AAGP eNews
Feb. 26, 2013

A call to restructure psychiatry general and subspecialty training
AAGP — AAGP President Paul D.S. Kirwin, MD
Over the past few months an AAGP working group convened to formulate ways to restructure general psychiatry residency and fellowship programs in order to incentivize training in geriatric psychiatry. For several years the AAGP has proposed similar positions to the American Council of Graduate Medical Education. We now seek support of other psychiatry subspecialties and psychiatry professional organizations to advocate our position before the ACGME and the American Board of Psychiatry and Neurology. Read the entire article at AAGPonline.org.More

The AAGP meets next month in Los Angeles
More than 1,000 participants, speakers, and exhibitors are headed to Los Angeles next month for the AAGP 2013 Annual Meeting. During the four days of the conference, participants will learn from the experts, share their experiences and knowledge, and network with the community of late-life mental health care professionals. If you have not yet registered, you can do so at the JW Marriott Los Angeles L.A. LIVE beginning March 13 at 4 p.m. Learn more about the conference at AAGPmeeting.org.More

How is the AAGP Annual Meeting put together?
Every year the AAGP Annual Meeting Program Committee meets during the Annual Meeting to discuss what worked well and what needs to be changed, and brainstorm new ideas for the following year. Although Annual Meeting locations are selected three to four years in advance, the actual meeting planning takes about 15 months from the time the Annual Meeting theme and artwork are developed to the attendees arriving on site. To learn what goes into creating the meeting and how you can participate, click here.More

AAGP protests possible sequestration cuts
The sequestration that would enact automatic spending cuts remains in place, and is scheduled to take effect on March 1. Senate Democrats have proposed a bill that would delay it until Jan. 2, 2014, and replace this year's cuts by ending federal payments to farmers, making deeper cuts to defense spending after 2015, and raising taxes. The proposal would spread cuts out over time, starting at $3 billion per year in 2015 and rising to $5 billion per year by 2021. As a member of the several advocacy coalitions, AAGP has been vocal about the impact of the sequestration reductions on mental health and aging programs. For example, as a member of the LEAD Coalition, AAGP opposed funding reductions to the Alzheimer's biomedical research programs including to the $50 million research funding added in fiscal year 2012. In addition to reduced research funding, AAGP is opposing sequestration cuts that would decimate workforce training funding (including Title VII and Title VIII programs) as well as patient and caregiver support programs such as those provided for in the Older Americans' Act, which provides flexible funding to state and local agencies to deliver a wide range of supportive services to seniors.More

Mental health bill introduced
A bipartisan group of Senators have introduced legislation on Feb. 7 entitled the Excellence in Mental Health Act, which would improve access to community mental health centers by requiring them to provide substance abuse treatment and 24-hour crisis care and allowing the facilities to bill Medicaid for those services. The primary sponsors are Debbie Stabenow, D-Mich., and Roy Blunt, R-Mo., and their motive, as articulated at their press conference, is in response to the gun violence and mental health debate. Additional cosponsors are: Jack Reed, D-R.I., Susan Collins, R-Maine, Barbara Boxer, D-Calif., Marco Rubio, R-Fla., and Patrick Leahy, D-Vt.More

House Gun Violence Prevention Task Force releases recommendations to improve mental health care and public education
House Gun Violence Prevention Task Force
On Feb. 7, a group of Democratic lawmakers tasked with crafting a response to the tragic Newtown shooting released its recommendations on reducing gun violence in the U.S. The recommendations include a section on mental health, which highlighted the importance of investing in prevention and public education around mental illness. The mental health recommendations include an endorsement of Mental Health First Aid, a public education program that raises awareness of the signs and symptoms of mental illness and teaches participants how to reach out to someone experiencing a crisis. They also include a recommendation to expand community-based services through the creation of Federally Qualified Behavioral Health Centers. Congressman Ron Barber, D-Ariz., has introduced the Mental Health First Aid Act in the House, and a companion bill to the Senate's Excellence in Mental Health Act is likely to be introduced soon.

Other mental health recommendations from the task force include:

• Fully enacting parity without delay;
• Funding school-based mental health programs;
• Funding mental health programs related to military service members, veterans and minority communities;
• Funding and deploying effective jail diversion programs; and
• Addressing the shortage of mental health professionals.

