Stay active in these pursuits, even
when you think you’re “too” busy.
Extracurricular activities can help keep
you sane and balanced.
#2: Spend time with people you love
– there is always more work waiting
tomorrow
The old quote that “No one ever wished
they had spent more time at the office”
holds true now more than ever. With
‘office’ work coming home more and
more (via cell phones, laptops, and
remote clinical access), it’s important to
have a time or location where you are
“work-free.” People may not wish they
had spent more time at the office, but
they may regret not spending time with
those closest to them. Seeing, talking
to, and spending time with loved ones
is invaluable.
#3: Never…ever…EVER leave
vacation days on the table
There are few things worse than leaving
vacation days unused. Feel like you’re
running out of time to take vacation
days? Speak with your supervisor about
rolling some over to next year. Feel like
it’s hard to get coverage? Coverage is
there, you just need to find it. Work on
getting the time covered, so you can
keep yourself balanced.
#4: If all else fails, and balance
escapes you, deal with it
We all have had days (or weeks) when
we have felt short-tempered, over-tired,
or irritable. Whether related to personal,
family, financial, or employment
stressors, sometimes balance escapes
us. When this happens, it is important
to address it.
Firstly, identify your shortcomings
transparently, and make amends
if anyone was negatively affected.
Secondly, talk to someone about it
(friends, family, therapist). Thirdly, see
if there are changes you can make, in
order to improve your circumstances.
Happy new academic year!
OPPA - INSIGHT MATTERS - SUMMER 2015
5
State and budget updates
Advocating on behalf of psychiatry
Janet Shaw, MBA
Executive Director
Legislative Update
Governor John Kasich signed the final version of Ohio’s biennial budget (House Bill
64) on June 30, 2015, after review and debate by the Ohio House of Representatives and
the Ohio Senate. The OPPA was an active participant in helping to shape provisions of
the budget to most favorably impact Ohio psychiatrists and the thousands of patients for
whom they care. Highlights of the final budget and other important pieces of legislation
on which OPPA has actively lobbied include:
State budget outcome
Medicaid carve-in
The final version of the state budget moves alcohol,
drug addiction and mental health services into Medicaid
managed care, a process known as “carving in,” no later
than Jan. 1, 2018, which is
one year later than what the
administration was proposing.
Implementation of the changes
will be monitored by the Joint
Medicaid Oversight Committee
(JMOC).
Increased addiction treatment
for prisoners
The Departments of Mental
Health and Addiction Services
(MHAS) & Rehabilitation and
Correction begin a partnership
to meet the needs of inmates
and reduce recidivism. DRC’s
Bureau of Recovery Services
will be transferred to MHAS
to provide more addiction
treatment within Ohio’s prison
system.
The language in HB 64 was very
similar to language in Ohio House
Bill 92, co-sponsored by State
Representative Nickie Antonio
(D-Lakewood) and Barbara
Sears (R-Sylvania), which passed
overwhelmingly in the 130th Ohio
House of Representatives, but then
stalled. The OPPA was a strong
proponent of that bill with OPPA
Government Relations Committee
member Megan Testa, MD,
advocating on behalf of the OPPA
and working in collaboration with the
AIDS Healthcare Foundation.
Other legislative news
Increased access to naloxone
via county health departments
The budget earmarks $1 million
over the biennium to increase
access to naloxone used to reverse opiate overdose. State
funding will be dispersed by county health departments
through a grant program to local law enforcement
emergency personnel and first responders.
Bloodborne-Infectious Disease Prevision Program
(a.k.a. Syringe Exchange Bill)
The passage of this year’s budget included language
that allows Boards of Health to authorize a “bloodborne
6
infectious disease prevention program” as a way to
prevent the transmission of HIV, hepatitis, and other
bloodborne diseases. Not only is this an important tool
in the fight against the spread of HIV/AIDS, it also can
create a pathway to addiction recovery because the bill
encourages the provision of referrals to substance use
treatment as well as other social
services.
House Bill 4 - pharmacists can
now dispense Naloxone without a
prescription
HB 4, signed into law this summer,
authorizes a pharmacist or pharmacy
intern to dispense naloxone without a prescription in
accordance with a physician-approved protocol. To assist
with the implementation of this law, the State Board
of Pharmacy has developed a dedicated page which
features a number of helpful resources including guidance
documents, patient educational materials and sample
protocol.
OPPA - INSIGHT MATTERS - SUMMER 2015
Continue on next page
What’s ahead
happening from a political and advocacy stand point.
Governor John Kasich formally announced his candidacy
for president on July 21st at Ohio State University during
an off-the-cuff address that lasted about 45 minutes.
The OPPA Government Relations Committee, chaired
by Alan Levy, MD, Executive Director, Janet Shaw
and legislative agent, Michelle Fitzgibbon continue to
meet with legislators and advocate for and against many
other pieces of legislation (check the OPPA website,
members only, advocacy section for a complete update).
We have also been informed by several legislators that
Ohio psychologists are “shopping” around to identify
legislators who will introduce a bill that would allow
them to prescribe medications and practice medicine by
way of the state legislature rather than formalized medical
training. If you’d like to get involved – we’d love to have
you join us! Simply contact our office to learn more about
opportunities to advocate on behalf of your profession and
your patients.
While the Ohio General Assembly remains on recess for
the balance of the summer months, there is still much
OPPA advocates
Allowance of PTSD through BWC
The Bureau of Workers Compenation (BWC) was initially designed
to compensate workers for physical injuries suffered on the job.
Alan Levy, MD
Subsequently, psychiatric injuries deemed secondary to allowed
President-elect
physical injuries could also be compensated as “allowable conditions.”
A primary psychiatric injury has never been permitted as a BWC-allowed condition.
Earlier this year, Senator Tom Patton introduced Senate
Bill 5 (SB 5) which would fundamentally change BWC’s
compensation policy by allowing first responders (police,
fire, EMT) to be compensated through BWC for a primary
injury of PTSD suffered on the job without necessarily
also experiencing a physical injury.
