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SPRING NEWSLETTER
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April-May 2020, Vol. 11, Issue 1 |
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NEWSLETTER EDITOR WELCOME
Maya Heck, MD
Newsletter Guest Editor
Secretary, Arizona Psychiatric Society
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Dr. Heck greeting a wallaby |
Dear Colleagues:
I hope this newsletter finds you staying well! Our COVID-delayed Newsletter celebrates the season of Spring as the season of new beginnings, re-birth, and possibilities for growth.
In the spirit of cultivating fresh ideas, this newsletter edition offers a focus on Integrative Psychiatry. This relatively new specialty of Psychiatry gives emphasis to holistic wellness and conceptualizing a patient's mind, body and environment operating as a whole. Psychiatric treatments are often combined with alternative techniques such as mindfulness, acupuncture, massage, supplements, and other complementary approaches. As a psychiatrist in training, I take pride in taking the biological, psychological and social aspects of a patient into account while considering my treatment plan. However, often times despite my best attempts to treat the whole person, I find that the current evidenced based treatment is not completely effective or that patients will ask for alternative strategies for managing their illness. I am excited to gain a new perspective from local Psychiatrists who are including alternative treatment options for patients.
This edition highlights the Banner University Medical Center Integrative Psychiatry Clinic with an article penned by Sneha L. Venkatraman, MD, Amelia Villagomez, MD, and Noshene Ranjbar, MD. Dr. Ranjbar is Medical Director of the Integrative Psychiatry Clinic, and training director of the University of Arizona Integrative Psychiatry Fellowship in Tucson which is about to launch into its second year. The Meet Your APS Member featured is Meera Mehta, MD, my co-fellow in the Creighton University School of Medicine Valleywise Health Center (Phoenix) Child and Adolescent Psychiatry Fellowship, who will be continuing her training in the 2020-2021 Integrative Psychiatry Fellowship class with Dr. Ranjbar.
In our own lives, and in the lives of our patients, as we navigate through these changing and challenging times, practices of mindfulness and self-care, and viewing our health as a whole, have the potential to provide great benefit.
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Premium Corporate Sponsor 2020-2021
CLICK HERE for American Professional Agency, Inc. Nuts and Bolts of Reopening Checklist for Insureds; or CLICK HERE for the Reopening Checklist for Non-Insureds |
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Don J. Fowls, MD |
PRESIDENT'S MESSAGE
Don J. Fowls, MD
President, Arizona Psychiatric Society
I hope you and your families are safe and doing well. COVID has presented unprecedented challenges for our community and nation as well as many opportunities to respond positively to them. APS continues to play a significant role in several ways. We meet regularly with other behavioral health provider associations as a Coalition to discuss COVID related issues and how we can help. I participate on a weekly to biweekly call with Governor Ducey and ADHS Director Cara Christ MD as our state figures out how best to balance safety and health with the economy and people needing to make a living. The Governor has made it clear that the main features of his telehealth Executive Order will continue beyond this crisis. We have also discussed the rising tide of behavioral health issues as people stay home and isolate. Politics aside, Governor Ducey and his staff doing an excellent job and are very sincere in their efforts to want to do what is best for Arizona and all its citizens.
It has been very disappointing and unfortunate to see the rioting in the midst of otherwise peaceful demonstrations related to the George Floyd death. Two of the best responses have been in Flint MI and here in AZ where police officers laid down their weapons and actually shook hands and interacted peacefully and positively with protesters. At a time of such discord, it is refreshing to see what can happen when people leave their stuff at the door and see and engage with each other as human beings. As psychiatrists, our professional training and practical experience give us opportunity to model and encourage listening with empathy and understanding and to provide the care and support to those members of the community whose mental health is impacted by the trauma of the world around us.
Our annual meeting has been postponed until October and will be virtual this year. This should be very productive and a lot of fun as APS learns about the many new and innovative things other organizations are doing for their virtual meetings. The Executive Committee will have a strategic planning meeting this month to begin to craft our vision and what we as a Society want to accomplish the next 2 - 3 years. Parity will continue to be a priority as more work needs to build on the legislative success we had this past session.
I do hope you have a safe and health summer season. Your comments and questions are always welcome so please send any if you have them.
All my best,
Don
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Premium Corporate Sponsor 2020-2021
CLICK HERE
for updated COVID-19 FAQs including state licensure waivers, telepsychiatry checklist, and a new resource, "Preparing for What's Next: To Do List"
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Sneha L. Venkatraman, MD |
PROVIDING HOLISTIC CARE THAT MEETS PATIENT NEEDS AND EDUCATING NEXT-GENERATION PSYCHIATRISTS:
The Banner-University Of Arizona Integrative Psychiatry Clinic
Sneha L. Venkatraman, MD,
Noshene Ranjbar, MD,
and Amelia Villagomez, MD
When I was in medical school, patients often asked me about a supplement they were taking, or an acupuncture session they wanted to explore, and whether it was safe or helpful for their medical condition. Other patients asked if exercising regularly improved their mental health. I felt unprepared to answer as my medical school training did not address these topics. Their questions reflect the fact that about one-third of adults in the US use some form of complementary healthcare treatment (National Center for Complementary and Integrative Health, 2017), and that those treatments are generally not integrated with their medical care. There are many reasons patients might choose a complementary treatment. They often hear about the efficacy of this or that supplement on the news or at the health food store, and they may believe that such products or techniques are less harmful or invasive than medical interventions. Other methods might align with the patient's cultural practices or traditions. Patients yearn for an approach to their health that addresses them as whole people, not just as a medical diagnosis. Medical providers need to take these patient motivations and into account and should work effectively with patients by reviewing the evidence for various treatments with the patient. Yet, for the most part, there is a gap between standards of care learned through medical training and patient practices and needs.
