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Notice: the VPA Listserv is now in operation. If you haven=t already done so, sign up by e-mailing Jessa Block at: jblock@vtmd.org. Please tell other Vermont psychiatrists about the Listserv. The Listserv can be accessed at: vpa@vtmd.org
VERMONT PSYCHIATRIC ASSOCIATION
Present: Ms. J. Block; Drs. F. Kalibat, R. Rubin, A. Siegel, B. McMains, S. Deppe, D. Fassler, U. Danielson, S. Graves
Minutes: Minutes of the last meeting were reviewed and accepted. Membership initiatives: There may be funding for a VPA and VMS joint membership initiative. Money may be available from APA to increase collaboration with the medical society. We may want to address the access to care issue by relationships with primary care clinicians, and primary care education in mental health issues.
Medicaid pharmaceuticals: We recently found out the state has come in under budget for pharmaceuticals by seven or eight million dollars for the last fiscal year. It was pointed out that crucial larger savings can only be realized in the future if we are allied with some sort of buying consortium that can get lower prices.
Counter-detailing initiatives: Given the fact that drug company representatives tend not to present all of the available information about medication choices, it was recommended that our psychotropic subcommittee develop a proposal for counter-detailing education for psychiatrists. Drs. McMains, Kalibat, and Graves are on that committee.
Access and psychologist prescribing: There was some discussion of psychologist prescribing and access issues in various states. The discussion will continue.
Primary care disaster training: Dr. Graves mentioned that the Vermont Agency of Human Services had shown some interest in disaster training in mental health issues for primary care clinicians. He suggested they contact Dr. Gail Barton.
The new Deputy commissioner of Mental Health is Susan Wehry, MD. She is the first psychiatrist commissioner of mental health in several decades. VPA extends its congratulations to Dr. Wehry on her appointment and offers our support to her. Dr. Kalibat will write to her. We hope that we can have open communication, email contact, and that she can attend a VPA Executive Committee Meeting.
Early Career Psychiatrist Education: There is money to send an ECP representative for training in Washington, DC, to learn about government relations and media work. He or she must live near the state capital. Several nominations were proposed. Jessa will check with those people.
Committee to Study the Financing of Community Mental Health Centers: Dr, Graves is on the committee to study CMHCs. The Vermont Legislature looked at two RFPs. A company has been selected. They will gather financial data, compare it to other states, project into the future, and make some decisions about what the CMHCs are doing and how they can be funded.
Act 129/Insurance Company Report Cards: Dr. Graves is a member of this group, which meets on a Thursday every other month. The committee includes representatives of insurance companies, the state, and clinician groups. The Legislature proposed measures for quality of care, but Dr. Graves would like to use better measures of quality. He would like to hand off this committee to another psychiatrist, as he cannot attend many of the meetings. He will ask another member to take over.
Vermont State Hospital Advisory Group: Dr. Fassler has been attending. There are lots of stakeholders involved. Questions are: What happens after VSH? What happens to get us there? This committee reports to AHS this fall. The current thinking is that VSH would be replaced by enhanced inpatient beds---one to three units in general hospitals which may or may not currently have units. There would be an array of other services, including secure residential, some peer-run programs, community integrated residential, etc. Medicaid funding cannot be obtained for greater than 16 beds in a freestanding psychiatric hospital. Larger units would have to be part of a general hospital. The units could be run by hospitals, the state, or a third entity, e.g., a community mental health center.
Treatment of adjudicated vs other patients. Should prison and non-prison mental health programs be mixed? There was quite a bit of discussion. Options under review include a continuum of services, both inpatient and community-based. We plan to make some recommendations to the Secretary of the Agency of Human Services in the next few months.
Development of relationships between psychiatrists in Vermont: It was observed that many psychiatrists feel a need for more opportunities to connect with peers, and this may also impact recruitment. Some Executive Committee members find a great deal of support in the VPA. How do we help people find support? How do we facilitate connections between small groups of psychiatrists to build a local sense of community? Would it help to have a letter welcoming people when they come to practice in Vermont? Do we need more opportunities for both education and schmoozing? Dr. Graves suggested that a fund for small CME honoraria could be provided by VPA and members could present their work to each other at dinners around the state. If you are interested in volunteering to be available to visit new psychiatrists and welcome them to your local area, please contact Bill McMains.
Access to psychiatric care: It is agreed that psychologist prescribing is not an optimal answer. Other options, such as consultation to, and further training for, primary care clinicians should be pursued. Ms. Block sent around a recent email regarding those options, as well as telepsychiatry. This will be explored further.
Magellan Mess: Magellan is post-bankruptcy, and owes millions of dollars to mental health clinicians in Vermont. Magellan is being extremely difficult. BISHCA is involved. The Vermont Medical Society and the Vermont Association for Mental Health are in the loop. Dr. Kalibat has heard from colleagues whose practices are profoundly affected by the mess.
Mark your calendars: On 1 October 2004, in Stowe, Central Vermont Medical Center will be conducting primary care education on management of psychiatric emergencies (suicidality, etc). They would appreciate our attendance and support.
Next Executive Committee Meeting is Thursday 23 September. It will be held at FAHC. There will be a noon luncheon with the UVM residents, followed by an Executive Committee Meeting. We hope to invite Dr. Melinda Estes, the new CEO of FAHC, to meet with us. Internist Dr. Mildred Reardon from the Vermont Area Health Education Centers will meet with us from 3-4:30pm. We hope to discuss access issues and how we might work together. A VPA Membership Dinner will occur that evening. Plans are in progress. All psychiatrists in Vermont are welcome and encouraged to come for the excellent meal (free of charge) and collegiality.
Fall Meeting: At the Burlington Wyndham Hotel (formerly the Radisson) on Saturday 23 October 2004. We will have our VPA business meeting during the VMS legislative session, after joining our medical colleagues for CME and lunch.
Respectfully submitted,
Susan Leigh Deppe, MD, DFAPA |
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