Senator Oeslager, Chair of the Senate Finance Committee,
held an Interested Parties meeting on May 14 to
investigate the appropriateness, necessity, and cost of this
significant change in policy. The OPPA participated in this
meeting. Along with Ohio Psychological Association,
NAMI, and groups representing Police and Firefighters,
we actively supported the bill. The majority of the room,
however, was filled with manufacturing and business
interests opposed to the legislation. While the bill
would not directly impact the business community, their
interest reflected a concern that should first responders
be permitted to utilize BWC for a primary PTSD claim,
businesses in the private sector may subsequently be
liable (driving up BWC premiums and costs) for primary
psychiatric claims.
Legislative Update
Amended House Bill 28 – suicide prevention
Governor John Kasich signed into law HB 28, sponsored
by State Representative Marlene Anielski (R-Walton
Hills), to create suicide prevention programs at Ohio’s
institutions of higher education. The bill would require
a five-part program to be implemented to help both on
and off campus students who may be suffering in silence.
The OPPA participated in interested parties meetings and
was a strong advocate for the initiative which will consist
of crisis intervention access, mental health program
access, multimedia applications, a student communication
plan, and a postvention plan. Each public institution
shall provide all incoming students with information on
available depression and suicide prevention resources.
All prevention materials shall be posted on the websites
of The Department of Higher Education and The Ohio
Department of Mental Health and Addiction Services.
Prevention materials are available free of cost.
Despite vigorous opposition, with PTSD described as
ill-defined, easily falsified, and poorly responsive to
treatment, OPPA countered with expert evidence to the
contrary. While cost remained a concern, OPPA was able
to identify the appropriateness of regarding PTSD as an
allowable BWC condition, stressing parity of physical and
emotional medical injuries the same for first responders.
Our message was sufficiently convincing that the Senate
included language in the budget bill to expand BWC
policy to include PTSD for first responders. The language
was, unfortunately, removed in the House/Senate
conference committee. We look forward to testifying on
SB 5 when the committee meets to further deliberate.
OPPA - INSIGHT MATTERS - SUMMER 2015
7
Membership report
Council
notes
March 14 - May 31, 2015
New Resident-Fellow members
Gregory Bredow MD Cleveland Heights
UHCMC
Aarti Chhatlani MD Cleveland MHMC
Brandon Hamm MD Cleveland CCF
Bhupinder Kaur MD Toledo UT
Jacob McBride DO Cleveland UHCMC
Ryan Rajaram MD Cleveland CCF
Karei Routhier MD Lakewood MHMC
Member news
New General Members
Ernesto Ortiz Cruzado MD Columbus GM
Amit Mohan MD Cleveland GM
Reinstatements
Julia Burrow MD Perrysburg GM
David Chaiffetz MD Mayfield Heights RFM/
CCF
Brian Dowling MD Cincinnati GM
Mona Ferrer MD Cleveland RFM/UHCMC
Hazel Fishel MD Northfield RFM/NEOMED
Amanjot Gill MD Toledo RFM/UT
Barbara Gracious MD Columbus DF
Vrashali Jain MD Bay Village GM
Daniel Keaton MD Kingsville GM
Ravinder Mann MD Cincinnati GM
Michael Potesta MD Youngstown GM
Fred Romeo MD Columbus GM
Mya Sabai MD Cincinnati GM
Meriam Salama MD Columbus GM
Jonathan Sarsiat DO Akron RFM/
NEOMED
Stephen Schuldt MD Lakewood GM
Ermias Seleshi MD Gahanna GM
Change in
dues payment
deadline
Plan ahead
The new deadline for paying
APA/OPPA dues is March 31st.
Membership dues for 2016 and
thereafter must be paid by March
31st or your membership will
automatically expire on that
date unless you enroll in the
APA Scheduled Payment Plan to
pay your dues by credit card in
installments.
Contact our APA Membership
coordinator, Traci Hill, to enroll:
[email protected]
8
Transfers To Ohio
Daniel Almeida MD West Chester RFM
Donald Bell MD Wooster LM
Eric Edwards MD Cincinnati GM
Otto Kausch MD Brecksville GM
Imad Melhem MD Saint Clairsville GM
Vinita Prasad MD Parma GM
Stephen Rush MD Cincinnati GM
Cristina Seicarescu MD Sylvania GM
Rajesh Tampi MD Cleveland FE
Transfers From Ohio
Kelly Andrzejczyk-Beatty DO McAlester
OK GM
Manish Aggarwal MD Elk Grove CA GM
Daniel Beal MD Scotts Valley CA DLF
Bryan Cairns MD Austin MN FE
Pu Cheng MD Muncie IN GM
Kayla Fisher MD JD Riverside CA DF
Debra Harris MD Scotts Valley CA GM
Adam Hedaya MD New York NY GM
Andrea Holinga MD Colleyville TX GM
Frances Koblenzer MD Coatesville PA GM
Ritesh Kool MD Las Vegas NV GM
Mercedes Kwiatkowski MD Redwood City
CA GM
Anne Miller MD Tucson AZ GM
Carl Ratliff DO Kokomo IN GM
Loretta Sonnier MD Birmingham AL GM
Michael Unger MD Acworth GA GM
Deceased
Mary Lenkay MD DLF/88
Fernando Manalac MD IM/61
4th APA Rep
Added
As a result of action taken by
the APA Assembly (which
convened just prior to the
APA annual meeting in
Toronto in May), the OPPA
will now have four (instead
of three) representatives
to the Assembly. For some
time, there had been a great
deal of discussion about
how best to reorganize
the representation by each
district branch (DB) to
ensure fairness to both the
densely populated areas and
rural areas that have very
low number of psychiatrists. May 31, 2015
Steven Jewell, MD, President,
chaired the meeting at the OPPA
Offices. Council took action on
the following items:
• Approved the minutes of the
January 24, 2015 Council
meeting;
• Approved the Treasurer’s
report – Statement of Assets
and 2nd Quarter 2015;
• Approved Executive
Committee to identify two
officer positions who, in
addition to serving the OPPA,
would be asked to serve on
the OPPF board during their
term as an OPPA officer;
• Approved outreach to
Addiction Committee to
write and submit, for review
at next council meeting, a
position paper regarding the
legalization, medicalization,
and decriminalization of
marijuana;
• Approved the Membership
Committee’s recommended
five nominees for
Distinguished Fellow. The
recommendations, with the
documents for the nominees,
will be sent to the APA;
• Approved Executive
Committee authorization
to appoint a 4th APA
representative (as newly
defined by the APA) to serve
until the next OPPA election,
at which time he or she may
be eligible to run for the
position again.