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| Noshene Ranjbar, MD |
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A
ccording to The Academic Consortium for Integrative Medicine and Health, Integrative Medicine "reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals, and disciplines to achieve optimal health and healing." The Banner-University of Arizona Integrative Psychiatry Clinic (
https://psychiatry.arizona.edu/patient-care/integrative-psychiatry-clinic
), which opened in 2017, is an insurance-based clinic that aims to provide a holistic approach to mental health for adults, adolescents, and children. Patients in the clinic are seen by residents and fellows who are in the University of Arizona Integrative Medicine in Residency - Psychiatry (IMR-Psychiatry) Track (
https://psychiatry.arizona.edu/academic-programs/child-adolescent-psychiatry-fellowship/integrative-psychiatry-elective-track
). IMR-Psychiatry is an elective designed to train psychiatry residents and fellows to provide holistic mental health care by incorporating the evidence base of various integrative approaches including nutraceuticals, exercise, mind-body skills and by teaching how to create a safe environment for patients from differing cultural backgrounds and belief systems. In addition to seeing patients in the clinic, residents and fellows complete 90 hours of online modules provided by the Andrew Weil Center for Integrative Medicine (AWCIM); these modules provide an evidence-based foundation for the study of integrative psychiatry.
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Amelia Villagomez, MD |
I was attracted to the University of Arizona psychiatry residency program so I could learn to practice integrative psychiatry. For me, it just made sense to incorporate the entire bio-psycho-socio-spiritual model in treatment planning, and as an eager medical student, I could not wait to get started. Drs. Noshene Ranjbar and Amelia Villagomez, with support from the Department of Psychiatry and in collaboration with the AWCIM, helped create the IMR-Psychiatry Track in 2015. They had noticed the need for holistic care in psychiatry training while completing their own residency and fellowship trainings. Dr. Ranjbar had struggled with her own burnout and illness during residency and had found mind-body skills training and self-care fundamental to her passion to stay in academia and to advocate for change and improvement in the healthcare profession on larger scales.
Now, as a resident in the IMR-Psychiatry Track, I am gaining practice with an integrative approach by working with patients in the Integrative Psychiatry Clinic. Learning to conduct a strength-based interview becomes a valuable skill as residents get to the core of what brings a patient in to their clinic without having to focus only on the problem. Additionally, I have learned the evidence base for various modalities such as broad-spectrum micronutrients, herbs, nutrition, and exercise. In group supervision we discuss when to recommend medication versus a different modality, all the while keeping in mind cost, efficacy, safety, and patient preference. Patients in the clinic complete a thorough historical packet including medical information, family history, development history, recent stressful life events, sleep and nutrition habits, screen time, and goals for treatment prior to the initial assessment; this way, the first meeting can be focused on getting to know and connecting with the unique individual or family in front of us. Due to COVID-19 social precautions, we have completely transitioned our Integrative Psychiatry Clinic to telehealth appointments. Many patients have mentioned that decreased commute times have given them more time for self-care. We have appreciated connecting with our patients in their natural environments for a more holistic view of their lives.
Though some mental health practitioners still view integrative medicine as excluding modern medicine, believing that integrative medicine focuses on non-pharmacological treatments or advocates for risky supplements with a limited evidence base, many have now shifted their perspective to see that integrative medicine practitioners are advocating for a holistic treatment plan that includes evidence-based modalities, whether they be medications and psychotherapy, or exercise, herbs, micronutrients, omega-3 fatty acids, or biofeedback. Essentially, this allows the opportunity to create an individualized treatment plan that considers a patient's level of activity, values, hobbies, and severity of mental illness.
The modern mental health practitioner will need to incorporate varying evidence-based modalities into their practice to help reach patients wherever they may be on their healing journey. The Track fosters this growth in the future generation of psychiatrists who can enhance the prevention and treatment of psychiatric disorders while also teaching residents tools for self-care and well-being.
Having completed the Track last year, I am continuing into more advanced aspects of the field as a fourth-year resident working with patients in the Integrative Psychiatry Clinic. I have seen firsthand how patients respond to integrative treatment and thrive, and I have been able to utilize integrative methods to care for myself through the challenges of residency training. Because of the integrative training experience, the practice of psychiatry has already become even more fulfilling than I ever could have expected.
