In addition to the everyday vicissitudes of psychoanalytic practice, psychoanalysts have in recent years been confronted by the necessity to provide reports to third party payers regarding the prescription of and the progress of psychoanalytic treatment. The economic climate and the increased utilization of benefits (including an increase in the number and variety of providers) has led to efforts by the insurers either to decrease or eliminate benefits or to require peer review as a condition for maintaining benefits. Peer review ideally will assure that treatment is being provided for covered conditions and that the treatment is appropriate and proceeding reasonably. It should be noted that the determination of whether treatment is for a covered condition is really claims review and should not require an extensive write-up.
As psychoanalysts, we have long been familiar with our own forms of peer review conducted through our educational institutes, our scientific meetings, and consultations with colleagues. In an effort to maintain and insure benefits for our patients, the American Psychiatric Association in conjunction with some of the major health insurance providers has established a system of peer review for psychiatric cases. The peer review committee of the American Psychoanalytic Association is also available to conduct peer review when the third party does not have a contract with the American Psychiatric Association.
These efforts in the interests of serving patients' needs while at the same time assuring third party payers that treatment is necessary and appropriate have not always functioned smoothly. Psychoanalysts have raised questions about issues of privacy and confidentiality and voiced important concerns about the effect on the psychoanalytic process itself. In some instances a review has seemed to facilitate the analysis or at least bring new issues into focus; on other occasions anaysts have felt the treatment has been threatened or compromised. Compiling the reports has at times been considered onerous and a burden; on other occasions the analyst has learned and benefited from the review. Having the patient read the report can have beneficial effects, but also, unfortunately, may function as a premature or inexact interpretation.
The Peer Review Committee has since its inception attempted to address these issues by conducting Open Forum meetings at the Fall and Annual Meetings. Here, members have had the opportunity to participate in presentations and discussions of the scientific, educational, and professional aspects of peer review. Since questions about peer review are of vital importance to our membership, Dr. Fogel, Editor of the Newsletter, has asked that these issues be debated here with the purpose of reaching a wider audience. What follows are three different views of the peer review process that can serve as departure points for further discussion and debate by our members.
Sol Altschul, Chicago
Chairman, Committee on Peer Review