OPPA - INSIGHT MATTERS - SUMMER 2015
2016 OPPA Annual Psychiatric Update
Psychiatry 2016 - Innovations and Controversies
Save the date!
Sunday, March 13, 2016
Hilton Columbus at Easton
Kevin P. Hill, MD
Addiction Psychiatrist, Clinical
Researcher, Author, Marijuana:
The Unbiased Truth about the
World's Most Popular Weed
Candidates
sought
The 2016 elections will include
the following offices:
President-elect - One year as
President-elect, then one year as
President
Secretary - Two year term
APA Representatives (2) Three year term
The Nominating Committee is
interested in hearing from you if
you wish to suggest a candidate
for any of the above offices, or
if you wish to be considered as a
candidate.
Send your suggestions by
September 8, 2015 to:
Stephen Pariser, MD
Nominating Committee Chair
Ohio Psychiatric Physicians
Association
[email protected]
Other topics include:
• Gun violence
• Transgender youth
• Involuntary outpatient
committment
DSM-5 & ICD-10-CM
Workshop
Last workshop!
Scheduled for September
10th in Columbus
Member news
Featuring:
Register today! Spaces are filling up quick!
See page 19 for details or visit the Education section of
www.ohiopsychiatry.org to register
Have you visited us lately?
Don't forget to visit the Members Only section of www.ohiopsychiatry.org.
You will have access to a Member Directory to assist you in contacting
colleagues around the state. Be sure to check on My OPPA Profile to
verify that your own information is up-to-date, and to let us know if you
would also like to be listed in an online directory that is available to the
public.
OPPA - INSIGHT MATTERS - SUMMER 2015
9
Easy Ways to Give to OPPF
2015 Enlightenment Award
Nomination deadline January 15
When you give to the Ohio Psychiatric Physicians
Foundation (OPPF), you are giving the gift of hope
for research, education and enlightenment for better
psychiatric care of all Ohioans. OPPF is a 501c(3)
organization, and gifts to the OPPF are tax deductible.
You can make a tax-deductible the following ways:
1. Print the OPPF Contribution Form, and mail or fax
it to us;
2. Call our office at 614-763-0040 and talk with a
staff member!
The award recognizes outstanding activity
or presentations which enhance the public’s
access to treatment and/or enhances the public’s
understanding of mental disorders or decreases
the stigma often associated with mental illness.
Foundation
3. Make a secure On-line Donation with credit card;
4. Register your Kroger card and shop/search via
iGive.com.
Visit www.ohiopsychiatry.org/foundation for details.
Support OPPF when
you shop at Kroger!
It’s very simple! All you need to do is register your Kroger
Plus card and every time you shop OPPF will be rewarded.
Here’s how to link your Kroger Plus card to OPPF:
•
Go to http://www.krogercommunityrewards.com
•
Click on “Sign In or Register”
•
Fill out information with * (store where you usually
shop,
•
Fill out information with an * (store where you usually
shop, your e-mail address and a password). Now click
“Confirm”. Confirm the account information and then
check your e-mail for a note from Kroger. Follow the
instructions to activate your account
•
Log-in and click on My Account, and use your email
address and password to proceed to the next step
•
Click on Edit Kroger Community Rewards information
and input your Kroger Plus card #. Update or confirm
your information
•
10
Enter Ohio Psychiatric Physicians Foundation
NPO#76017 or name of organization, select organization from list and click on confirm. To verify you are
enrolled correctly, you will see your organization’s
name on the right side of your information page.
Nominees can include:
•
An individual, organization, government
entity, media (newspaper, radio or TV station
or internet based communication) or, a form
of art.
Applications must include the following items:
1. A letter of nomination describing nominee’s
contribution which positively impacts mental
health;
2. A copy of the presentation/supporting
material. Examples include newspaper
article, television documentary, news
program, You Tube presentation, art form
(book, story, play, musical or art piece); and,
3. Telephone numbers, addresses and e-mail
addresses of both nominee and nominating
party.
Nominations for 2015 will be accepted from
individuals or organizations and must be received
no later than January 15, 2016. For more
information please visit www.ohiopsychiatry.org/
foundation.
Please submit nominations to:
Dale Svendsen, M.D.
Ohio Psychiatric Physicians Foundation
3510 Snouffer Rd., Ste. 101
Columbus, OH 43235-4217
E-mail: [email protected]
OPPA - INSIGHT MATTERS - SUMMER 2015
Research Awards – Call for Entries!
Deadline is December 31st
The Ohio Psychiatric Physicians Foundation (OPPF) is currently accepting entries for the
2015 OPPF Research Awards in each of the three categories below.
The winners and runners-up in each category will be invited to attend the OPPA Annual Meeting on Sunday, March
13, 2016, at the Hilton Easton in Columbus. Each winner will receive a plaque and each runner-up will receive an
award certificate. The registration fee to attend the Annual Meeting will be paid for by the OPPF for the winners and
the runners-up. This is a great opportunity to recognize individuals for the contribution they are making to psychiatry
and the understanding of mental disorders. We sincerely hope you will participate!
The award will be given to the
best article authored by an
OPPA member. The article may
have been published or accepted
and in press at any time
between Jan. 1 and Dec. 31. All
psychiatric topics are acceptable
for the competition. Data-based
papers are encouraged, but
critical review articles are also
acceptable.
Resident-Fellow Member
The award will be given to the
best article authored by an OPPA
Resident-Fellow Member. At the
time of entry submission, the
article may have been published,
accepted and in press,or
submitted but not yet accepted
for publication at any time
between Jan. 1 and Dec. 31. The
article may be authored by the
resident alone or in combination
with a faculty member, but the
resident must be the first author
for the paper to be considered.