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MEET DR. MEETA MEHTA
Senior Fellow, Child & Adolescent Psychiatry
Integrative Psychiatry Fellow 2020-2021
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Meeta Mehta, MD |
Hello readers! My name is Meera Mehta and I'm honored to share my story as a Resident Fellow Member of the Society. I'm currently a senior fellow in the Child and Adolescent Psychiatry Fellowship Program at Creighton University/Maricopa Medical Center. Following graduation this summer, I will be traveling to Tucson to join the first class in the Integrative Psychiatry Fellowship. I graduated from Adult Psychiatry Residency at the University of New Mexico, and before that, I attended medical school at St. George's University in West Indies, Grenada. Prior to medical school, I pursued yoga teacher training and became an Ayurvedic Wellness Counselor. This was an important part of my desire to understand more about the intersection between eastern and western healing modalities.
With regards to my personal background, I'm blessed to come from a lineage of healers. My grandparents were physicians and Vipassana Meditation teachers and my parents are physicians who have also had interest in integrative modalities. It is the greatest honor to be able to continue this work in the form of addressing mental health needs through the combination of eastern and western modalities. Although I do not have children of my own, I am lucky to be an aunt to a wonderful niece and nephew and am fortunate to live close to my immediate family.
Psychiatry appealed to me because it was a field that offered how healing comes with connectedness and relationship. This field aligned with my personal journey of self-improvement and I loved that it was a field that offered the possibility of self-transformation through difficulty and hardship. Additionally, Integrative Psychiatry offers for individuals to be empowered in taking charge of their health through self-care, discipline and commitment to themselves. What I love about Psychiatry is the potential for transformation and growth that can arise from a place of discomfort, vulnerability and suffering. There is immense value in the power of connection, community, medications and treatment in healing.
In terms of areas of interest within the field of Psychiatry, I have interest in working with those with affective disorders and trauma. I am curious and interested about neuroscience, mind-body practices and integrative and complementary strategies for patients. I love that our field understands more about neuroscience and genetics. We have a better understanding of mindfulness, its' effect on the brain and on healing trauma. We are also gaining better evidence for the use of integrative modalities in the treatment of mental health conditions.
My recent interest has been in better understanding polyvagal theory, somatic work and psychotherapies. Because of the structure of the medical system and time constraints, it can be challenging to address the underlying needs of the patient in a truly holistic manner. I think we can also continue to improve our ability in emphasizing both the role and limitations of medications in an individual's full healing potential.
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| Dr. Mehta Ballroom Dancing |
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A big hobby of mine - what keeps me well enough to do work with others - is competitive/ Latin ballroom dancing. I dance regularly and go to competitions. Latin ballroom dancing ties together a lot of my personal growth, wellness, fitness, nutrition, etc. I love having something outside of medicine that keeps me fit, active, and expressive, and helps me decompress!
The greatest highlight in my career has been the constant growth and exploration that comes with being in the mental health field. I thank all of those who have inspired me and continue to spark curiosity within me. I'm grateful for those who have held space for my own growth and have guided me, both personally and professionally. I am blessed to have the support of loving family and friends.
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Jasleen Chhatwal, MBBS, MD, FAPA |
JASLEEN CHHATWAL, MD, FAPA ELECTED
APA ECP REPRESENTATIVE TO THE ASSEMBLY
The Arizona Psychiatric Society congratulates Jasleen Chhatwal, MBBS, MD, FAPA, President-Elect of the Society, for her election to the national position of American Psychiatric Association ECP Chair of the Assembly. On serving in this position, Dr. Chhatwal shared: "As ECP chair, my primary focus will be making the practice of medicine healthier for the physician psychiatrist, and as a result, for our patients. At this time of dramatic change in the healthcare industry - global pandemic, political upheaval, access to care, MOC requirements and scope of practice concerns - greater focus on supporting the well-being of young leaders in psychiatry is paramount for our profession." Thank you, Dr. Chhatwal, for your commitment to physician leadership and advancing the profession of psychiatry for Early Career Physicians all across the U.S.
Dr. Chhatwal is the Chief Medical Officer and Director of Mood Program at Sierra Tucson. She currently serves on the Executive Council of the Arizona Psychiatric Society in the role of President-Elect. Concurrently, she is also serving as the Early Career Psychiatrist Representative for Area 7 to the American Psychiatric Association Assembly. She also holds membership in the American Association of Physician Leadership and the World Psychiatric Association.
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"We're Still Here" Mental Health COVID-19 Support Video |
COVID-19 MENTAL HEALTH RESOURCES
Arizona Behavioral Health You Tube Channel, a collaboration of the Arizona Psychiatric Society and the Arizona Psychological Association
A Note from Nicholas Ahrendt, MD
Disaster Response Chair
The Arizona Psychiatric Society has partnered with the Arizona Psychological Association to create the Behavioral Health Arizona YouTube page, a resource for psychologists, healthcare providers and the public as we all navigate the changing landscape of COVID-19.
Click here to visit the page. Please subscribe and follow this You Tube channel, and feel free to share the channel and the specific video resources as you feel appropriate. Share widely the "We're Still Here" video, which is posted on its own, and is incorporated as the introduction of each of the self-care videos on this Channel.
