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President's Column: You and AAGP
By David C. Steffens, MD, MHS
It is a truism that the strength of any organization lies in the individual strengths, talents and involvement of its people. AAGP is a strong organization because its members are passionate about our field and are willing to devote time to advancing our clinical, research and educational missions. Over the past couple of years, AAGP has made several structural changes that will help empower members to get involved. Among these changes are the establishment of core committees, Clinical Practice, Research, and Teaching and Training, and the inclusion of each committee chair on the Board of Directors. I'd like to spend this President's Column highlighting these important committees in the hopes that you will consider joining one or more committees to add your voice and your talents to our organization.
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  Medical Professional Liability Insurance
PRMS manages The Psychiatrists’ Program, a full-service medical professional liability insurance program. Safeguard your practice with in-house claims services and psychiatric-specific risk management resources, including expert advice on call. Coverage for administrative defense and forensic services is included. Telepsychiatry coverage available. Call (800) 245-3333 or visit to learn more.

The Scholars Program needs your help!

Applications due Oct. 1. AAGP is now accepting applications for the Scholars Program, designed to provide an introduction to the field of geriatric psychiatry to medical students and psychiatry residents. Applications are due Oct. 1, so please spread the word about this popular program, which provides beneficiaries with full access to all AAGP member programs and activities through association membership and activities during the AAGP Annual Meeting, including structured mentorship programs and tools for medical students and residents to make informed choices about their medical careers. Medical students in an LCME- or COCA-accredited medical school and general psychiatry residents in PGY 1-4 in an ACGME- or AOA-accredited training program in the U.S. or a Canadian accredited residency program may apply for general scholarships. Psychiatry residents in PGY-1, 2, or 3 may apply for the honors scholarships. Learn more and apply online:

Donations needed by Sept. 30. To help the Scholars Program perform at its full potential, your support is needed. Donations to the Scholars Fund allow trainees to attend the AAGP Annual Meeting and benefit from special programming, including a mentorship program; donations cover travel, housing, and meal expenses for the trainees. Please support this valuable program. Donations received by Sept. 30 will be used for the 2014 program. Learn more and donate:

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Welcome, new AAGP members!
Psychiatrist Members
• Michael Conley, MD, Decatur, Ga.
• Randall William Fehr, MD, Oro Valley, Ariz.

• Reiko Emtman, MD, Seattle, Wash.
• Esther Teverovsky, MD, Pittsburgh, Pa.

• Catherine Daniels, MSN, Manchester, N.H.
• Darrell Owens, DNP, Seattle, Wash.

• Oluwaseun (Sean) Aina, MBBS, Elgin, Ill.
• Amy Bailey, Southlake, Texas
• Vipan Kumar, BA, Bellerose, N.Y.
• Melissa Lizette Sanchez, BS, Houston, Texas

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Behavior Imaging Solutions

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Credible Behavioral Healthcare Software

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The Community Health Facilities Fund
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Reimbursement reform marked up in House subcommittee
On July 22 and 23, the Subcommittee on Health of the House Energy and Commerce Committee considered a draft bill to repeal the current Medicare physician payment system and replace it with one based on quality of care measures and new care models. On the second day of consideration, the subcommittee approved the legislation (no bill number as yet) by voice vote and forwarded it to the full Energy and Commerce Committee for consideration. This subcommittee action represents the first in several years to repeal the sustainable growth rate formula and institute a new system for Medicare reimbursements to doctors.

The subcommittee's framework would replace the current SGR with an enhanced fee-for-service system in which providers report quality measures that will lead to better care in a more efficient manner. In addition, providers would have the option of leaving the fee-for-service system and opt instead to participate in alternative payment models. In the fee-for-service program, providers would get payment updates and incentives based on how they met specified quality measures. Physicians would receive a 0.5 percent annual increase per year for the first five years of the new payment system. Beginning in 2019, they would be eligible for an additional one percent update based on their performance against quality measures.