The article can be a data-based
paper, a case series, a case
report, or a review article.
Submission Process
Medical Student
The award will be given to the
best article authored by a medical
student. The author of the entry
must have been enrolled in one of
Ohio’s medical schools at the time
of article submission. The article
may have been published, accepted
and in press, or submitted but not
yet accepted for publication at any
time between Jan. 1 and Dec. 31.
Faculty and residents can be coauthors, but the medical student
must be first author for the
submission to be considered. The
article can be a case report, a case
series, a selected review or a databased paper. Members of the OPPA
affiliated with medical schools in
Ohio are encouraged to inform
medical students interested in
psychiatry about this award
throughout their four years.
Mentorship in identifying a topic
and preparing an article for
submission is also encouraged.
Foundation
General Member
The following must be received via electronic submission to
[email protected] no later than 11:59 p.m. on December 31.
Submission materials must be received as attachments to a single email
and should include the following:
1. The article in either a PDF or Word format.
2. A cover letter signed by the first author, verifying that s/he personally conducted the study and/or wrote the
paper being submitted (with some input or help from co-authors where applicable). Either an electronic
signature inserted into the cover letter or an electronic scan of the completed cover letter is acceptable.
Note: Incomplete submissions will not be considered for a research award.
Award Selection
The OPPF Board of Directors will appoint a selection committee comprised of OPPA members to judge the entries.
Award Announcement
The selection committee will review qualifying submissions in all three categories and will send their
recommendations for a winner and runner-up in each category to the OPPF Board of Directors. The OPPF president
will announce the awardees at the end of the first week of February via an email to all OPPA members. The OPPA
quarterly newsletter, Insight Matters, will profile the awardees and runners-up in all three categories in the issue
following announcement of awardees.
OPPA - INSIGHT MATTERS - SUMMER 2015
11
Editor’s note
Continued from page 2
refused access to public locations)
o Psychiatric Service Animal is a separate
subtype of a service animal, still highly trained;
could help with dizziness from medications,
disorientation from mental episodes, bring
medications to their owner (but is specifically
excluded from definition of service dog in 15
states, including Michigan)
o By Law, a business or location may only ask (1)
if the dog is a Service Animal required because
of a disability, and (2) what work or task the
dog has been trained to perform
•
Public service animals - Assist service personnel (like
a police dog)
•
Therapy animals - Used by a health care professional
to implement treatment, usually psychological or
physiological “Animal Assisted Therapy” (helping
paralysis patient with physical therapy, motivate a
motor-delayed child to crawl or walk toward the
animal); excluded from access protections
•
Visitation animals - Provide comfort, support,
companionship, and social interactions; excluded from
access protections (like at a nursing home or hospital)
•
Emotional support animals - Provide emotional
support to individuals in homes usually
(sometimes airplanes); usually allowed for housing
accommodations, and sometimes for airlines with
variable exclusion from access protections
So what will you do the next time a patient asks you to sign
off on their animal? I recommend that you take a look at
the specific questions posed, follow the guidelines of the
various federal organizations, and do what you believe to be
most appropriate. Perhaps it’s time to reconsider prescribing
“lorazepam TID” in favor of “Pet and cuddle with your
animal TID” – just a thought!
Airline requirements for cabin travel of an
emotional support or psychiatric service animal
 Provide letter to the airlines at least 48 hours
prior to the flight
 Letter dated within the past year and on official
letterhead
 That the author is a licensed mental health
professional, clearly indicating what type
(psychiatrist, psychologist, clinical social worker,
etc) and some require license information
(license number, expiration date, state)
 That the passenger is under his or her care
 The passenger has a mental health related
disability that appears in the DSM-IV or DSM-5,
which substantially limits one or more major life
activities
 The presence of the animal is necessary to the
passenger’s health or treatment during the flight
and/or destination
Benefits of pet ownership for companionship
Improves cardiovascular health and
blood pressure
Physical relaxation response when
petting
Increased physical activity from
caretaking
Decreases isolation, loneliness, and
anxiety
Improves psychological well-being
Provides non-judgmental support
Particularly helpful for individuals with
autistic spectrum disorders or dementia
Humane Society’s Visiting Pets Program
Sources :
“Could Rx : Pet Therapy come back to bite you?” Mossman D. Current
Psychiatry 2014 June;13(6):33-36
Assistance Dogs International
“Pet ownership and physical health.” Matchock RL. Curr Opin
Psychiatry. 2015 Sep;28(5):386-92.
Therapy Dogs International
“Oxytocin-gaze positive loop and the coevolution of human-dog bonds.”
Kikusui T. Science 17 April 2015: Vol. 348 no. 6232 pp. 333-336
Delta Society Therapy Dogs
http://www.ada.gov/service_animals_2010.htm
For more information
Service Dog Central
https://portal.hud.gov/hudportal/documents/huddoc?id=servanimals_
ntcfheo2013-01.pdf
http://servicedogcentral.org/content/node/62
12
OPPA - INSIGHT MATTERS - SUMMER 2015
The transformation of psychiatry
The impact of cultural and societal norms
Tamara Campbell, MD
Secretary
As I reflect on how psychiatry may continue to transform over the next
several years, I am mindful of a number of important issues, one of which is
service care delivery. Generally speaking, membership in our organization,
spans from the Post-War cohort (1945-1979) to Generation Y (1977-1994). One’s
thinking about the transformation of psychiatry may be tempered by cohort of origin.
Treatment or service care delivery in psychiatry has
ranged from psychoanalysis to tele-psychiatry. There is
little argument that the interpersonal dynamics between
doctor and patient changes significantly as we move
from the couch, to an office chair, and on to a computer
screen. Some research indicates that tele-psychiatry
is just as efficacious as face to face sessions; not to
mention convenient and economically advantageous
for the patient. Others have argued that this change in
interpersonal dynamics results in therapeutic distance
within the doctor patient dyad and compromises the
integrity of the therapeutic process.
