We are unsure at this point... (11/11/2001)
At this point we are not sure about the fate and the success of the Caucus. We are planning to have a meeting of the Caucus in the APA meeting in Philadelphia in May, 2002. At the same time the APA Assembly continues to try to move a motion in the direction that the APA opposes any carve-out of mental health services (private and public). What is at stake here is the US health care system that remains centered on the employer and on the health corporations and that - so far - denies the physicians the right to organize and get together to have a common voice for themselves and their patients. This is a process that will take a long time to reach its goals. But in America we trust the eventually the people will will and will have the health care system that they deserve. Corporate health places profits and dividends ahead of good care and proper compensation for doctors. They also continue to strive to maintain their protection in the law, being not liable for poor patients' care. We just must keep moving...


Caucus For Psychiatrists Treating People Covered By Managed CareThe Caucus met at the last APA Meeting in New Orleans! (Photo: Dr. Ed de la Cruz).

The Caucus is growing... so is the revolt inside the APA against Behavioral Managed Care (4/17/2001)
The Caucus For Psychiatrists Working With Patients Covered By Managed Care is growing. It now has 43
registered members, and its own list serv.  The Caucus is going to meet in New Orleans in the next Annual
Meeting of the American Psychiatric Association. If you are a member of the APA please contact Karen
Sanders at ksanders@psych.org to register for the Caucus.

Another good news! Sort of... (1/14/2001)
The Board of Trustees of the American Psychiatric Association approved an action paper, and took a position opposing private sector carve outs. This was long due. It is incomprehensible that mental health care remains separated from health care in general, and given to for profit behavior mental health corporations! The only problem is that someone or a few voices in the Board of Trustees managed to exclude public carve outs from the Board's decision. This is unfortunate. Our hope is that the Board will correct this exception, and oppose ALL CARVE OUTS because they have done more harm than good when it comes to proper patients' care, private and PUBLIC.

The Caucus is taking shape (9/13/2000)
The Caucus for Psychiatrists Who Work With Patients Covered by Managed Care Corporations, is taking shape. There are now many psychiatrists who are registered. The requirement is simple: any clinical psychiatrist who treats patients covered by Managed Care. Anyone else connected, employed, associated in any way with the Managed Care Organizations
will not be welcome at this time. We are going to have our own List Serv and we will be meeting in Philadelphia on Oct. 27 in the Annual Meeting of Psychiatric Services. Will keep you all posted.

The Caucus met the first time! (05/26/2000)
In the APA Meeting in Chicago, on 5/16/2000, the Caucus of Psychiatrists Who Work with Managed Care Patients met for the first time. It was a good meeting and the attendance was better than we expected. We discussed many shared experiences and issues dealing with patients who have health insurance and are carved out to Mental Health Managed Care Corporations. The APA is giving us support. I am very thankful for this. Many officers of the APA were present. This is very good news I am hoping that we are starting a movement that will give voice to front line psychiatrists who work with insured patients. Here is how I see the need for this Caucus.

I am sure now! Good news! (4/18/2000)
The APA will indeed have the first Caucus For Psychiatrists Working with Managed Care Patients. This, I hope, will be the beginning of  movement of psychiatrists who are treating Managed Care patients in their offices. The Caucus is scheduled for May 16, Tuesday from 9 AM to 11 AM at the Convention Center, McCormick Place, Lakeside, room E267, Level 2. By allowing this Caucus to convene the APA is opening its doors to front line "providers" who want to get together to share experiences and views on how to deal with Managed Care. THE APA IS CHANGING! GOOD!

I am not so sure about the Caucus... (3/12/2000)
I am not so sure about the Caucus. We are in March but up to know I have not heard that there is a place for the Caucus to meet in Chicago. Also it will be difficult to let the membership know about this Caucus. Finally I am not sure how popular this will be with the membership. It seems - but I am not sure - that many members of the APA see this Caucus as a form of condoning the MCOs and working with them. They seem to feel that the best course of action is to resign from the MCO panels and work privately. They also seem to be in favor of MSAs. I am not so sure because I believe that the majority of the American people want to share the costs of health care, and have access to good treatment. This is why they buy health insurance. But the mental health sector is carved out to Behavior Managed Care Corporations For Profit, and it is becoming very difficult to treat patients under their restraints and constraints.

Better News!!! (1/2/2000)
Happy New Year to all. Here is the better, much better news! The Board of Trustees of the American Psychiatric Association has approved the Creation of a CAUCUS OF PSYCHIATRISTS WORKING WITH MANAGED CARE PATIENTS. Finally  we will able to meet and to share ideas about working with insured patients. To what extent it is possible working with patients covered by managed care, when this becomes unethical and what we want to change to keep our honorable profession and the respect of  the doctor-patient relationship. Most likely in the next APA meeting in Chicago this Caucus will meet for the first time.

