While attending the Fall Meeting of the American this past December, I couldn't help but marvel at the fact that a “new” American Psychoanalytic Association appears to be emerging. Witness the panel, open to the public, on homophobia put on by Leon Hoffman's Committee on Public Information (see page 34).
A few years ago such a public discussion would have been unimaginable in our Association, but there it was — this difficult, psychoanalytically complicated subject being discussed openly and, I think, generally nondefensively by members of the American and prominent members of the gay community. This panel was widely attended by many individuals outside the American. A breath of new life seemed to infuse the Grand Ballroom of the Waldorf.
The very same winds of change are felt elsewhere in the American, including the Committee on Government Relations and Insurance (CGRI). A new attitude in our committee is that advocacy efforts in the American's behalf can indeed help us gain more favorable legislation at both the local and the national level. The “real world” outside our consulting rooms and our institutes must hear us.
Most importantly, we need not feel helpless when it comes to influencing legislation and regulation merely because we are a small organization. There are strategies we can use to enhance the strength of our efforts. I will focus here on things happening at the national level and on the work of the CGRI as a whole. (The new CGRI Subcommittee on Local Health Care Initiatives will work at the local level.)
The committee's efforts derive from the APsaA's action plan crafted during the 1994 Spring Meeting in Philadelphia. This collaborative plan was developed as a consequence of the Coalition for Patient Rights (CPR) and CGRI combining their agendas. Since privacy legislation is inevitable this year, our major focus is to achieve the best legislation we can in this area. This does not mean that other areas of the action plan are no longer important to us, but privacy is in the forefront and this is where our efforts must be focused.
Privacy is of necessity a crucially important issue for us. It is an essential element of the psychoanalytic frame, and the current threats to privacy constitute a crisis. Glen Gabbard, chair of the Joint Committee on Confidentiality, has clearly and powerfully articulated these issues in his article on page 21. Please read it carefully and let your voice be heard on this matter.
First and most important in pursuing the work of CGRI is our affiliation with Powers, Pyles, Sutter & Verville. With PPSV we are pressing for advocacy in a far more active way than previously. PPSV should not be considered merely a lobbying firm; it is a sophisticated health law firm with more than twenty-five attorneys, serving a major educational and consultative function in the legislative and regulatory arenas.
Jim Pyles, brother of APsaA president Bob Pyles, is a senior partner in this firm and one of our representatives. Our major contact person aside from Jim is Judi Buckalew. She has been appointed Director of Policy and Legislation at PPSV, replacing Janet Shikles, who worked effectively with us for the last several years.
Buckalew, who has a master's degree in public health, comes to PPSV with an extensive background in legislative work and a vast network of contacts. She has served as a policy advisor to two senators and as a legislative assistant to another. She was a special assistant to President Reagan and legislative assistant to the Senate Labor and Human Resources Committee.
Here are just two examples of exactly how PPSV works. Jim Pyles recently developed a scholarly paper dealing with the question of a legal right to privacy. He has presented this information to a significant number of individuals, committees, and agencies in the legislative and regulatory areas. Here PPSV is making a major effort to educate key people in Washington on issues of privacy. Jim Pyles recently completed another significant piece of legal research that looks at the first sixty-six cases in which the findings of the Supreme Court in Jaffee vs. Redmond were applied. In general, the scope of psychotherapist patient privilege established in Jaffee has been either maintained or extended in these cases. This paper has also been widely circulated in our capital city.
A second example of PPSV's work for us is the CGRI/CPR Washington meetings that began a year ago. Shikles vigorously encouraged this idea almost as soon as she came aboard PPSV. She pointed out to me the paradox of an organization seeking to advance its legislative agenda without actually going to Washington and meeting directly with the significant people and agencies involved. I was unable to explain why this was the case, but I immediately realized that we had to change it. Thanks to the support of Bob Pyles, the budget for CGRI was expanded to support a trip to Washington for the committee's members. Subsequent CGRI budgets have expanded to support two trips per year to Washington.