MARK YOUR CALENDAR
Difficulties with access to care has been the main reason
psychiatrists are encouraged to practice tele-psychiatry.
Generation Z (1995-2012) is described as being the most
diverse generation having grown up with higher levels
of technology. Communicating through a computer
screen for this group, is a daily occurrence. Telemedicine/
psychiatry may very well be their treatment of choice
regardless of access to care issues. What some cohorts
interpret as a cultural shift may be just the cultural norm
for others.
As a profession how and when do we adapt to societal
norms? The mental status examination is our “physical
examination.” Can we accurately complete this
assessment through a computer screen? Should the
profession of psychiatry be able to assess the health or
See Transformation on page 18
ProMedica’s Continuing Medical Education Department presents
19TH Annual Psychiatric Symposium:
Clinical Updates in Psychiatry
Friday
November 6, 2015
Registration: 7 a.m.
Conference: 7:45 a.m. – 4 p.m.
New Location
Hilton Garden Inn Conference Center
6165 Levis Commons Blvd.
Perrysburg, Ohio 43551
This activity has been approved for
6 AMA PRA Category 1 credits™.
Topics to be presented:
• Treatment of Co-Occurring Substance Abuse
and Mood Disorders
• Treatment of Prescription Opioid Dependence
Roger D. Weiss, MD
Professor of Psychiatry, Harvard Medical School
Chief, Division of Alcohol and Drug Abuse, McLean Hospital
• Psychotic Disorders in DSM-5: Clinical Implications
of New Approach
• Treatment of Schizophrenia: Current State of the Art
Rajiv Tandon, MD
Chief of Psychiatry, Program of Mental Health
State of Florida Department of Children and Families
• Management of Psychosis in the Geriatric Population
• Dementia and Depression
Susan M. Maixner, MD
Clinical Associate Professor of Psychiatry, University of Michigan
Geropsychiatry Program Director
Conference brochures will be mailed in early September.
For more information contact ProMedica’s Continuing Medical
Education Department, 419-291-4176.
For future continuing medical education opportunities and to view the calendars
and conference brochures, visit promedica.org/continuingmedicaleducation.
© 2015 ProMedica
OPPA - INSIGHT MATTERS - SUMMER 2015
13
Parity
Continued from page 1
Practice Issues
its view that plans discourage
psychiatrist participation in networks
(and many violate the Mental Health
True parity will not
Parity and Addiction Equity Act) by
become a reality
paying psychiatrists less than other
unless we make it
medical doctors for the same CPT
happen!
codes, including onerous terms in
contracts for psychiatrists that are not
included in other medical doctor’s
contracts, imposing unreasonable prior authorization requirements and
telephone wait times on psychiatrists, and unnecessarily auditing the higher
service CPT codes, even when used to treat patients with severe mental illness,
and by employing practice guidelines that are not the accepted standard of
clinical care. Each audience expresses interest and asks for proof.
Here’s how YOU can help change things!
1. The APA is ready and willing to help address this issue! However, specific
examples of problems are needed. First, the APA does not need patient
names or even your name or any other HIPAA protected information.
On Aug. 20, the U.S. Court of
Appeals for the Second Circuit
REVERSED in part the district
court’s dismissal of a key mental
health parity case brought by the New
York State Psychiatric Association
(NYSPA) and others. The ruling states
unanimously that the NYSPA has
standing to sue UnitedHealth Group
for treating mental health claims
differently than other health claims
and claims administrators may be
liable for coverage decisions under
the Employee Retirement Income
Security Act (ERISA).
Accomplishments of this decision
include:
•
Recognition that NYSPA could
represent its members and their
patients in pressing a claim under
the Mental Health Parity Act
through Associational Standing. This issue may sound familiar to
you, because APA, and separately
the AMA, filed Amicus Briefs in
this case addressing this point.
•
Recognition that United could be
sued even when it acted not as the
insurer, but as the administrator
of a self-insured plan. United
argued that because it was not the
insurer, the plaintiffs had to sue
their employers who provided
the health plan. NYSPA and the
US Department of Labor argued
otherwise. The Court concluded
that carriers who violate
MHPAEA and exercise significant
discretion in the administration
of the plan’s benefits were
appropriate defendants.
They do, however, need you to send:
•
Third-party payor fee schedules (with plan, the city and state of
practice);
•
Provider contracts, patient explanation of benefits from the plan
for primary care and for psychiatry visits (include plan and city
and state);
•
Copies of any clinical guidelines that do not meet the standard
of care (with plan name, city and state);
•
Prior authorization requirements (include plan name and city
and state), and any details you can share about wait times for
telephone calls to the plan, unfair treatment denials, charging
double co-payments or any other practices that discriminate
against mental health patients.
You can redact any confidential information from anything you send to the APA.
2. Be sure to review network provider directories and confirm that your
information is accurate. If you have left the network and are still listed,
please let the APA know. All information should be sent via email to
[email protected] or fax to 703-907-1087 or you can call our hotline with
any questions 1-800-343-4671 or for more information.
3. Finally, complete and return the questionnaire on page 16 —or
complete it online by going to https://www.surveymonkey.com/r/APA_
Confidential_Practice_Questionnaire.
14
Court rules TPAs
may be sued over
mental health
parity law
This is a victory for psychiatry!
http://law.justia.com/cases/federal/appellatecourts/ca2/14-20/14-20-2015-08-20.html
OPPA - INSIGHT MATTERS - SUMMER 2015
Federal law is clear that insurers can no longer discriminate against patients with mental illness, including
substance use. But how many people know what constitutes a violation under the Mental Health Parity and
Addiction Equity Act (MHPAEA)? Patients who know their rights are better equipped to protect their rights.
That’s why the APA has created a new tool to help enforce the parity law and end discrimination. The poster
clearly and simply explains the law and the steps to take when a violation is suspected. Print it out and post it
(in physicians’ offices, clinics, break rooms at workplaces etc.).
