New Hampshire Psychiatric Society
Newsletter
Summer 2011
In This Issue
President’s Message
Anthem Utilization Review
This society is one of the best kept secrets in New Hampshire medicine.
Top 5 Picks
It’s time for that to change. Over the past year under Len Korn’s presidency, we
have been the public face of the psychiatric profession for our state. Our members
advocated for the mental health system during this year’s budget battles in the
legislature, building alliances with NAMI-NH, the Mental Health Coalition and
others, giving psychiatrists a seat at the table in Concord.
Leadership Award
We screened over 600 bills and tracked those relevant to psychiatrists, shaping
them as they wound through the legislature. Our national AMA delegate has been
a leader in the struggle over onerous ABPN Maintenance of Certification
requirements. Our Spring Meeting was a great success with Eric Vance’s
fascinating keynote presentation on Resilience. But among the state’s
psychiatrists, our profile could be higher.
Next Meeting:
NHPS Executive
Council
Weds, Sept 7
6:30 PM.
Details on p. 3
In my term as president I hope to build this Society into a community of
psychiatrists across New Hampshire. In a rural state where it is easy for individual
practitioners to feel isolated from their colleagues, the Society should serve as a
means to connect and to meet members’ career goals in psychiatry. To achieve
this professional community, I will work with the Executive Council to find novel
ways to reach out to members. You will receive an email survey shortly to help us
understand how to proceed.
The second priority is financial strength. The Society has weathered the economic
downturn well due to Alex DeNesnera’s and Len Korn’s efforts in adjusting
operations. But nobody can know when an expensive legislative effort may be
necessary, and we can no longer count on the APA to help out with a grant as it
has done in years past. It is only prudent to prepare for a rainy day, and the
Council is exploring several options to save for the future.
With major state and federal changes to the healthcare landscape around the
corner, psychiatrists never had more need for a strong state Society. I hope you
will join us if you haven’t, come to our next meeting if you have, and help us work
for the benefit of our patients and our profession.
Jeffrey C. Fetter, MD
Letter from the Editor
This is the first all-email edition of the NHPS Newsletter. I hope we can get more
NH psychiatrists on our email list so the NHPS Newsletter reaches most of NH
psychiatrists. Our goal is to communicate more frequently about what NHPS is
doing while providing a venue to voice to the concerns of psychiatry in NH.
My theme for this letter is “United we stand, divided we….” As psychiatrists in
our small state of New Hampshire, we need each other. We can have some
power to influence state and national decisions if we are together in our thinking
and our actions, but have not much influence if we are not connected.
It is in that context that I want to share with you my experience on the Executive
Council of the New Hampshire Medical Society for the last two and a half years.
It has been a beneficial connection for NHPS. I recently brought to the NHMS the
issue of marriage equality in the “Freedom to Marry” Bill that the NHPS Executive
Council had endorsed. I am pleased to report that the NHMS also came out in
support of that legislation, helping it pass both the NH House and Senate. It has
been signed into law by Governor Lynch. NHMS and the AMA also support the
new Health Care Law. They also strongly support Tort Reform and maintaining
the Pre-Trial Panels that have worked to reduce malpractice cases markedly.
I urge all psychiatrists who are not members of NHMS to consider joining. NHMS
is the voice of medicine in NH; they need us and we need them.
I have been editor of NHPS Newsletter now for the last four plus years. I want to
encourage more dialogue on the issues that are impacting psychiatry. Let us hear
from you! You can reach me at lenkorn.md@gmail.com.
Top 5 Picks
J. Eric Vance, MD
Dr. Vance was the featured speaker at this year’s Spring Meeting of the NH
Psychiatric Society. He is Assistant Professor of Child Psychiatry at Dartmouth
Medical School and practices at the Sununu Center, New Hampshire’s youth
correctional facility. Here are his Top 5 articles on Resilience.
1. Dennis Charney MD “Psychobiological mechanisms of resilience and
vulnerability: implications for successful adaptation to extreme stress,”
American Journal of Psychiatry, 161:195-216, Feb 2004. Integrates an
exhaustive amount of research material to propose a neural model of
resilience encompassing reward, fear, and social behavior networks.
2. Fatih Ozbay MD, “Social support and resilience to stress: from neurobiology to
clinical practice,” Psychiatry, 4(5): 35-40, 2007. Details the critical role of
social support in resilience (free in Pubmed Central).
3. Garmezy N, Masten A,Tellegen A (1984). The study of stress and competence
in children. Child Development. 55:97-111. A landmark cohort study of
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protective factors in children.
4. Rutter M (1979), Protective factors in children’s responses to stress and
disadvantage. In: Primary Prevention of Psychopathology ,Vol. 3, Kent MW,
Rolf JE, eds. Hanover, NH: University Press of New England, pp 49-74. A
helpful review chapter.