The Gun Violence Prevention Task Force was convened by the House Democratic Caucus and led by Congressman Mike Thompson, Calif. The 11 other members of the task force were: Ron Barber, Ariz., John Dingell, Mich., Elizabeth Esty, Conn., Chaka Fattah, Pa., Carolyn McCarthy, N.Y., Grace Napolitano, Calif., Ed Perlmutter, Colo., David Price, N.C., Bobby Scott, Va., Jackie Speier, Calif., and Bennie Thompson, Miss.More

Mental Health First Aid Act introduced
On Jan. 24, Sens. Mark Begich, D-Alaska, Kelley Ayotte, R-N.H., Richard Blumenthal, D-Conn., and eight bipartisan cosponsors introduced S. 153, the Mental Health First Aid Act of 2013, to expand mental health first aid training and increase the effectiveness of mental health care across the country. The bill, which has been referred to the Senate Committee on Health, Education, Labor and Pensions, provides funding for training programs to help the public identify, understand, and address crisis situations safely. In addition, it calls for protocols for initiating timely referrals to mental health services available in communities.

Specifically, S. 153 would:

• Highlight available mental health resources in local communities, including Community Mental Health Centers, emergency psychiatric facilities, hospital emergency rooms, and other programs offering psychiatric crisis beds;
• Teach the warning signs and risk factors for schizophrenia, major clinical depression, panic attacks, anxiety disorders, trauma, and other “common” mental disorders;
• Teach crisis de-escalation techniques; and
• Provide trainees with a five-step action plan to help individuals in psychiatric crisis connect to professional mental health care.

Rep. Ron Barber, D-Ariz., introduced an identical bill (H.R. 274) in the House of Representatives in January. That measure has been referred to the House Energy and Commerce Committee.More

Bipartisan bill introduced to reform Medicare physician payment system
On Feb. 6, Rep. Allyson Schwartz, D-Pa., and eight bipartisan cosponsors introduced H.R. 574, the Medicare Physician Payment Innovation Act. This bipartisan legislation permanently repeals the Sustainable Growth Rate formula and sets out a path toward comprehensive reforms of Medicare payment and delivery systems. It puts in place delivery system and payment reforms designed to ensure long-term stability in the Medicare physician payment system and contain the rising growth in health care costs. In early February, the Congressional Budget Office lowered its estimate of the cost to permanently repeal the SGR from $254 billion to $138 billion.

For over a decade, the SGR formula, which is used to determine payments for physicians' services under Medicare, has threatened to impose steep cuts in Medicare payments for care provided to Medicare beneficiaries. These cuts threaten to drive physicians out of Medicare, creating severe access problems for the nation's older adults and leading to uncertainty and instability for patients, health care providers and the federal budget.

The Medicare Physician Payment Innovation Act would do the following:

• Permanently repeals the SGR formula;
• Provides annual positive payment updates for all physicians for four years;
• Ensures access to preventive care, care coordination, and primary care services through increased payment updates for these services;
• Tests and evaluates new payment and delivery models;
• Identifies a variety of unique payment models to provide options for providers across medical specialties, practice types, and geographic regions;
• Stabilizes payment rates for providers who demonstrate a commitment to quality and efficiency within a fee-for-service model; and
• Ensures long-term stability in the Medicare physician payment system through predictable updates that accurately reflect the cost and value of providing health care services in coordinated care models.

H.R. 574 has been referred to both the House Energy and Commerce Committee and the House Ways and Means Committee for consideration.More

Congress appoints members to Long Term Care Commission

On Jan. 2 the American Taxpayer Relief Act was signed into law by President Barack Obama. The primary purpose of the legislation was to delay the so-called "fiscal cliff", but this new Act included a provision to create a federal Commission on Long Term Care, aimed at developing and implementing a plan to establish high-quality long-term care services and support for Americans. The commission will address how Medicare, Medicaid, and the private long-term care insurance market can be improved to benefit long-term care users and providers. The Commission has six months to report its findings and recommendations to Congress.

Members of the Commission are appointed by the White House and members of Congress, and to date, the following appointments have been made: Dr. Javaid Anwar of Nevada; Laphonza Butler of California; Judith Feder of Virginia, health care policy expert; Bruce Greenstein, Louisiana Health Secretary; Mark Warshawsky, a Treasury official under President George W. Bush; Judy Brachman of Bexly, Ohio; Stephen Guillard of Chatham, Mass.; Grace-Marie Turner of Alexandria, Va.; Neil Pruitt, chairman and CEO of UHS-Pruitt Corporation; Dr. Bruce Allen Chernof of the SCAN foundation; Judith Stein of the Center for Medicare Advocacy; and George Vradenburg, an Alzheimer's activist. Three remaining slots are to be filled by Obama.More

CMS administrator named
The Obama administration made its second formal nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services. Tavenner was first nominated for the post in November 2011 and has been the acting administrator of the agency since then. She is a former nurse and hospital chief executive.More