Fair Insurance Coverage:
IT’S THE LAW
Under the federal “Mental Health Parity” law:
are entitled to the treatment your physician says
1 You
is necessary for your mental health or substance use
disorder. Your health plan cannot require you to fail first
at less-expensive treatments if it does not have the same
“fail first” requirement on all other illnesses covered by
your plan.
few exceptions your co-payment or co-insurance
2 With
for your mental health benefit should not be higher than
it is for other medical care, and you should have only one
deductible and out-of-pocket maximum that covers all of
your health care.
you visit a psychiatrist for medication management
3 When
and for psychotherapy on the same day, you should pay
only one co-payment.
should have access to an “in network” mental health
4 You
provider who:
• is qualified to treat your condition
• can see you in a reasonable amounof time at a location
accessible from your home.
health-related visits or treatment should not require
5 Mental
pre-authorization, unless your plan requires
pre-authorization for most other medical care.
number of visits or hospital days should not be limited,
6 The
unless similar limitations apply to most other medical
illnesses under your plan.
health plan should pay even if you don’t complete the
7 Your
treatment or a prior recommended course of treatment.
health plan is required to provide you with a written
8 Your
explanation of:
• how it evaluated your need for treatment
• why it denied the claim
• the basis for its conclusion that the plan complies with
federal law.
have the right to appeal your plan’s decision about
9 You
your care or coverage.
You have the right to appeal the claim with your plan and
with an independent review organization. (Check with
your state insurance commissioner’s office: www.naic.org/
documents/members_membershiplist.pdf)
an out-of-network benefit in your plan and
10 Ifseeyouanhave
out-of-network psychiatrist, the health plan should
Practice Issues
Federal law prohibits your private health insurance plan from discriminating against you because you
have a mental illness, including a substance use disorder. Coverage for a mental health concern now
must be equivalent to coverage for physical health problems, like heart disease, diabetes and cancer.
reimburse you for a portion of the amount you paid for the
visit. If the amount you are reimbursed is significantly less
than the amount the health plan pays to other doctors who
are out-of-network, this may be illegal. You can see what
doctors are paid by checking the explanation of benefits
you receive from your plan.
If you have concerns about your health plan’s compliance with federal law:
✔Call
❑
the federal government’s Center for Consumer Information and Insurance Oversight (CCIIO) at 877-267-2323
ext. 6-1565 or email its Public Health Interest Group, also part of CCIIO: [email protected]
✔
Contact a benefit advisor at the U.S. Department of Labor at 866-444-3272 or www.askebsa.dol.gov
❑
✔
❑Call your state insurance commissioner’s office (list at www.naic.org/documents/members_membershiplist.pdf)
Commissioner:
Phone:
Terms of plans differ. This document is not intended to be legal advice.
It is intended for public education and awareness only.
OPPA - INSIGHT MATTERS - SUMMER 2015
7/15
15
American Psychiatric Association
CONFIDENTIAL PRACTICE QUESTIONAIRE
GENERAL: EVERYONE PLEASE ANSWER
1. Are you aware of any insurance plan medical necessity guidelines [inpatient or outpatient, including partial hospitalization and
intensive out-patient] which do not meet accepted clinical standards of care.
□ Yes
□ No
If yes, which plan and what guidelines? ___________________________________________________
2. Are you aware of any insurance plan guidelines [inpatient or outpatient, including partial hospitalization and intensive out-patient]
which on paper meet the accepted standards of care, but the insurance plan’s application of the guidelines do not result in acceptable
standards of care? □ Yes
□ No
If yes, which plan and what guidelines? ___________________________________________________
IN-NETWORK OR PARTICIPATING PROVIDERS
3. Are you contracted with any plans to provide services on an “in network” or “participating” basis? □ Yes
□ No
If yes, please list all plans with whom you contract and for each: (a) check whether you negotiated your fee schedule or
whether it was determined solely by the plan; and (b) estimate the current percentage of your patients with that plan:
Plan
Negotiated
Not Negotiated
% of patient current load
4. Of all patients that you see what percentage are out of network? ____________%
5. Would you be willing to share your contract(s) with Colleen Coyle, Esq. for analysis on a confidential and anonymous basis?
□ Yes
□ No
6. Which two plans are the worst you have worked with in the past 12 months and what makes them the worst?
A._________________________________________________________________________________________
B._________________________________________________________________________________________
7. When you have disassociated from a network, have you [check one]:
____
____
Followed the termination procedures and notice requirements in the contract; or
Just stopped taking new patients with that insurance
OUT OF NETWORK PROVIDERS
8. Do you bill insurance companies on behalf of your patients?
□ Yes
□ No
A. If not, do you know how much your patient is reimbursed by the plan for their visit?
□ Yes
□ No
B. Have you ever negotiated your out of network fee with the insurance plan?
□ Yes
□ No
9. Why do you not participate in insurance plans – rank reasons in order of importance (1 is the most important)? If a reason does
not apply to you, leave it blank.
___ Rates too low
___ Medical management standards do not allow me to treat my patients within standards of care
___ Do not have staff to do the paperwork
___ Other (please specify) __________________________________________________________________________
10. Assuming other issues could be controlled, how much would rates need to increase above Medicare rates in order for you to be
interested in participating in a network? ______ %
11. Do you have any contracts or agreements with plans for special situations (e.g. particular patients), but you do not participate as
part of a network for all patients? □ Yes
□ No
If yes, which plan? ________________________________________________
Name
City and State of Practice
Phone where you can be reached
_____________________________________________________________________________________________________________
Please return completed survey:
Mail: 3510 Snouffer Rd., Ste. 101, Columbus, OH 43235
Fax: 614-481-7559
16
OPPA - INSIGHT MATTERS - SUMMER 2015
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our clients receive individual attention, underwriting
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including Claims-Free,
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Visit us at apamalpractice.com or call 877.740.1777 to learn more.
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OPPA - INSIGHT MATTERS - SUMMER 2015
17
Psychiatrist finally appointed to Medical Board
PSYCHIATRIST
Small town living at its best....
– oUtPatIent PosItIon –
Horizon Health is assisting our
client hospital in Marietta, OH
in their search for an additional
psychiatrist to do outpatient work.
