I am writing about two matters of urgent concern for those members of the Association who are concerned about the effective participation of psychoanalysts in the peer review of psychoanalytic treatment, insofar as it is governed by contracts between insurance carriers (e.g. CHAMPUS or commercial companies) and the American Psychiatric Association.
The first problem concerns who is designated as a psychoanalytic reviewer under these contracts. The original procedure by which members of your local APA District Branch were credentialed as psychoanalytic reviewers (or child psychiatry reviewers, or whatever) was a two-step process. Initially, names were requested by the APA's Office of Peer Review from DB presidents and peer review committee chairs, where one existed. Next, these designated reviewers were asked to define the areas in which they felt competent to review, e.g., psychoanalytic treatment. There are more than 20 areas of subspecialty competence that can be self-designated in this way.
The Association's Peer Review Committee, in its Manual of Psychoanalytic Peer Review, has recommended that for psychoanalysis, “The reviewer be recognized by the psychoanalytic community as a psychoanalyst.” This point was being made in regard to the necessity for psychoanalysts (rather than general psychiatrists who are psychoanalytically oriented or who use psychoanalytic consultation) to carry out peer review of ongoing psychoanalytic treatment. However, it is equally valid for the more general question of who is self-designated as a reviewer with psychoanalytic competence within a particular District Branch Peer Review Committee — for the purpose of reviewing cases which come under contracts between APA and insurance carriers. The phrase, “recognized by the psychoanalytic community,” explicitly does not contain the fringe of meaning, “Certified in Adult Psychoanalysis by the American Psychoanalytic Association.” It does have the fringe of meaning, “Recognized as a psychoanalyst within the local APA District Branch.”
The current problem arises from the fact that this credentialing process is scheduled to occur once again during the summer of 1983. It will take place in two steps: first, the already listed reviewers will be asked to self-designate their areas of competence to review; second, the District Branch will be asked to validate that designation. These requests will come once more from the APA's Office of Peer Review. Thus, any changes that members of the Association wish to see made in the locally sanctioned, self-designated group of reviewers competent to review psychoanalysis must be made rapidly and through your local District Branch. Your DB should have the names and self-designations of your local reviewers. If not, they are available from the Office of Peer Review at APA Headquarters, whose new phone number is (202) 682-6201.
The second problem concerns the number of psychoanalytic reviewers assigned to review cases of ongoing psychoanalytic treatment. Generally, the procedure has been for the APA's Office of Peer Review to assign at least one reviewer, self-designated as competent to review psychoanalytic treatment, to each team of three reviewers. The Association's Psychoanalytic Peer Review Committee, in
its Manual, has consistently recommended that, for ongoing psychoanalytic treatment, |in contrast to review of the initial prescription for psychoanalysis i.e. “prior authorization”) all the reviewers of such cases should be psychoanalysts, by the criterion of local recognition described above. The APA administration has not thought this to be necessary. However, an analogous procedure is currently in effect, viz. three child psychiatrists are being assigned to review Residential Treatment Centers for children. Therefore, it is clear that, if you are interested in all the members of a Peer Review team actually being psychoanalysts for the reviews of ongoing psychoanalytic treatment cases, this will require both a change in policy in the APA and a change in administrative procedure in the APA's Peer Review Office. Again, such a request for a change is best implemented through your local APA District Branch, and preferably by its President.
If anyone has any questions about the foregoing, or what course of action you may wish to select, you are free to telephone me at (414) 962-4811.
William Offenkrantz, M.D.
Milwaukee