Society members are invited to submit brief videos, preferably 3 - 5 minutes in length, but we will accept videos up to 10 minutes in length. Content ideas include but are not limited to educational videos, specific exercises and coping strategies and can be directed to behavioral health providers or the public.
Please contact Dr. Ahrendt for more information. Dr. Ahrendt is also available to conduct the video an in interview format if that is more comfortable for you.
CLICK HERE for a listing of COVID-19 Resources compiled for our members, including local and national resources for psychiatry and telepsychiatry, as well as self-care and crisis response resources for patients and families. If you missed our regular COVID-19 updates to members, those e-mails have been posted on the Arizona Psychiatric Society website. Please contact teri@azmed.org if you have any questions regarding past Newsletters or the resources shared here. |
CRISIS RESPONSE NETWORK AND 2-1-1
In an update provided to our disaster response and mental health resources coalition of associations, Crisis Response Network provided information on the restoration of the statewide 2-1-1 support number and the services provided to the community and changes and increases observed during the early months of COVID-19, highlights from which included:
*
Increase
in Total Mobile Team Dispatches
(6.3%)
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Increase in depression, SI/DTS, DV, and DTO calls
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Decrease in Anxiety and Medical calls
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Increase in both adult and child
clients
(8%)
For patients and families in need of resources, 2-1-1 is available to assist Arizonans from throughout Arizona.
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 APA ADVOCACY:
COVID-19 RESPONSE ON THE NATIONAL LEVEL
APA's Government Relations and Policy teams have been working around-the-clock in responding to the COVID-19 global pandemic to ensure your psychiatric practice and patient care are not interrupted. CLICK HERE for the May Advocacy Alert providing information on the actions being taken. Following are ways you can help today:
Advocate for Emergency Behavioral Health Funding
With your help, we can ensure that mental health and substance use organizations in local communities have the resources needed to keep their doors open and provide much needed mental health and addiction care.
Act Now »
Share Your Story
You are our boots on the ground during this crisis. Keep us informed of what's happening in your community - let us know if these new regulations are working or not working for you, and where the gaps in access or provision of care are. We will use these stories to shape our legislative strategies and share your story with lawmakers when appropriate.
Share your story here »
Condemn Anti-Asian Racism During the COVID-19 Pandemic
Since January 2020, there has been a dramatic increase in reports of hate crimes and incidents against members of the Asian American community.
Recently, APA joined nearly 50 other professional scientific organizations in condemning these acts and offering support to people of Asian ancestry. Stand
with your colleagues and ask your federal lawmakers to support a congressional resolution that condemns all forms of anti-Asian sentiment during the COVID-19 pandemic.
Take Action Today!
Call for COVID-19 Funding to Address Health Care Inequities
As physicians, we know that centuries of systemic and institutional racism toward communities of color have led to decreased access to health care and multiple adverse health outcomes. This is particularly apparent during the COVID-19 pandemic where Black, Indigenous populations, Latinx, Asian Americans and other communities of color are being harmed disproportionately by the crisis. T
hese disparities are linked to social determinants of health, including but not limited to employment, housing, health insurance and medical care, neighborhood pollution, and food deserts. Right now, a bipartisan group of Representatives are asking their fellow lawmakers to join them in sending a letter urging Congressional leadership to address these health care disparities when they negotiate the next COVID-19 legislation. We need you to ask your Representative to join them!
This important resolution would condemn anti-Asian sentiment in any form and call on law enforcement at all levels of the government to investigate and track all credible reports of hate crimes, incidents and threats against the Asian American and Pacific Islander Community in the US.
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APA UPDATES CORONAVIRUS INFORMATION HUB: Financial Impact, CMS Payments 6-3 Deadline, Guidance on Reopening and Returning to Service, Taking Care of Yourself and Your Teams
In the listing of Mental Health Resources, and in our COVID-19 updates, we have been sharing information from the APA Coronavirus Information Hub. Below is a summary of the most recent, important updates and additions to the same:
How Has COVID-19 Impacted You & Your Practice Financially?
APA is surveying members to understand the financial impacts of coronavirus on your practice. This information will inform our advocacy work on behalf of our members. Information you share is not personally identifiable and will only be used only in the aggregate.
Take the survey »
June 3 Response Required for All Who Received CMS Payments Through the Provider Relief Fund
Health and Human Services (HHS) has distributed $70 billion in a Provider Relief Fund to physicians who accept Medicare to help alleviate financial loss due to COVID 19. If you accept Medicare, you should have received these funds automatically. We recommend you check with your financial institution regarding a deposit from Optum Bank with "HHSPAYMENT" in the notation. If you received these funds you must agree or disagree to the program terms and conditions by June 3, 2020.
Click here for more information »
Guidance on Reopening Your Practice and Returning to Service
New APA-developed resources have been added to the Coronavirus Hub for psychiatrists who are reopening practices and returning to clinical service. Find a list of resources like these in the
"APA Resources" section of the hub.
