Dear Colleagues,
 
It is time to get involved. 
 
The crisis in mental health care for Oregonians continues to grow:

• The Oregon State Hospital is filled to capacity.
• Arrests by law enforcement continue to occur for individuals with untreated and under-treated serious mental illness.
• Demand at local hospitals for short-term admissions continues to rise, which in turn leads to long stays in emergency rooms.
• Families struggle to find support as they try to assist their loved ones (which often includes children and adolescents) and obtain treatment for them.
• Institutions of higher education are now on the front line of helping young adults with emerging mental illness.
• Psychiatrists become busier and busier as we try to keep up with the demand for our services and the increasing acuity of patients at every level of care.
• Although we are busier than we ever have been, reimbursement rates for our services in the face of increasingly onerous documentation requirements continue to create barriers to care and contribute to physician burnout.

 
And yet this state's psychiatrists remain dedicated to advancing the quality of patient care, improving our practice environments, and maintaining our commitment to to lifelong learning through CME and other activities. It is obvious to me that Oregon's psychiatrists are a remarkable group of intelligent, caring professionals.
 
Although we exert extraordinary efforts at helping our patients, at times we forget that we can be even more effective (and happier!) when we also help ourselves and each other as fellow psychiatrists. Membership in the OPPA is an important way we can help each other and ourselves. 
 
I joined the OPPA in 2008 because I knew that the help I could give to my individual patients was limited by my practice environment, my patients' socioeconomic environment, and their level of access to health care. I joined the OPPA because I knew that supportive colleagues could help me through my first patient death. I joined the OPPA because I knew the organization would work to ensure that I would be reasonably reimbursed for the work that I do. I joined the OPPA because I could meet colleagues in other practice niches so I could build a strong referral network for patients who needed something other than what I could give them.
 
I joined the OPPA because we can do together what I cannot do alone.
 
I'd like to draw your attention to some of the activities that we have done together that individuals could not accomplish alone. These include recent committee work as well as other organizational activities. Along the way I will highlight some of the industrious and inspiring people in our organization who have led these activities. I fully realize that this is a partial accounting of the many people who contribute. I invite you to email me at mayalopezmd@gmail.com to let me know of other members who are leading efforts to advance psychiatry in Oregon.
 
Member Assistance Committee: After decades of energetic dedication to helping psychiatrists and other physicians in crisis, Dr.Henry Grass has stepped down from chairing the Membership Assistance Committee. Other members have risen to the occasion and Drs. Tom Hansen, Candace McKenna, Clara Ruiz, Linda Toenniessen, and others have been continuing the committee's important work. The committee seeks new members. No experience is required, the time commitment is small, and the rewards are great.
 
Public Psychiatry Committee: Dr. Daniel Towns has reinvigorated this committee. He has creating a closed Google group for public psychiatrists and other interested members. As the numbers of Oregonians covered by public funding grows, public psychiatry becomes an increasingly important part of the solution to the problems I outlined in my opening statement above.
 
Legislative Committee: Drs. Daniel Dick and Craig Zarling in conjunction with our lobbyist, Katy King, have been working hard to advance the quality of psychiatric care and practice environments in Oregon. Some of the actions taken by this committee include advocacy for improvements in the Health Professional Services Program (which serves and oversees physicians and other health professionals who face significant mental health and substance use challenges), working to preserve intensive mental health care services, promoting OPPA interests to influential state legislators and other government officials, and working with other health care organizations. Please see Katy King's excellent summary of recent and upcoming legislative issues elsewhere on this website.
 
The OPPA is well-represented in the Oregon Health Authority's Behavioral Health Collaborative with OPPA members, Drs. Maggie Bennington-Davis, John Bischof, Mark Bradshaw, Caroline Fisher, and Mike Franz.
 
Our Past President and current Chair of the Membership Committee, David Conant-Norville, was a private (non-OPPA) sponsor for an Elizabeth Steiner-Hayward fund-raising breakfast. I am proud to report that OPPA members were well-represented at the meeting, with Drs. Bennett Garner, Daniel Dick, Jon Betlinski, and David Pollack as well as Katy King in attendance. Support for our physician colleagues in the state legislature is essential for further advances of our members' interests.
 
Program Committee: Chaired by Dr. Jonathan Betlinski with administrative assistance from Patti Legarda, this OPPA committee provides high-quality CME that is relevant not just to national practice standards but also the unique demands of serving our fellow Oregonians. This committee has many active, dedicated members that shape these great meetings year after year. If you see a Committee Member at an OPPA CME meeting, please thank him or her for the Committee's hard work.
 