A thriving adult and geriatric
outpatient practice is available for
the right candidate. Potential for
medical directorship of outpatient
day program. Opportunity for child/
adolescent psychiatry based on
candidate interest.
For many years, the OPPA has been a strong advocate of having a
psychiatrist (preferably who specializes in addiction) appointed to the State
Medical Board of Ohio. In June, Governor Kasich appointed former OPPA
member Michael Schottenstein, MD. In 2000, he established his private
practice in Bexley, specializing in child, adolescent, and adult psychiatry.
The OPPA congratulates Dr. Schottenstein on his appointment and looks
forward to working with him and other members of the medical board as
we continue our advocacy efforts on issues that include the “one-bite rule,”
discriminatory questions contained in the medical license application,
telemedicine and regulations related to the Ohio Automated Reporting Rx
System. This opportunity includes periodic call
coverage (1:3) on the hospital’s 13-bed
secure inpatient Geropsychiatric Unit for
seniors 55 and older, and adults who are
experiencing psychiatric symptoms that
require 24-hour acute inpatient treatment.
This is an excellent opportunity for a BC/
BE psychiatrist to join an established
hospital-employed group. A very
competitive salary, work schedule and
benefit package is available to the right
candidate. Offering base salary, signing
bonus, relocation, and education loan
repayment.
In Marietta, outdoor enthusiasts enjoy
activities on two rivers and all their
tributaries and on hundreds of miles
of trails. Live in this welcoming city
with a wonderful, relaxed quality of life;
great for families.
Please contact:
Terry B. Good, Horizon Health
Call: 1.804.684-5661
Fax #: 804.684.5663
Email: [email protected]
otHeR PosItIons are available outside
of OH. Call for locations.
eoe
18
OPPA - INSIGHT MATTERS - SUMMER 2015
Jointly provided by the American Psychiatric Association and the Ohio Psychiatric Physicians Association
Transitioning to DSM-5 & ICD-10-CM
for Mental and Behavioral Disorders
Thursday, Sept. 10 — Columbus
OPPA Office, Upstairs Boardroom
3510 Snouffer Rd, Columbus, OH 43235
AGENDA
Who Should Attend
This workshop is designed for Psychiatrists and other Physicians who treat
individuals with mental health disorders. Psychologists, Advanced Practice
Nurses, Social Workers, Clinical Counselors, Marriage and Family Therapists,
Case Managers, Billing Personnel and all others who need to know about the
Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition and the
International Classification of Diseases, 10th Edition, Classification of Mental
and Behavioral Disorders, will also find it beneficial.
8 - 8:30 a.m.—Registration
8:30 a.m. - 12:15 p.m. (with 15 min. break): ICD-10-CM
At the conclusion of this part of the workshop, participants should be able to:

Explain the process for selecting the appropriate, corresponding
ICD-10-CM code for billing and reimbursement by payors;
Why You Need to Attend
Beginning Oct. 1, 2015, all entities, including health care providers, covered by
the Health Insurance Accountability Act (HIPAA) must convert to using the
ICD-10-CM diagnosis codes for billing and reimbursement purposes. The
mandate represents a fundamental shift for many psychiatrists and other mental
health professionals who are far more attuned to the Diagnosis and Statistical
Manual of Mental Disorders (DSM), which also underwent a major overhaul
with the fifth edition, released in May 2013. And, while there is a “crosswalk”
from DSM-5 to ICD-10 codes, there’s a great deal more that must be understood by both clinicians and billing personnel to ensure accurate coding for
both diagnostic as well as billing and reimbursement purposes.

guidelines section of the ICD-10-CM process;

Diane Zucker, M Ed, CCS-P, is a health care management and reimbursement
consultant who has spent the last 28 years as a consultant providing
physicians and practices with educational programs, support and ongoing
information on the complex maze of documentation, coding and compliance.
Ms. Zucker has a Master’s degree in Education and a Bachelor’s degree in
social work from Kent State University with additional coursework in health
care management and reimbursement. Prior to consulting, Ms. Zucker worked
in health care as a social worker and for a major health insurance company.
Ms. Zucker is also a certified CPT coder and ICD-10-CM trainer.
Explain, within the documentation, the elements of the note that would
lead to specific ICD-10-CM coding based on timing, status and quality
of the condition;

Describe and understand the rank order process for psychiatry
diagnoses as well as secondary medical diagnoses that may be required
to identify the care of the patient by using the index and relevant codes
throughout the text; and
Speakers
Molly McVoy, MD, is an Assistant Professor in the Division of Child and Adolescent Psychiatry at Case Western Reserve/University Hospitals of
Cleveland and is the Training Director for the Child and Adolescent Psychiatry
Fellowship training program. Dr. McVoy also serves on the American Psychiatric
Association’s Board of Trustees that developed and approved the DSM-5.
Dr. McVoy is the associate editor of the Child and Adolescent Psychopharmacology Newsletter and she recently published the “Clinical Manual of Child and
Adolescent Psychopharmacology, 2nd Edition.” Dr. McVoy also sits on the board
of NAMI Greater Cleveland.
Identify the rules specifically for psychiatry, the key rules within the

Provide examples of documentation that may require the coder to
"query the physician" for additional information for accurate coding.
12:15 - 1 p.m.: Lunch (provided)
1 - 4:45 p.m. (with 15 min. break): DSM-5

Explore the general themes of the DSM
changes (from DSM-IV to DSM-5) and how
they relate to the growing body of evidence
from mental health research;

Please be sure to bring the
ICD-10-CM book and the
DSM-5 book with you!
They will not be sold or
available on site!
Explain the specific changes occurring in the DSM-5 regarding
particular diagnoses and diagnostic criteria;

Discuss some of the practical ways that the new DSM will change
mental health practice and how mental health issues are conceptualized
and addressed; and

Practice selecting appropriate DSM-5 code(s) based on case examples.
Continuing Medical Education Credit
Continuing Education Credit
PHYSICIANS
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education
through the joint providership of the American Psychiatric Association (APA) and OPPA. The
APA is accredited by the ACCME to provide continuing medical education for physicians.”