The Congressional Budget Office has estimated that the cost of freezing physicians' Medicare reimbursement and preventing SGR-related cuts would cost $139.1 billion over ten years—much lower than it has been in recent years. Members of Congress have yet to identify ways to pay for the legislation. Although the latest draft bill from the Energy and Commerce Committee's Health Subcommittee does not address how to pay for the cost of repealing the current payment system, Congressman Fred Upton, R-Mich., chairman of the Energy and Commerce Committee, has pledged that the final bill would be fully paid for. Upton has stated on several occasions that it is his intent to have a bill reported out of the full Energy and Commerce Committee prior to the start of the August Congressional recess on Aug. 3.

The draft bipartisan legislation is the latest step in the process to reform the SGR system and reward providers for delivering high-quality efficient health care. The House Ways and Means Committee and the Senate Finance Committee are currently working on their own versions of SGR reform legislation.

"I'm pleased to be part of this bipartisan effort to reform the Medicare physician payment system and replace the SGR system that has resulted in the specter of large unsustainable cuts in physician payment every year, frustrating Medicare physicians and beneficiaries alike. We know this legislation is a work in progress," said Full Committee Ranking Member Henry Waxman, D-Calif. "While we all agree on the problem, getting the right solution is complicated and necessarily complex. We want to move our payment system to one that rewards quality and efficiency and improves patient outcomes. We want to build on the reform efforts underway. This is the first step and an important one. It undoubtedly can and will be improved as we move through the legislative process, but I believe we already have a stronger product because of our joint effort. This is a process that has to start—and we can’t accept the current system any longer. We have bipartisan agreement on that, and I believe that commitment to working together will serve us well."

For the past decade, members of Congress have ignored the Medicare payment cuts called for by the SGR, instead instituting a series of payment patches with flat or small increases.

AAGP is continuing to work with other physician organizations to reform the Medicare payment system on a permanent basis and is providing feedback to congressional committees and others. There needs to be a permanent solution to this problem in order to preserve Medicare beneficiaries' access to care and to provide for fair reimbursement for all practitioners under the Medicare system.

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Garrett Lee Smith Memorial Act reauthorization introduced in the House
On July 19, Representatives Bill Cassidy, R- La., and Danny Davis, D-Ill., introduced H.R. 2734, the Garrett Lee Smith Memorial Act, a bill which helps state and local governments and universities develop suicide prevention programs. That bill would revise and extend provisions of the original Act signed into law by President George W. Bush in 2004. A similar bill was introduced in the Senate in January by Senators Jack Reed, D-R.I., and Lisa Murkowski, R-Alaska. GLSMA funds assist states, tribes, colleges and universities develop suicide prevention and intervention programs, which are often the first line of defense for those battling mental illness.

According to the Centers for Disease Control and Prevention, more than 38,000 Americans die by suicide every year, and suicide remains the second-leading cause of death for young people aged 15 to 24. The CDC also reports that 157,000 young people are treated for self-inflicted injuries annually, often a result of failed suicide attempts.

This legislation is named for former Senator Gordon Smith's, R-Ore., 22-year-old son Garrett, who took his own life in September of 2003. Senator Smith led the original bill, which was strongly supported by AAGP and numerous other mental health organizations, and continues to champion suicide prevention and mental health initiatives.

H.R. 2734 is budget-neutral and has been referred to the House Energy and Commerce Committee for consideration. AAGP has been a long-time supporter of this legislation which provides a comprehensive approach to addressing the national problem of youth suicide and will work with other mental health organizations to ensure that the GLSMA is reauthorized.

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Earn CME with AAGP 2013 Annual Meeting recordings
Access a wealth of educational sessions on late-life mental health with recordings of AAGP 2013 Annual Meeting sessions and earn up to 46 hours of CME. Hear audio of the sessions, access handouts, and take online CME tests. See the list of sessions, learn more and purchase online:
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American Psychiatric Association's Geriatric Psychiatry Awards:
Nominations due Aug. 15

Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. This award recognizes an early career geriatric psychiatrist who has made noteworthy contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service, and has demonstrated the potential to develop into a future leader in the field. The honoree must be a psychiatrist who holds a position no higher than assistant professor and is no more than seven years removed from completion of a geriatric psychiatry fellowship.