Physician Payments Sunshine Act regulations finalized
On Feb. 1, the Centers for Medicare and Medicaid Services published the long-awaited final regulations implementing the Physician Payment Sunshine Act. The Sunshine Act requires drug, medical device, biological and medical supply manufacturers to track and report, for publication by CMS, payments made to physicians and teaching hospitals. In the final regulations, organizations that provide continuing medical education, such as AAGP, are exempt from these new requirements.More

Requirements for nursing homes under the Affordable Care Act
Kaiser Foundation
Kaiser Foundation has released a new fact sheet detailing the new requirements for nursing homes under the Affordable Care Act. See that information here.More

Research update

The American Journal of Psychiatry published an article on Feb. 1 (Busch et al) that documents the effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders. The 2010 Mental Health Parity and Addiction Equity Act required many private health insurance plans to provide coverage for mental conditions in the same manner as they do for general health services. Researchers compared the 1999 behavioral health treatment use and spending in the Federal Employees Health Benefits plan, which had implemented a parity program, and privately insured patients unaffected by parity. They reported that total spending was unchanged for patients with bipolar disorder and major depression, and decreased with those for adjustment disorder. Out-of-pocket spending for patients decreased in all cases.

The Journal of the American Medical Association published an editorial by Katherine L. Record and Lawrence O. Goslin entitled "A Systematic Plan for Firearms Law Reform" discussing President Barack Obama's plan and the need to reduce the devastating toll of firearm injuries and deaths through a public health strategy.More

How is the AAGP Annual Meeting put together?
Every year the AAGP Annual Meeting Program Committee meets during the Annual Meeting to discuss what worked well and what needs to be changed, and brainstorm new ideas for the following year. Although Annual Meeting locations are selected three to four years in advance, the actual meeting planning takes about 15 months from the time the Annual Meeting theme and artwork are developed to the attendees arriving on site. To learn what goes into creating the meeting and how you can participate, click here.More

New jobs page on AAGPonline
Looking to find or post a listing for a job opening? Visit the new Jobs page on AAGP's website. Through February, there is no charge to post a job listing. To list a job opening, write to kmcduffie@aagponline.org. More

Alzheimer's, Parkinson's disease not contagious, study shows
Despite concerns that faulty brain proteins could be transferred from person to person by treatments involving human fluids and tissues, a new study finds no signs of increased risk for two major degenerative brain diseases among recipients. "I think it's reassuring to people who had transplants, blood transfusions, morticians and researchers who work on these diseases," said the study's senior author, Dr. John Trojanowski, from the University of Pennsylvania Perelman School of Medicine in Philadelphia.More

Total dietary antioxidants not linked to stroke, dementia
No association was found between total dietary antioxidant intake and subsequent risk for dementia or stroke in a Dutch cohort study. Noting that previous studies have suggested specific antioxidants may benefit stroke or dementia risk, the authors say the message from the current study is that total antioxidant intake is not as important as specific antioxidant sources.More

Scientists claim smoking doubles risk of developing Alzheimer's
It has long been known that smoking is harmful for the health and is one of the major risk factors for developing the killer brain disease as well as a host of other chronic conditions. But now, researchers have found a direct link between smoking and Alzheimer's, showing that the smoke from cigarettes directly causes changes in the brain which can lead to the disease. A study led by Dr. Claudio Soto of the University of Texas Health Science Centre in Houston, Texas, has shown that mouse models of Alzheimer's disease exposed to cigarette smoke display increased disease abnormalities in the brain.More

New federal rule requires insurers to offer mental health coverage
The New York Times
The Obama administration issued a final rule defining "essential health benefits" that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result.More

Elderly in care in the UK 20 times more likely to be on antipsychotics
The Guardian
Prescriptions for psychotropic drugs, including those sometimes referred to as the "chemical cosh", soar amongst elderly people who are admitted to residential care homes, a new study from Northern Ireland shows. The study, in the Journal of the American Geriatrics Society, looks at the prescribing of drugs to calm anxiety and sedate, as well as the antipsychotics which are supposed to be prescribed for severe mental health conditions such as schizophrenia and bipolar disorder and only for dementia as a last resort.More

How Alzheimer's caregiving impacts U.S. work force
EHS Today
A new poll reveals that 15 percent of American workers are current or former caregivers for someone with Alzheimer's or dementia, a number that can have wide-reaching effects on work force retention and productivity. The new poll, commissioned by Workplace Options in conjunction with the Alzheimer's Association, showed that only 47 percent of these caregivers were able to maintain their employment while providing care for the Alzheimer's or dementia patient.More