Membership Committee: Dr. David Conant-Norville leads this committee assisted by Jennifer Boverman. This committee has hosted, for two years now, an annual members-in-training mixer where psychiatrists at all levels of experience and practice environment can meet each other and share their experiences and advice with early career psychiatrists, I attended the most recent event and it was fun and inspiring. If you are wondering why you are a member of  the OPPA, contact me at mayalopezmd@gmail.com or Dr. Conant-Norville. If we are not serving you in the ways we should be, we want to know how we can better meet your needs.
 
OPPA and OCAAP member Kirk Wolfe, MD spearheaded a recent risk management seminar free of charge to OPPA and OCAAP members. It was well-attended and it provided much-needed risk management strategies for medication prescribing and and minimizing risk when tearing suicidal and violent patients.
 
Our Executive Director, Patrick Sieng, continues to bring innovations to the OPPA. He is developing a summer CME conference in July 2017 for us to be held in beautiful Sunriver, Oregon. This meeting will be focused on risk management issues, a topic that is always useful for us. In addition, psychiatry residents from Oregon Health and Science University  and Samaritan Health Services will be presenting as well. The OPPA is committed to promoting a culture of professionalism and lifelong learning among its members at all stages of training, career, and geographic locations in Oregon.
 
On October 28, OPPA member Alisha Moreland-Capuia, MD moderated an important a panel discussion at the City Club of Portland's Friday Forum entitled #WhatDoctorsLookLike. This forum examined the overt and hidden biases many physicians of color and other underrepresented minorities  face as they strive to provide health care and advance their careers. As it that were not enough, Dr. Moreland-Capuia also spoke on a panel entitled Healthcare in the US-- Are we ready for more reform? She spoke alongside Governor John Kitzhaber and renowned health care policy expert Donald Berwick, MD at this City Club of Portland event.
 
Year and after year, the Ethics Committee, chaired by Vic Richenstein, serves the OPPA with sensitivity and careful deliberation as it reviews ethical concerns brought to its attention.
 
Our allied organization, The Oregon Medical Association, continues to support important improvements in health care for Oregonians. Among the more prominent recent approvals by the OMA:

• Support for the removal of the non-medical exemption for childhood immunizations from Oregon law
• Support for the view that firearm-related violence represents a public health crisis
• Support for the “One Key Question" initiative which was approved and to be forwarded to AMA House of Delegates for consideration

 
But let me return to my original thesis: The OPPA can help us do together what we cannot do alone. And yet, the active members of the OPPA cannot accomplish all that you would like us to accomplish without some help from you. I am asking you to consider how you can contribute to the OPPA such that we, as a group of dedicated psychiatrists, are further enriched and inspired as we advance our careers and personal missions of helping others.
 
What I want from you:

• Your voice: send us your opinions, contact your local elected representatives, and attend our semi-annual business meetings. We need to hear from you so we know how best to represent our membership.
• Consider joining a OPPA Committee: joining a committee doesn't mean you have to do a lot of work. It is often a small time commitment. What is often needed is your ideas, thoughts and opinions followed by specific actions, often limited in scope and time commitment
• The OPPA Political Action Committee is in desperate need of your contribution. Although the legislative committee can accomplish some goals without making campaign contributions, the effectiveness of the committee is sharply limited unless it can also contribute to the campaign efforts of those legislators who understand our needs and who can advocate on our behalf. Please make a donation of $50 or more so we can continue to effectively advocate for you.
• Ask a colleague to join the OPPA: The OPPA aims to represent all psychiatrists in the state. if you know a colleague who is not a member, ask that person to join and make their voice heard within our organization.
• Make your membership in the OPPA known to your local and state politicians and civic leaders: When you make your affiliation with the OPPA known, you multiply your influence with your political leaders and promote new avenues of relationships between our state and local leaders and the OPPA.

 
It is with gratitude that I reflect on the Oregon Psychiatric Physicians Association (OPPA) and what it has given to me. I hope you can take a moment to reflect on what the OPPA has done for you.The OPPA strives to serve our entire membership and your ideas are valuable. I invite you to let me know what else this organization can do for you.
 
Many thanks to each of you for the work you do.
 
Warm regards,
 
Stephanie
 
Stephanie Maya Lopez, MD, FAPA
President, Oregon Psychiatric Physicians Association

What’s New at the APA

• APA announced their new Mental Health Registry PsychPRO. PsychPRO will help psychiatrists deliver high quality care and meet new MACRA quality reporting requirements by the Centers for Medicare and Medicaid Services, (CMS). It will also serve to spur future medical research and the development of better treatment and prevention methods for mental illness. You can read more about PsychPRO here.
•  APA applauded a report from Surgeon General Vivek Murthy about the public health crisis of drug and alcohol abuse and calls for collected coordinated action to address the problems. APA is an active participant in TurnTheTideRX, the Surgeon General’s campaign to address the prescription opioid epidemic, and pledged to continue collaborative efforts to combat the crisis. You can read more about the Surgeon General’s report here.