Nominations for this award must come from APA Members. All applications should include a detailed nomination letter highlighting the nominee's contributions to geriatric psychiatry, and two additional letters of support highlighting more specific facets of the nominee's career and contributions. At least one letter should be from a geriatric psychiatrist familiar with the nominee's work, and two of the letters should come from people outside of the nominee's institution. Applications should also include the nominee's CV, including a list of publications as well as grant support.

This award is made possible with funds from the John A. Hartford Foundation, a private philanthropy working to improve the health of older Americans.

Jack Weinberg Memorial Award for Geriatric Psychiatry. Established in 1983 in memory of Jack Weinberg, MD, this award honors a psychiatrist who, over the course of his or her career, has demonstrated special leadership or who has done outstanding work in clinical practice, training, or research into geriatric psychiatry. Candidates for the award must be psychiatrists who are nominated by an APA member.

Applications should include a nomination letter summarizing the accomplishments of the nominee, two letters of endorsement from APA members, a current CV and bibliography. Nominations are due Aug. 15.

Send nominations to Sejal Patel at or Sejal Patel, American Psychiatric Association 1000, Wilson Blvd. #1825, Arlington, VA 22209; 703-907-8579; fax: 703-907-7852.

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Issue of sexual consent between elderly adults with dementia proves problematic
As increasing numbers of older Americans have had to deal with dementia and Alzheimer's disease, Bryan Gruley of Bloomberg News reports that nursing homes find themselves ill-equipped to handle issues of sexual relations.

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UC Davis researchers: A second amyloid may play a role in Alzheimer's disease
A protein secreted with insulin travels through the bloodstream and accumulates in the brains of individuals with type 2 diabetes and dementia, in the same manner as the amyloid beta Aβ plaques that are associated with Alzheimer's disease, a study by researchers with the University of California, Davis Alzheimer's Disease Center has found.

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AAGP member news: Wallack publishes book on Alzheimer's
AAGP student member Max Wallack, along with Carolyn Given, recently published a book on Alzheimer's disease for children. Wallack's book is available through

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Nominations for the 2013 Dementia Care Professional of the Year Award due Sept. 1
The Dementia Care Professional of the Year Award is offered by the Dementia Care Professionals of America, a division of the Alzheimer's Foundation of America. The award recognizes individuals who demonstrate professional excellence in care, compassionate performance that exceeds expectations, and a dedicated commitment to those diagnosed with Alzheimer's disease or a related dementia. Past winners include a horticultural therapist, an LPN and a certified elder crime practitioner, all of whom truly define care, compassion and commitment in the dementia care community.

The deadline for nominations is Sept. 1, so submit your nomination today. Visit to complete a nomination form. Individuals may be nominated by more than one person, so spread the word among your peers, colleagues, employers, clients and their families. Thank you for taking the time to recognize the individuals who are changing the field of dementia care for the better.

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National Memory Screening Day is Nov. 19
The Alzheimer's Foundation of America welcomes health care professionals to participate in the 11th annual National Memory Screening Day on Tuesday, Nov. 19. Community sites nationwide will offer free, confidential memory screenings and educational materials to the public. Here's how you can help: host a screening site, offer to be a screener, encourage people with memory concerns to be screened, post a Web banner about the event, spread the word. To learn more, visit or call 866-232-8484.
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CDC and Alzheimer's Association release 'The Healthy Brain Initiative'
On July 15, the U.S. Centers for Disease Control and Prevention and the Alzheimer's Association unveiled "The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018."

The report encourages public health officials to act now to stem the growing Alzheimer's crisis. The "Road Map" includes more than 30 action steps that the public health community can take at the federal, state and local levels over the next five years to address cognitive health and cognitive impairment from a public health perspective. Agencies are encouraged to select those actions that best fit state and local needs and customize them to match priorities, capabilities and resources. AAGP will monitor the action taken on the report's provisions.

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Findings released at the Alzheimer's Association International Conference
Studies released at the Alzheimer's Association International Conference in Boston earlier this month help illuminate Alzheimer's risk factors and point to potential new strategies for treatment and prevention.