These meetings give us the opportunity for direct contact with legislators, aides, policy advocates, and regulatory officials. The first meeting, held at the Washington offices of PPSV in March of 1998, was extremely successful for us. A highlight was our meeting with Linda Ruiz, the Director of Program Integrity at the Health Care Financing Administration (HCFA). Our meeting with her helped us to understand HCFA's audit policies concerning Part B of Medicare, specifically the question of whether or not Medicare could review non-Medicare patients' records during audits. Ruiz made it very clear that Medicare did not have the authority to examine practitioners' non-Medicare files. This point had been made earlier during the same set of Washington meetings when we talked with Jack Emery, Associate Director of Public Affairs for the American Medical Association. During this extremely beneficial visit, not only were we able to meet with Ruiz and Emery but we also developed contacts with other officials and representatives of provider and consumer groups.
Warren R. Procci, M.D., chair of CGRI, also chairs the Education Committee of the Southern California Psychoanalytic Institute, where he is a training and supervising analyst. He is a clinical professor of psychiatry at the Harbor/UCLA Medical Center and an APsaA councilor-at-large.
A direct and ongoing benefit of our meeting with Ruiz has been the two series of ongoing discussions, between Bob Pyles and Aaron Primack, the National Medical Director for the Medicare system, and between Pyles and Medicare's legal department.
The discussion with Primack concerns the use of our practice guideline, “Charting Psychoanalysis,” as the mechanism for reporting for psychoanalyses conducted under Medicare. As a result of these discussions, Primack supports in principle the use of “Charting Psychoanalysis.” He has been invited to attend the 1999 Annual Meeting of the American in Washington. We hope that he will have been able to attend the meeting of the Executive Council and have had an opportunity to discuss this issue with us.
In the discussions with the Medicare legal department, we are attempting to obtain a statement specifying Medicare audit policies.
Another accomplishment of our meeting in Washington was that one of our members, Deborah Peel of Texas, was able to set up a meeting for several of us with Rep. Richard Gephardt (D-Mo.). We discussed a number of significant issues with him. Still another favorable result of the meeting in Washington is that the Executive Committee, in part persuaded by Bob Pyles, scheduled the Spring 1999 meeting of the Steering Committee of the American in Washington rather than in New York during the weekend before CGRI's 1999 meeting. CGRI worked at bringing a number of privacy experts to speak to the Steering Committee. Some members of the Steering Committee were able to attend CGRI's Washington meeting, providing further opportunities for leaders of the American to meet with officials in Washington and to further advance our agenda.
A new focus of CGRI's work is our collaboration with collegial organizations. We now have a formal liaison from the Independent Psychoanalytic Societies (IPS) as a member of CGRI, Jeff Golland of New York. Janice Lieberman, a member of the IPS and a member of the American, also is a member of CGRI. While she was not considered a specific IPS liaison, it was helpful to have somebody who had contact with the IPS as a CGRI member.
Karen Shore, president of the National Coalition of Mental Health Professionals and Consumers, a powerful advocacy group, has also been in frequent contact with CGRI, with Bob Pyles, and with our representatives at PPSV. As a result of these contacts, Shore spoke at the December meeting of CGRI concerning “Rescue Health Care Day,” planned for April 1, 2000. This will be a national day of protest concerning the patient-unfriendly policies and practices of managed care. As Shore says, it is an attempt to “bring managed care down.” We urge those of you who are so inclined to participate in the coalition's organized activities on that day.
All of these activities represent significant efforts on our part to reach out and work collaboratively with like-minded colleagues in areas of common interest to us and our patients.
A relatively new and exciting component of our committee's work is the development of the Subcommittee on Local Health Care Initiatives, chaired by Howard Levine. This subcommittee concentrates on advocacy efforts at the local level. One of its goals is to develop a group of health-care advocates at the local level as a complement to our work at the national level. The subcommittee deals with state-level legislative issues, since more and more of our states are enacting complex legislation and regulations that have an effect on our practices. It is essential to have members well-placed at the local level, able to act when important local legislation or regulation is proposed (see page 24).
Our committee is assuming a much more active role in making the American heard for the sake of our patients, and in protecting and advancing the conditions required to help them. It is clear we cannot go back to a more quiet, more insular, less active role. The American as a whole, and CGRI in particular, is committed to making our voices heard and responded to in the real world.