 
Mark Your Calendar

• World AIDS Day (Dec 1)
  

December Course of the Month
Each month, members have access to an online course on a trending topic. The December course is Early Detection and Intervention for Adolescents with Early Psychosis, Steven Adelsheim, M.D., Stanford University School of Medicine. This course discusses U.S. and international efforts in early intervention for young people with early psychosis and focuses on some of the critical components necessary to build on the existing models of early psychosis. Access the course here.

The 100% Club deadline has been extended!

Residency-training programs now have until December 31, 2016 to achieve 100% Club status. We need your help recruiting residents and fellows at your residency training programs. Please encourage your new residents to join online at www.psychiatry.org/join, and remind current members to pay their dues online at www.psychiatry.org/paydues. Email cvanwagner@psych.org to request your residency program’s membership status.
Now Accepting Applications for APA/APAF Fellowships
APA/APAF Fellowships allow residents and fellows to expand their skills and explore interests while completing their regular training program. Many come with funding for projects or research and provide an excellent opportunity to connect with colleagues from across the country. Applications are due January 30, 2017. Explore the fellowships today.  

Time to Renew for 2017!
Renewing your APA Membership is a great way to maintain your commitment to psychiatry, and reap the benefits of available to APA members. Follow this link to Renew Your Membership.  

For Job Announcements, visit the OPPA Job Board

Office Space Available
 
For immediate occupancy in Lake Oswego. Congenial group of independent, private practice, office expense-sharing -- no other professional/business affiliation -- mental health providers (four psychologists, one psychiatrist) seek one other like-minded professional to lease 235 sq. ft. office (12' x 4.5' window) in five-office suite: second floor of two story commercial building, adjacent to retail center (Oswego Towne Square), set well back from main road (Boone's Ferry), large free parking lot, offset studs (no wall touches another), heavy insulation between walls, thick “sound blanket” over ceiling tiles. Separate utility room with refrigerator, microwave, coffee maker, hot/cold pure water dispenser, sink,  paper shredder, copier with scanner, fax, and memory printing capacity. Separate entrance (waiting room to therapy offices) and exit (offices to main building corridor). Waiting room, utility room, interior hallway and five-office suite comprise 2029 sq. ft.
 
Five-year lease commencing December 1, 2016 to November 30, 2021. $744/month with annual escalations. ($865/month in year #5.)
 
Please contact: Rick Cohen, MD: wil.coh5@comcast.net.

What’s New at the APA

• APA President Maria A. Oquendo, M.D. authored a post responding to the recent unrest in some U.S. cities related to gun violence.  The post highlights resources for physicians, patients and their families that can be useful to address the trauma caused by these events. You can view the post and access those resources here.
•  APA offered comments to the Centers for Medicare and Medicaid Services (CMS) on their Medicare Physician Fee Schedule proposed rule for 2017. The APA strongly commended CMS for many of the proposed changes, and offered suggestions to make them even better for psychiatrists and their patients. You can view APA’s specific comments to CMS here.
• The APA Assembly will meet at the Omni Shoreham in Washington, D.C. from Nov. 4-6. You can read more about the Assembly and find meeting dates here.

 
Mark Your Calendar

• ADHD Awareness Month
• Mental Illness Awareness Week (Oct. 3-7)
• National Depression Screening Day (Oct. 6)
• World Mental Health Day (Oct. 10)
• Red Ribbon Week (Drug Free America Oct. 23-31)
• IPS: The Mental Health Services Conference (Oct. 6-8)

 
Changes to DSM-5 to Take Effect on Oct. 1
Important changes to the DSM will take effect on Oct. 1. These changes are designed to bring ICD-10 codes in line with updated diagnoses in the DSM-5. As of Oct. 1, some ICD-10 codes relating to disorders in the DSM will no longer be valid. For a complete list of the disorders affected by this change, and the new codes associated with them, please visit the Psychiatric News story on the changes here.
 
October Members’ Course of the Month: Childhood Precursors of Borderline Personality Disorder
Each month, members receive free access to a CME course on a trending topic. Most take less than 30 minutes to complete, perfect for over lunch. The October course is Childhood Precursors of Borderline Personality Disorder: Why are Childhood Precursors Important? Take the course today and view the upcoming Members’ Course schedule.
 