Taking Care of Yourself and Your Teams
Finally, we urge you as fellow physicians to take the time to care for yourselves and each other through this unique and stressful time, which can lead to burnout and depression. APA is co-sponsoring a webinar on June 23 to promote peer recognition of the signs and symptoms of suicidal depression. This webinar will also cover how to build a supportive environment in team-based settings.
Register for the webinar »
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News from the Arizona Capitol |
HEALTH CARE LEGISLATIVE REPORT
Arizona Legislative Session
Joseph F. Abate, Esq.
APS Lobbyist
The 2020 session was greatly influenced by the world around us: beginning strong, with a healthy state budget surplus, and despite the normal influence in a campaign year to drive a session for early adjournment, saw 1,607 bills drop before the deadline (1,031 introduced from Republican sponsors; 576 from Democratic sponsors). With strong work from multiple advocacy organizations relating to health care, the early favorable climate found bills advancing relating to prior authorization, step therapy, non-retaliation policies, graduate medical education, and reimbursement issues. The Society was actively monitoring almost 100 of the pending bills, with a vote of the Legislative Committee for a position of support on 24 key health care and behavioral health related bills. For a detail of the position of the Society on those key bills, and a description of the same, CLICK HERE.
In 2020, the Arizona Psychiatric Society, in addition to its long-standing lobbying support from APS Lobbyist, Joseph F. Abate, Esq., joined the Arizona Healthcare Advocacy Coalition (AHAC), comprised of the Arizona Medical Association, Arizona Osteopathic Medical Association, Pima County Medical Society, Arizona Society of Anesthesiologists, Arizona Ophthalmological Society, Arizona Radiological Society, Arizona Allergy & Asthma Society, Arizona Dermatological Association, and Arizona Psychiatric Society. Portions of this report and update are available from the weekly legislative tracking and reporting from AHAC to its members. AHAC also facilitates the expansion of support for key legislative issues brought forward for consideration by each member association. As part of AHAC, the Society had opportunity to both reach out for support on mental health parity legislation and contribute to AHAC messaging of support on prior authorization and step therapy legislation.
A key advocacy issue for the Arizona Psychiatric Society has been and continues to be mental health parity. As part of the Arizona Coalition for Insurance Parity, the Society leadership and lobbyist, with support from the APA, was part of stakeholder meetings, discussions, and the legislation development for SB 1523/HB 2764 (Jake's Law). Jake's Law, named in honor of Jacob Edward Machovsky, the son of The JEM Foundation co-founders Ben and Denise Denslow, was signed into law by Governor Doug Ducey on March 3, 2020. This mental health omnibus includes many expanded provisions in addition to state enforcement of mental health parity (insurance coverage of mental health care on the same level with physical health). For a summary of those provisions, visit https://www.azleg.gov/legtext/54leg/2R/summary/S.1523HHS-APPROP_ASENACTED.pdf. Through voting and testimony in four Committee hearings and in the House and Senate bodies, members of the legislature voted unanimously to pass SB1523.
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| Governor Ducey signs Jake's Law (CLICK HERE for video from the signing) |
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The Society was proud to stand with members of the legislature, including bill sponsors Senator Brophy-McGee and Representative Jeff Weninger, Governor Ducey, Christina Corieri, Cara Christ, Carly Fleege, the members of the Coalition (JEM Foundation, Arizona Council for Human Service Providers, Mental Health America of Arizona, Arizona Psychiatric Society, MIKID, Arizona Chapter of the American Foundation for Suicide Prevention, and Neighborhood Council), Representative Epstein, Senator Bowie, Senator Carter, AHCCCS, the Arizona Department of Insurance, members of the insurance industry, and the many individuals and family members affected by the loss of suicide or the stigma of mental illness at that signing.
The meaningfulness of the early and strong support from the Governor and the legislature in voting on and signing Jake's Law without shelving it for budget discussions would hit one week later on March 11, 2020 when the Governor signed the first COVID-19 related Executive Order, and the progress of over 600 pieces of legislation from this session that remained active were halted or delayed. Despite the many challenges facing the community and the Legislature, there was a big win for physicians and patient care in the passage of HB 2668 Hospitals; unreimbursed costs; assessment fund, a bill that has the potential to restore physician reimbursement rates from AHCCCS to where they were before the recession in 2009, which would mean a nearly 15% rate increase for physicians who serve Medicaid patients in Arizona. AHCCCS must seek approval from the Centers for Medicare and Medicaid Services to use the hospital assessment monies for hospital, physician, and dentist reimbursement.
Following the Governor's Stay Home, Stay Healthy, Stay Connected Executive Order, the Legislature worked to pass essential legislation relating to the continuation of agencies and services, such as the Arizona Department of Health Services, the Psychiatric Services Review Board, and the Arizona Board of Psychological Examiners; worked on COVID-19 relief package; and passed some final pieces of legislation and a skinny budget, adjourning to a tentative return date of April 13, 2020. As the Governor's Stay Home directive was extended, so was the return date for the legislature.