COUNSELORS, SOCIAL WORKERS & MFTs
The Counselor, Social Worker & Marriage and Family therapist Board has approved this
program for 7 clock hours of credit for Counselor CPE, Social Worker COE and Marriage &
Family Therapist.
The American Psychiatric Association designates this live activity for a maximum of 7 AMA
PRA Category 1 Credits™. Physicians should only claim credit commensurate with the
extent of their participation in the activity.
Register online at:
https://oppasept10.eventbrite.com
Mail registration below to:
Ohio Psychiatric Physicians Association, 3510 Snouffer Rd., S-101, Columbus, OH 43235-4217
Fax to:
(614) 481-7559
Or, call to register by phone: (614) 763-0040
Deduct $20 from fees if you previously attended an OPPA
sponsored DSM-5 workshop!
(Must be verified by OPPA—please call us!)
Please print
Early-bird
(Until 8/10)
Regular
(After 8/10)
OPPA Member Psychiatrist
$ 59
$ 79
OPPA Member Resident or Fellow Psychiatrist
$ 39
$ 59
Social Workers/Clinical Counselors/MFTs
$ 99
$119
All Others
$149
$169
Method of Payment:
_____ Credit Card
_____ Check Enclosed
License/Degree (MD, DO, PhD, LISW, etc.)
Address
City/State/Zip
Phone
Fax
E-mail
Please check here ____ if you would like a vegetarian lunch
Account #
Exp. Date
Name
(We regret we are not able to accommodate other specific dietary needs.)
3 or 4-digit security code _____
Billing Address (if different from registration address)
Registration fee includes workshop, materials, beverages and boxed lunch.
Cancellations: We encourage you to send a colleague in your place if you are not able to attend. Cancellations
received seven business days before workshop will be refunded in full; otherwise, there is a $50 processing fee.
No refunds will be made the day of the event or after the event. However, you will be provided with the printed
materials.
Americans with Disabilities Act: If you need assistance related to sight, sound or mobility, please contact the OPPA
office as soon as possible so that we may accommodate reasonable requests.
Signature
OPPA - INSIGHT MATTERS - SUMMER 2015
19
Transformation
Continued from page 13
pathology of cultural transformation
across generations? To paraphrase
the DSM 5, culture refers to systems
of knowledge, concepts, rules and
practices learned and transmitted
across the generations. In the DSM
5, the section on cultural formulation
remains at the back of the book. I
suggest we keep cultural formulation
at the forefront of our brain, as we
continue to evaluate not only how
we deliver services, but the impact
that cultural shifts is having on our
profession.
Inpatient and Emergency Psychiatry
The Ohio State University Wexner
Medical Center
Classifieds
Looking for a better quality of life,
tired of call and working weekends?
Join our team! The State of Ohio
is hiring Physician Administrator 2/
Psychiatrists in various locations
across Ohio. The positions are full time
Monday – Friday and call is virtually
non-existent. The qualified candidate
will provide direct psychiatric care to
adult offender patients housed in the
Ohio correctional system and act as the
lead of the treatment team. Minimum
qualifications include but not limited to
a Certificate to practice Adult psychiatry
in State of Ohio and completion of
adult/general psychiatry residency.
BC is preferred. Many locations are
designated as health professional
shortage areas. We offer a competitive
salary and exceptional benefit package
valued at over $250K. Review entire
postings at Http://www.careers.ohio.
gov. Contact Rhonda Johnson, Program
Administrator/Recruitment Specialist
for more information 614-644-4959,
[email protected].
The Department of Psychiatry and
Behavioral Health at The Ohio State
University (OSU) Wexner Medical
Center is actively recruiting highly
motivated, academically oriented
general psychiatrists at all levels with
special interests and experience in
inpatient psychiatric care delivery and
psychiatric emergencies. Leadership
opportunities are available for qualified
candidates with ambitions to develop
a robust program of clinical care,
research, and training. Salary is highly
competitive, with bonus potential
and an excellent benefits package.
Please direct queries to: John V.
Campo, MD, Sinsabaugh Professor
and Chair, Department of Psychiatry
and Behavioral Health, The Ohio State
University Wexner Medical Center,
OSU Harding Hospital,1670 Upham
Drive, Columbus, Ohio 43210. Email
[email protected]. Office (614)
685-5602
Addiction Psychiatry
The Ohio State University Wexner
Medical Center.
The Department of Psychiatry and
Behavioral Health at The Ohio State
University (OSU) Wexner Medical
Center is actively recruiting highly
motivated, academically oriented
psychiatrists at all levels with special
interests and experience in the care
of addictions. Exciting opportunities
include dual diagnosis initiatives and
medication assisted treatment (MAT)
across all levels of care delivery.
Leadership opportunities are available
for qualified candidates with ambitions
to develop a robust program of clinical
care, research, and training. Salary is
highly competitive, with bonus potential
and an excellent benefits package.
Please direct queries to: John V.
Campo, MD, Sinsabaugh Professor
and Chair, Department of Psychiatry
and Behavioral Health, The Ohio State
University Wexner Medical Center,
OSU Harding Hospital,1670 Upham
Drive, Columbus, Ohio 43210. Email
[email protected]. Office (614)
685-5602
INSIGHT MATTERS is published quarterly:
January/February, May, August, and November.
Material must be received no later than the first
day of the publication month.
The Ohio Psychiatric Physicians Association
reserves the right to refuse or delete submitted
material without explanation at the publisher’s
discretion.
Institutional or corporate advertising that features
the company but not individual products or
product-specific information, may be considered
and are subject to review and approval by the
Ohio Psychiatric Physicians Association.
Send advertisements (classified/display) and
written material to: Ohio Psychiatric Physicians
Association, 3510 Snouffer Rd., Ste. 101,
Columbus, OH 43235. [email protected]
Articles published in this newsletter may be
reprinted without permission.
STAFF
Janet Shaw, MBA, Executive Director
[email protected]
Michelle Mazza, Administrative Assistant
[email protected]
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OPPA - INSIGHT MATTERS - SUMMER 2015
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OPPA - INSIGHT MATTERS - SUMMER 2015