100% Club Deadline is Oct. 31!
APA 100% Club is in full force and the Oct. 31 deadline is just around the corner! The APA 100% Club promotes a collaborative community of training programs throughout the U.S. and Canada. This year’s enhanced 100% Club benefits provide more day-to-day value; check out the new 2016-2017 benefits. Residents may complete the membership application and pay their dues online. Or, interested in Institutional Billing for your residents? Contact membership@psych.org. The first year of APA national dues is free!
 

The Membership Committee has been working hard to identify  the best way for OPPA to offer value to its members and appeal to residents and other potential new members.  We continue to evaluate the survey results in an effort to best serve our  members. After much work on our survey, it is apparent many are seeking to network and socialize with other psychiatrists in our community.
 
To that end, October 14 is our Second Annual Resident Social.  It will be co-hosted by the OPPA and Mind Matters PC, and is an event  for residents and fellows to get to know some of the psychiatrists in our community  We invite all residents at Good Samaritan and OHSU, as well as OPPA members that have experience in specific areas that the residents have mentioned are of interest to them. It is a fun evening to meet members of the  OPPA, make new friends and take advantage of the opportunity to network with your peers.  There will be drinks and hearty appetizers, socializing and a brief welcome and introduction period. If you are interested in attending, feel free to reach out  to the Membership Committee so we may include you.
 
We also got  feedback during our survey that members would like some sort of roster to facilitate members reaching out to other members. The Membership Committee is working to put together a roster. We do not have a time frame but stay tuned for a roster coming soon.
 
We are also looking for a few members to join the Membership Committee, specifically Early Career Psychiatrists.  We know  it is a challenge for ECPs to make time for a new commitment when they are already managing a career, potentially balancing a new family, new home and community,  but that it is exactly why we need ECP representation. Not only is this an opportunity to help us better serve ECPs, but a great way for you to have your voice heard and be involved in the  Psychiatric community.  Please consider joining the Membership Committee.  We meet monthly in Hillsboro, video conferencing is available for those who cannot join in person, and a meal is included, generously offered by Dave Conant-Norville, our committee chair.
 
Please feel free to reach out to our committee if you have any input, suggestions or are interested in joining the  committee.  Contact Dave Conant-Norville MD at drdave@mindmatterspc.com or Jennifer Boverman at Jennifer@oregonpsychiatric.org.
 
Jennifer Boverman
Membership Coordinator
 
 

Area 7 Report
The Area 7 Council , which is composed of representatives from the 13 District Branches (DBs)in the far west of the United States (excluding California) met in August.  Several themes amongst the various DBs emerged from this meeting:

• Scope: psychologist prescribing passed in Iowa and Illinois, and was defeated in Hawaii.
• Member recruitment: several DB’s working on this including calling the drop list and providing a variety of events for members to interact with each other.
• Physician burn-out:  several DB’s discussed how isolating it is to be in a busy / overwhelmed practice and the need for more support after an adverse event like a physician suicide.  One DB is helping implement the American Medical Association burnout evaluation and prevention program (StepsForward) in their area. See: https://www.stepsforward.org/modules/physician-burnout
• Services for rural areas:  one DB has noticed an increase in psychiatrists working in their underserved area after participating in a residency program located there.  The group discussed more ways to help serve underserved areas including the use of telemedicine and a program called Project ECHO (Extension for Community Health Outcomes) which has been developed in New Mexico.  See:  http://echo.unm.edu/

 
Support for MACRA Changes Available from APA
The Medicare Access and CHIP Reauthorization Act (MACRA) transforms the payment and quality programs for Medicare Part B physician services by replacing the old sustainable growth rate (SGR) with a stable update system.  Right now this is scheduled to go into effect as of January 2017.  APA has developed a web page devoted to the implementation of MACRA which includes a webinar and more to come as this gets closer. See: https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/payment-reform
 
American Psychiatric Association to Fund a Registry
Changes to health care delivery as a result of the Affordable Care Act will require improvement in quality of care, while at the same time reducing costs. With an increasing national focus on quality and cost, the opportunity to leverage clinical registries to improve outcomes and appropriate utilization has never been greater. The AMA believes that the establishment of a registry will assist members in meeting these new requirements and is an investment for the future of the profession of psychiatry.
Establishing a registry will also help members comply with Physician Quality Reporting System (PQRS) & Merit-Based Incentive Payment System (MIPS) requirements and avoid penalties, which began in 2016 (2%) and will increase to 9% in 2022. A registry would also allow members to submit performance and practice data from the registry for Maintenance of Certification (MOC) Part IV credit.  A registry will provide a national research data base with aggregate de-identified data to help improve patient outcomes, develop new diagnostics and therapeutics, develop practice guidelines, identify gaps in care and inform APA educational programs, and support advocacy initiatives.  It will also allow the APA to develop new psychiatric quality measures (with funding from CMS until 2019).