Many key Executive Orders have been enacted during this public health emergency. To view a listing of the Governor Executive Orders, visit https://azgovernor.gov/executive-orders. Most impactful to the continued provision of psychiatric care is the Governor's Emergency Order No. 2020-15 Expansion of Telemedicine, which requires health insurance plans to provide telemedicine coverage for all services that would be covered for an in-person visit., and further requires that health insurers must reimburse providers at the same rate for telemedicine as they would for in person services, and allow a patient's home to be an accepted location for provision of services. As leadership for the Society have had opportunity to communicate needs for mental health resources and care to the Governor and his staff, we have reinforced the importance of the telehealth order in supporting that care. The Executive Order in effect through the state of public health emergency.
On March 23, 2020, the Governor issued an opt-out letter to CMS Administrator Seema Verma requesting that Arizona be exempt from the requirement that CRNAs be supervised by a physician. This opt-out notification did not limit the exemption period to that of the public health emergency. The Arizona Society of Anesthesiologists, ArMA, AOMA, and fellow AHAC member associations, including the Society, are communicating concerns to the Governor regarding this change in scope of practice and its potential impact to Arizona's longstanding commitment to patient safety and physician-led, high quality care and requesting confirmation that the exemption is exigent in nature and will cease with the conclusion of the public health emergency.
On April 29, 2020, the Governor issued an extension of physical distancing measures while laying out a step-by-step approach to re-energize Arizona's economy (Stay Home, Stay Healthy, Stay Connected, Return Stronger). In the first week of May, the Arizona legislature resumed, some meetings being held virtually, with the Senate quickly concluding its business and voting 24-6 to adjourn sine die.
On 11:21 am, Tuesday, May 26th the 2nd Regular Session of the 54th Legislature officially adjourned sine die, ending the 135-day session with a record breaking number of bills introduced and the lowest number of bills ever making it across the finish line (89 bills passed (87 Republican, 2 Democrat), with 58 bills signed, and 31 awaiting executive action (29 Republican, 2 Democrat). The House business following the adjournment of the Senate was a difficult period. In the final week, the House sent two brand new pieces of legislation to the Senate, HB2912 and HB2913, related to limiting business liability for COVID-19 and allocating federal childcare dollars. However, the Senate did not vote on these measures, which killed them. The House transmitted 29 bills to the Senate that needed a third calendar read, but a motion to adjourn was made by Sen. Rebecca Rios (D-27) before any of those bills were considered. The motion to adjourn was supported by all 13 Democrats, and they were joined by three Republicans including Sen. Kate Brophy McGee and Sen. Heather Carter, legislators who have consistently raised public health concerns about continuing the 2020 session during the pandemic. As a result, the motion to adjourn crossed the 16-vote threshold and it passed. The Governor has ten days to either sign the 31 remaining measures, veto them, or do nothing, at which point they become law without his signature. CLICK HERE for the AHAC listing of the 89 bills that will become law this year.
With the regular session concluded, it is likely there will be least two special sessions: one to address the state's budget and one for COVID-19 relief matters. When these sessions will take place is anyone's guess, but most agree the budget session must occur in June before the new fiscal year begins on July 1, and any COVID matters may take a backseat until later in the summer or early fall. Projections on the budget shortfall range from $600 million to $1.6 billion, a bleak contrast to the State financial picture at the beginning of the session.
Thought to be stalled out by the court decision against collecting ballot referendum signatures online, organizers of some controversial referendums are continuing their efforts to meet the minimum signature thresholds to be on the ballot, the deadline for which is July 2, 2020. There is the potential for several looming referendum issues on the November ballot that are impactful to health care, among them the legalization of marijuana and the California union driven Arizona Hospital Worker Minimum Wage and Insurance Regulations Initiative. Contained within that Initiative are several provisions appealing to voters on their face (increased minimum wage and protection of prior authorization), but in total the measure, if enacted, could have dire consequences in the State of Arizona, forcing the closure of many rural hospitals.
Legislators may now resume campaigning (i.e. fundraising) for the upcoming primary and general elections, with the primary just over 60 days away. With difficult decisions ahead to balance the state budget moving forward, it will be ever important to support legislators who value funding health care needs and the health equity of our community as a priority. Society advocacy will also have important work to do in the implementation of the rules and regulations regarding Jake's Law and in the ongoing discussions with the Governor and the state legislature on keeping the safety net for mental health care intact in Arizona moving forward from COVID-19.
If you would like any additional information, please contact the APS Lobbyist, Joe Abate, at 602-380-8337. If you would like to be part of the Legislative Committee of the Arizona Psychiatric Society, please contact Teri (teri@azmed.org, 602-316-3241).
