We wish to call attention to serious inaccuracies in Paul Mosher's recent article, “A Disturbing Trend: Defining Confidentiality Down” (TAP 29/1). Dr. Mosher's misunderstanding and misrepresentations of the history of The American's Peer Review Committee and its development of the peer review procedures “two decades ago” leads him to the false conclusion that “until recently the precondition of maintaining strict confidentiality … has not played a prominent part in The American's efforts to promote [expanded insurance] coverage.” The inaccuracies in the article are as follows:
The development and subsequent publication of the Peer Review Model Criteria Sets was not, as Dr. Mosher states, simply because “somehow it came to be believed that the hostility to analysis … could be ameliorated by proposing a method of utilization management.” The Peer Review Committee and its subsequent Joint Task Forces were established in December 1974 in response to a need expressed by fiscal intermediaries for a set of peer review procedures by which long-term psychotherapy and psychoanalysis could be evaluated. These peer review procedures enabled dozens of our members to be reimbursed for psychoanalytic treatments, which would otherwise have been impossible.
The form developed by the Peer Review Committee and approved by the Executive Council was not “based on one used by candidates of that era for making periodic reports on the progress of supervised cases.” It was developed from scratch specifically for the purpose of peer review by the Joint Task Force on Diagnostic Criteria for Analyzability, chaired by Dr. William Offenkrantz. The Joint Task Force on Process Criteria, cochaired by Drs. Herbert Schlesinger and Robert Michels, developed the criteria for assessing an ongoing analysis. Some institutes subsequently adopted both forms for educational purposes.
Dr. Mosher confuses peer review with claims review in his statement that “in December 1991 this reporting method was implicitly superseded by … the most recent version of ‘Reporting Information for Claims Review of Psychoanalysis.‘ ” Dr. Sheila Hafter Gray, chair of the current Peer Review Committee, explicitly clarified this when she stated on the floor at the December 1991 Council meeting that the earlier document would be retained for peer review, when such was indicated.
Most important, Dr. Mosher misrepresents the position of that Peer Review Committee regarding confidentiality. The committee did not naively rely on “a reasonable hope that a report marked ‘confidential’ … would be handled in an ethical and discreet manner.” The committee made quite specific recommendations regarding the “sanitizing” of all reports, which were then to be submitted to a peer—that is, to another psychoanalyst, not simply to the “medical director.” When Dr. Mosher announces that his Committee on Confidentiality has decided “that psychoanalysts should not participate in any review procedure in which any data allowing identification of the patient are released by the treating analyst,” he appears unaware that his committee is rediscovering just what the Peer Review Committee strongly recommended in 1974. Not only was the committee fully cognizant of the need for confidentiality, but workshops were held and papers published on the effect even of anonymous and sanitized reporting on an ongoing analysis (see H. Rudominer's “Peer Review, Third-Party Payment, and the Analytic Situation: A Case Report,” JARA, 34:773-795).
In view of these facts, Dr. Mosher may wish to revise his opinion that the adoption of those peer review procedures was “a blunder,” defined by Webster as “a gross error or mistake, resulting from mental confusion or blindness, carelessness, stupidity, or ignorance.” In any event, we believe that at least the historical record on which he bases his judgment should be an accurate one.
Robert Michels, M.D.
William Offenkrantz, M.D.
Allan Rosenblatt, M.D.
Herbert Schlesinger, Ph.D.