Socioeconomic disparities may account for the increased risk of Alzheimer's among African Americans. AAGP member Kristine Yaffe, MD, of the University of California, San Francisco and the San Francisco VA Medical Center, and colleagues evaluated dementia risk among 3,075 black and white elders (mean age 74.1 years) participating in the ongoing prospective "Health, Aging and Body Composition Study" who were free of dementia at baseline. In this population, African-Americans were 1.5 times more likely to develop dementia than whites (21.9 percent vs. 16.4 percent). However, after adjusting for socioeconomic factors including education level, literacy, income and financial adequacy, the researchers found that the difference in risk was no longer statistically significant. "Our findings suggest that differences in socioeconomic factors may, in large part, explain racial and ethnic disparities in dementia rates," said Yaffe. "Future studies that investigate these disparities should take a broad range of socioeconomic factors into account." Yaffe suggested that more studies are needed "to explore the potential benefits of improving socioeconomic risk factors as a way of reducing dementia rates."

Older age at retirement appears to be associated with reduced Alzheimer's risk. In an analysis of health and insurance records of more than 429,000 self-employed workers in France, researchers found that retirement at older age is associated with a reduced risk of dementia. The researchers linked health and pension databases of self-employed workers who were living and retired as of Dec. 31, 2010. Workers had been retired on average for more than 12 years. Prevalence of dementia in this group was 2.65 percent. Analyses showed that the risk of being diagnosed with dementia was lower for each year of working longer (i.e., higher age at retirement). Even after excluding workers who had dementia diagnosed within the 5 years following retirement, the results remained unchanged and highly significant (p< 0.0001).

Most kinds of cancer are associated with a significantly decreased risk of Alzheimer's disease. In an analysis of the health records of 3,499,378 veterans age 65 and older who were seen in the VA health care system between 1996 and 2011 and who were free of dementia at baseline, the objective was to evaluate the relationship between a history of 19 different cancers, cancer treatment and subsequent Alzheimer's disease. Researchers found that most types of cancer were associated with reduced Alzheimer's risk, ranging from 9 percent to 51 percent. Reduced risk was greatest among survivors of liver cancer (51 percent lower risk), cancer of the pancreas (44 percent), cancer of the esophagus (33 percent), myeloma (26 percent), lung cancer (25 percent) and leukemia (23 percent). Cancers that did not confer a reduced Alzheimer's risk, or were associated with an increased risk, included melanoma, prostate and colorectal cancers.

Metformin, a medication for type 2 diabetes, may be linked with lower Alzheimer's risk among type 2 diabetes patients compared with other therapies. Colleagues at Kaiser Permanente Division of Research studied a cohort of 14,891 type 2 diabetes patients age 55 and older who began diabetes therapy between October 1999 and November 2001. Only patients who started a single therapy (metformin, sulfonylureas, thiazolidinediones or insulin) were included. The patients were followed for up to five years. Patients initiating metformin, an insulin sensitizer, had a significantly reduced risk of developing dementia compared with patients on other diabetes therapies. Compared with those taking sulfonylureas, those initiating metformin had a 20 percent reduced risk of dementia, while those initiating TZD or insulin had no difference in risk. Trials are currently under way to evaluate metformin as a potential therapy for dementia and mild cognitive impairment.

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Magazine profiles AMA's RUC Process
Washington Monthly
The Washington Monthly recently published an interesting take on the American Medical Association's Specialty Society Relative Value Scale Update Committee, which helps set Medicare payment rates. The article "Special Deal: The shadowy cartel of doctors that controls Medicare" is online at:
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Alzheimer's blood test edges closer
Researchers believe they are closer to developing a blood test that could diagnose Alzheimer's. There is no definitive test for the brain-wasting disease. Doctors rely on cognition tests and brain scans. A technique published in the journal Genome Biology showed differences in the tiny fragments of genetic material floating in the blood could be used to identify patients.
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Issue of sexual consent between elderly adults with dementia proves problematic
VideoBrief As increasing numbers of older Americans have had to deal with dementia and Alzheimer's disease, Bryan Gruley of Bloomberg News reports that nursing homes find themselves ill-equipped to handle issues of sexual relations.
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Alzheimer's pathways could offer drug targets
Researchers have identified key molecular pathways that lead to late-onset Alzheimer’s, the most common form of the disease. Much of what is known about Alzheimer’s is based on laboratory studies of more rare forms of the disease.
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