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ASSEMBLY NOTES FROM THE APA ANNUAL MEETING
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APA Speaker Paul O'Leary Leading the Virtual Assembly |
Virtual Assembly, April 2020
Payam Sadr, MD, FAPA
Jason Curry, DO, FAPA
Arizona Assembly Representatives
Jasleen Chhatwal, MD
Area 7 ECP Deputy Representative
As the APA pivoted from the effects of COVID-19 and the transition of an in-person to a an April virtual meeting of the Assembly, a tremendous effort was put into organizing and orchestrating the format for the meeting by Speaker Paul O' Learly, MD, APA staff, and Assembly leadership, in order to streamline priority actions within a 2-hour meeting, rather than the traditional 2½ days of APA Assembly meetings in person. The pandemic has taken a toll and had an impact on colleagues around the country, and circumstances involving COVID-19 have precluded the conducting of business as usual.
Among the award recipients from the Assembly, the Ronald A. Shellow Award - established in 2004 in honor of Ronald A. Shellow, M.D., past Speaker of the Assembly, recognizing departing members of the Assembly who have served the Assembly far beyond the general standards of service shown by most members of the Assembly, was presented for 2019 to Charles Price, MD from our own Area 7 (Nevada physician leader who has made lifelong contributions to Area 7 and the advocacy work of the APA and the APA Political Action Committee).
Among the Actions taken during this virtual session, the Assembly voted to support all means of ordering or prescribing medication, including electronic, written, fax, and telephonic, and to reaffirm APA's Commitment to Achieving Mental Health Equity. For more information on the other action papers, reports, awards, and outcomes of the APA Annual Meeting Assembly,
CLICK HERE.
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 ARIZONA MEDICAL ASSOCIATION HOUSE OF DELEGATES POSTPONED; PARITY RESOLUTION; COVID-19 ARIZONA RESOURCES; DR. PATRICE HARRIS (AMA PRESIDENT AND APA PSYCHIATRIST) SPEAKS AT ARMA TOWN HALL
Brian D. Espinoza, MD, FAPA
Stephen D. Herman, MD, LFAPA, DFAACAP
After significant consideration, including the CDC's recommendation of cancelling or postponing all events of 50 or more people for the next 8 weeks, leadership of the Arizona Medical Association (ArMA) made the decision to postpone the 2020 ArMA Annual Meeting.
A rescheduled date is being identified by a planning committee, who is also deciding on hosting the event live or virtual. Updates will be provided through the ArMA website, email, and the ArMA member only online community. Any specific questions can be directed to Blaine King at
bking@azmed.org.
The
Arizona Psychiatric Society submitted a Resolution for consideration by the upcoming House of Delegates relating to mental health parity. The Resolutions were posted and will remain up for comment through the rescheduled date. You do need to be an ArMA member to comment.
Throughout COVID-19, ArMA is distributing highlights of its weekly updates to non-members as a courtesy, and has compiled
COVID-19 resources,
telepsychiatry resources, and
financial resources that are available to the public. If you are not receiving the same, but are interested, please
CLICK HERE to sign-up.
ArMA has been conducting weekly Town Halls, which are also open to non-members. On June 3, 2020, AMA President Dr. Patrice Harris will be speaking about COVID-19, including issues of health care inequity in the United States. If you missed it, this Town Hall, and past Town Halls, which have included speakers from the Arizona Department of Health Services, insurance industry, and telehealth experts, will be (or are) posted on the
Arizona Medical Association YouTube Channel.
ArMA is also running a 50% dues promotion for any members joining now (pro-rating the full year dues to half-year); if interested, visit the
ArMA Membership webpage for more information or contact the
ArMA Membership Department.
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STEP UP ARIZONA -
JUNE 10 COALITION MEETING
The next
Arizona Mental Health & Criminal Justice Coalition meeting will be June 10, 2020, from 10-11:30 am. The meeting will feature special guest, Dr. Pennington-Stallcup, Mental Health Director at the Maricopa County Jail.
You can dial in using your phone. 1-571-317-3112
Access Code 205-129-277
Due to the current public health alert, the Coalition meetings will be held online, until further notice. At this time, the Step Up Arizona annual event for 2020 is on hold.
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PEERS PUBLISHED: FOCUS SERIES ON CULTURE, TRAUMA, AND PSYCHIATRY
Francisco A. Moreno, MD; Noshene Ranjbar, MD; Jasleen Chhatwal, MBBS, MD
It is our pleasure to share, with the authors' consent, a recent series of articles in "FOCUS" on the topic of culture, trauma, and psychiatry (Volume 18, Number 1, Winter 2020).
"Diversity and Inclusion in Psychiatry: The Pursuit of Health Equity," Francisco A. Moreno, MD, and Jasleen Chhatwal, MD: Differences between providers and patients may sometimes support division, limiting trust and understanding and complicating care. This issue of Focus is a call to sensitivity, humility, commitment, and action to support advocacy and service for those for whom we care, especially the most disadvantaged.
"Affirmative Care Across Cultures: Broadening Application," Natasha S. Mendoza, MSW, PhD, Francisco A. Moreno, MD, et al. The authors offer recommendations for affirmative care in practice with African-American, Asian, Indigenous, and Latinx individuals, as well as those living in rural communities.
Members are invited to share their peer-reviewed published articles by submitting the same to the
administrative offices.