Good News (12/9/99)
The Assembly of the American Psychiatric Association approved an Action Paper that will create a Caucus for Psychiatrists Working With Patients Covered By Managed Care Patients within the APA. We are now waiting for the Board to approve it. But, guess what? The votes in the Board are secret... Will wait and see. Will let you all know.

Continue to be perplexed... (10/9/99)
I have been defeated in my attempts to create a Caucus of MCO psychiatrists. In the mean time 60% of the American people is under Managed Care. A large number of psychiatrists, not necessarily by choice, is working with Managed Care patients. The only problem is that we have been - so far - unable to get together and to form a cohesive group. The APA is dreaming of Medical Savings Accounts and Catastrophic Insurance (most likely with Managed Care). In the mean time MCOs are growing and growing and we, "providers", have not be able to organize themselves in the Association. The APA has Caucus for everybody else... Puzzled!

I am perplexed... (9/13/99)
I have been trying for start a Caucus of Psychiatrists who work with Managed Care patients. I believe the number of psychiatrists who are providers for managed care is increasing a lot. I thought that we should get together as a group to exchange ideas and to have a say and a voice about the conditions under which we will or will not work. Although there are many APA members who agree with me, the official organization has systematically blocked my attempts to form this Caucus. I have no idea about why. Would we, as psychiatrists, be stronger if we organize ourselves to stand up - as a group - against the managed care industry? If the APA is against managed care why we are  not being supported in this endeavor?

Were are the AMA and the APA going?... (09/12/99)
The AMA and the APA are moving towards Medical Savings Accounts and Catastrophic Insurance. They say that this "empower the patients" but in reality, from our way of seeing things, this empowers the doctors, the healthy, the young and the wealthy. It also empowers the Catastrophic Insurance Corporations that will be able to offer a "product" with a high deductible. Of course, the higher the tax bracket of the citizens, the bigger the tax brake. It is not clear how such a system will deal with the citizens who can't have a medical savings account, spent his savings or can't buy insurance. I don't know about you, but as I think about society and the well being of the population. I continue to believe that the Canadians  found the right formula. Their system is not perfect but there, yes, the citizen is empowered because he can chose his doctor, and because he negotiate the doctors' fees through a Provincial Council.

The Board of Trustees of the American Psychiatric Association voted (unanimity) to endorse the Adhoc Committee to Defend Health Care "Call to Action".  Needles to say, I am becoming proud to belong to both organizations!!

Very good news!
The Assembly of the American Psychiatric Association approved an Action Paper to endorse the Adhoc Committee to Defend Health Care on 11/7/98.. Finally the APA is taking a stand!!!

As I write these notes...
The American Psychiatric Association still has not taken a clear stand on the question of a good health care system for the American people. I think that a professional organization like the APA could be doing better. It should be very involved in promoting the best health care system for the American people.

Where is my professional organization, the American Psychiatric Organization?
I am trying to figure out where the American Psychiatric Association stands in terms of the present health care system in America. Yes, I know that this Association has a lot of diversity among its members. Hence  it may be difficult for it to take a stand in terms of the issues psychiatry is facing now. I know there is a lot of dissatisfaction among its members.

Let me guess...

A large contingent of members believe in "private practice" that is, patients paying out of pocket for their services. I agree that this private care in psychiatry may be the  best for doctors and patients. But I am concerned that a large portion of the population is not able to go private and is very much afraid of the doctors' bills.

Some of these private psychiatrists don't mind being "non participant providers" with the HMOs. This usually means that the patient does the paper work and can be charged  beyond what the insurance will pay the doctor. Usually this group is also in favor of Medical Savings Accounts.

Although the APA is against HMOs and Managed Care it doesn't seem to be too interested in confronting these organizations. These private doctors feel that they will offer better services than the HMOs/MCOs. Because of that, people will chose them.  Of course, the HMOs and Managed Care are also glad that these psychiatrists are around because the patients will still pay their premiums, and will cost less to them.

I suppose that among the membership in the APA some are in favor of a Single Payer, similar to what the Canadians have. But I don't know how many and even if they are a substantial number.

This kind of discourages me. When I am thinking that the American Psychiatric Association is helping us to stand up against Managed Care, after hearing speeches of the past and present presidents taking a strong position against these organizations, I found this:

The NCQA , an organization created by the Managed Care Organizations to legitimize and accredit their operations, that a representative of the American Psychiatric Association is a member of their "Practicing Physicians Advisory Council"!

So, my professional organization is an advisor to Managed Care!


Strange bedfellows
But come to think, maybe things are like this for good reasons. Let's think... The private psychiatrists are very pleased when Managed Care makes it impossible for patients to have proper treatment. Why? Because they will say: "Come to me, pay more, and I will do a better job" So, the worse the Managed Care treatments are, the better are their chances to have patients paying out of pocket. On their side, Managed Care Corporations of course will love when their insured patients go to a private doctor and pays out of pocket. Why?... Because they will be collecting their premiums, and will not spend  money in their treatments.

So, they are not such strange bed fellows as they seem.  Some private professionals treat people only as non participant providers or fee for service patients.

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