5. Werner EE (1996), Vulnerable but invincible: high risk children from birth to
adulthood. European Child and Adolescent Psychiatry, 5 (Suppl. 1):47-51.
Kauai Longitudinal Study results, finding clusters of protective factors that
enabled high-risk individuals to grow into competent, adjusted adults
September 7th NHPS Executive Council Meeting
Start the Fall by getting involved in the NHPS Executive Council. All NHPS
members are welcome to attend. We hope to see you there.
When: Wednesday September 7, 6:30 PM (dinner at 6:15)
Where: NH Medical Society office, 7 North State Street, Concord
Contact Joy Potter for details and directions (joy.potter@nhms.org).
Anthem Utilization Review Update
Representatives of Anthem came to NH on 7/20/11 to meet with representatives
of the state’s behavioral health units at the NH Hospital Association. Jeff Fetter
represented NHPS. The meeting was called due to concern that utilization review
had become more aggressive in the past year.
Anthem representatives stated that in 2010 there had in fact been an increase in
the daily reviews for psychiatric admissions due to an initiative to decrease
length of stay. However, they stated that several factors had convinced them to
cease this practice.
First, they noted that usually only one or two days are left uncovered with each
denial and they pay for each review, such that they recognized the practice was
not saving them much money. Secondly, since the beginning of 2011, the
company has begun to prioritize reducing readmissions anticipating health care
reform and Accountable Care Organizations entering the scene. Thus they are
willing to approve an extra day or two to decrease the chance of bounce-back.
Behavioral health units reflected that not all of us have seen a decrease in
aggressiveness in the past six months. Several attendees also pointed out that
Anthem’s physician reviewers are not uniformly professional in their dealings with
treating clinicians. Any psychiatrist who feels treated unprofessionally by Anthem
reviewers is encouraged to contact the Anthem medical director Steven Korn
directly at steven.korn@anthem.com.
Finally, we provided feedback that daily reviews are taxing on staff time, as a
review requires extensive information exchange, much of which is duplicative of
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prior contacts. Anthem agreed to explore the use of an informal ‘update’ when
daily contact is desired which would be less burdensome on unit staff.
Executive Council Inaugurates Leadership Award
At the last NHPS Executive Council meeting we discussed inaugurating an
award for leadership in either the clinical or public policy arenas. We decided
to defer decision until we could have additional information, but here is a
rough draft resolution for the board to authorize the award, as a place to start:
The NH Psychiatric Society Leadership Award is hereby inaugurated to
recognize and encourage excellence in advancing the goals of the Society.
Recipients may be nominated at any time by any member of the Society by
writing a letter in support of the nomination, and will be chosen at the
discretion of the Executive Council by simple majority vote. The Award will be
bestowed based on meeting at least one of three criteria: demonstrating
leadership by excellent clinical example, advancing the care of the mentally ill
in New Hampshire through exemplary public service, or outstanding service to
the NH Psychiatric Society.
Comments welcome.
-Jeff
Submitted by Peter Olsson, MD
In response to the Editor’s request for submission of thoughts and ideas for this
publication, the following poem was submitted by Dr. Peter Olsson. Comments to
the Editor are welcome.
Madness of Mangled Obamacare
The opinions
expressed in this
Newsletter belong
to the authors only
and do not
necessarily reflect
the official opinion
of the NHPS.
Sheep find familiar paths profound
Obama claims great promise for,
The health of “Masses”, mesmerized.
Neatly balanced budgets so profitable,
For SEIUs that sleep soundly, but fat.
Souls sold-out collectively … exponentially
Costs contained by sharing wealth around.
Neo-Marxist pied piper dollar dreams,
become troubling nightmares in disguise.
Offer favorite bromides and shibboleths!
Pay those TAX premiums on time!
Individuality discounted to purchase,
new clothes for emperor Obama and his czars.
Peter Olsson MD
Keene, NH
polsson@ne.rr.com
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New Hampshire
Psychiatric Society
7 North State Street
Concord, NH 03301
Tel: 603-224-7083
Fax: 603-226-2432
www.nhpsych.org
joy.potter@nhms.org
NHPS Executive Council
Jeff Fetter, M.D. President. jfetter@crhc.org
Leonard Korn, M.D. Past-President, Membership Chair, and Newsletter Editor.
lenkorn.md@gmail.com
Jonathan Schwartz, M.D. jrs.schwartz@gmail.com
Alex de Nesnera, M.D. Treasurer, Liaison to NH Legislature.
adenesnera@dhhs.state.nh.us
American Psychiatric
Association
1000 Wilson Blvd
Arlington, VA 22209
TEL: 703-907-7300
apa@psych.org
www.psych.org
Bob Feder, M.D. Liaison between NHPS and APA. feder@charter.net
Wendy Martin, M.D. Early Career Representative.
Wendy.m.martin@dartmouth.edu
Rebecca Neal, M.D. Ethics. Rebecca.r.neal@dartmouth.edu
PAID ADVERTISEMENT
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