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Premium Corporate Sponsor 2020-2021 |
NAVIGATING TELEHEALTH COVERAGE CHANGES FOR MEDICARE FEE-FOR-SERVICE, MEDICAID, AND PRIVATE INSURERS
Dear Arizona Psychiatric Society,
In response to the COVID-19 pandemic, our healthcare system has had multiple policy changes, offering some flexibility to meet the needs of new patients and for those needing continuity in care. One of these changes includes access and coverage of telehealth during the current public health emergency.
This resource document from the Center for Connected Health Policy
https://www.cchpca.org may be helpful as you navigate telehealth coverage changes that have occurred via legislative and regulatory processes for Medicare Fee-for Service, as well as information on Medicaid, private insurers, and recent state policy actions on telehealth policy.
Since the resource is updated frequently,
this link may also be helpful in providing the latest content.
Additional resources on telehealth policy can be found on the
American Psychiatric Association website as well as from the
American Medical Association.
Please consult with your organization's health care expert to determine what is best for the patients you serve.
Regards,
Shannon M. Groppenbacher
Healthcare Policy & Advocacy Director
Cell 602.410.5199
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CME AND LOCAL EVENTS: APA FREE CME FOR JUNE; SMI ADVISER; MENTAL HEALTH AMERICA ARIZONA PARITY WORKSHOPS JUNE 2020; MHA AZ SEEDS CONFERENCE OCTOBER 2020
APA FREE MEMBER CME:
CLICK HERE for information about the APA Member Course of the Month.
Each month, members have free access to an on-demand CME course on a popular topic through the APA Learning Center.
COVID-19 ON-DEMAND WEBINARS:
Telepsychiatry in the Era of COVID-19:
This free webinar from SMI Adviser (APA & SAMHSA) offers learners an overview of how to use telemental health and video visits in the changing landscape surrounding the 2020 COVID-19 pandemic.
Managing the Mental Health Effects of COVID-19:
This free webinar from APA will outline how psychiatrists can support patients, communicate with family members and children, and be a resource to other providers during the COVID-19 outbreak.
COVID-19 AND SERIOUS MENTAL ILLNESS (SMI)
Have questions about COVID-19 and serious mental illness (SMI)?
MENTAL HEALTH AMERICA OF ARIZONA PARITY WORKSHOP (JUNE 2020): As part of the June webinar series, Mental Health American Arizona will be offering an online webinar for patients and families on Jake's Law, the mental health parity law adopted on March 4, 2020 in Arizona. Please watch for updates on this webinar series or check the
Mental Health America Arizona website for the same.
MENTAL HEALTH AMERICA OF ARIZONA SEEDS CONFERENCE 2020:
October 7, 2020, 9 am to 2 pm
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REPORT FROM 25th NATIONAL PSYCHOPHARMACOLOGY UPDATE
February 12-15, 2020
Las Vegas, Nevada
Brian Espinoza MD
Interventional Psychiatry
Dr. Espinoza shares with us a report from the 25th National Psychopharmacology Update, a nationally noted event held annually in Las Vegas, Nevada. To review the highlight notes from the Psychopharmacology Update, please CLICK HERE.
Looking ahead to the next updates, the 2020 ISEN (International Society of ECT & Neurostimulation) Annual Meeting held in conjunction with the Annual APA Meeting in April, was cancelled due to China-COVID-19; and is currently planning to meet in 2021 in Los Angeles.
Provided current public gathering protocols permit the gathering to occur, next report is hoped to be from the Focus on Neuropsychiatry, American Academy of Clinical Psychiatrists, Washington D.C., August 13-14, 2020.
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 SAVE THE DATE: ARIZONA PSYCHIATRIC SOCIETY NEW 2020 ANNUAL MEETING DATE
Annual Business Meeting - October 2, 2020
Annual Scientific Meeting - October 3, 2020
Recently the Arizona Psychiatric Society leadership shared its carefully arrived at decision, for the health and welfare of our members and community, to postpone the 2020 Annual Meeting to Saturday, October 3, 2020 (for the educational sessions, with Posters, Awards, and Business Meeting in the evening on Friday, October 2, 2020) and to host the meeting in a virtual setting. The health and safety of our members remains the driving consideration in adapting this meeting from a live event, and we are hopeful that the Society will return to gathering together in person for its 2021 Spring Annual Meeting.
In case you missed it, CLICK HERE to read that full announcement, including information on opportunities to submit a peer for Career Achievement in Psychiatry Award, to poster present, and other business relating to the Annual Meeting.
Please save the dates of October 2-3, 2020, and plan to join us from the safety and comfort of your own home or office. Our invited faculty have been very flexible about these changes and have indicated each are available to support this change in schedule. The Agenda for October 2-3, 2020 is included here.
As we adapt to bring these noted speakers and current topics to you in an online setting, we are excited about the education and insights to be shared. We thank you for your support and flexibility in supporting the 2020 Annual Meeting. Registration will be open soon--the meeting will continue to be free to our members, thanks to the support from our annual premium sponsors (highlighted in this Newsletter) and the traditional support of our exhibitors, who will be available in a virtual exhibit hall setting (more information to come!).
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