SAMHSA Director Resigns
Charles G. Curie, administrator of the Substance Abuse and Mental Health Services Administration, is resigning effective Aug. 5. In his resignation letter to President Bush, Mr. Curie lauded the president's leadership in the New Freedom Initiative and the Access to Recovery program, which he said “cemented recovery as the new framework for public policy development in mental health and substance abuse services in this country.” He also noted that “After years of debate, we have established that individuals with cooccurring disorders should be the expectation, not the exception, in our treatment systems.” Michael J. Fitzpatrick, director of the National Alliance on Mental Illness, called Mr. Curie “a leader who has been truly committed to principles of individual dignity and recovery. He understands the needs of people living with mental illnesses, and their families, and has served as our advocate.” Mr. Curie, who was confirmed for his position in 2001, was previously deputy secretary for mental health and substance abuse services for the state of Pennsylvania.
New Inpatient Rule
A new Medicare rule for recertification for psychiatric inpatients went into effect this month, but it's not expected to have a major effect on psychiatrists. The rule requires that psychiatrists recertify psychiatric inpatients on the 12th day of their stay, rather than on the 18th day as was previously required. After that, subsequent recertifications are required at intervals established by each hospital's utilization review committee, but no less frequently than every 30 days, the rule notes. “This shouldn't have much impact, in part because lengths of stay tend to be shorter than 12 days,” said Carol Szpak, director of operations and communications at the National Association of Psychiatric Health Systems, in Washington. “The median length of stay in Medicare is somewhere around 9 days, which means at least half of the cases are shorter than that.” Changing the recertification requirement to 12 days brings psychiatry in line with other medical specialties, Ms. Szpak said.
New Detox Protocol Released
SAMHSA has released a new treatment improvement protocol (TIP 45) for detoxification and substance abuse treatment. This TIP, a revision of one published in 1995, stresses that detoxification by itself does not constitute complete substance abuse treatment and that detox patients therefore need to be connected with substance abuse treatment services. “Detoxification is one component in the continuum of health-care services for substance-related disorders,” said Mr. Curie, SAMHSA administrator. “The TIP defines detoxification as a broad process with three essential components–evaluation, stabilization, and fostering a patient's entry into treatment.” The TIP is available online at
http://store.health.org/catalog/productDetails.aspx?ProductID=17398
Licensure for Drug Sales Reps?
A proposal making its way through the Massachusetts legislature would require that pharmaceutical company sales representatives be licensed by the state, and complete continuing education programs to renew that license. The proposal passed as an amendment to the state budget and was in a joint House-Senate conference report. State Senator Mark C. Montigny, a Democrat from New Bedford, has sought to pass such a licensure requirement several times over the past few years, without success. Under the latest proposal, pharmaceutical companies–and their representatives–would also be prohibited from giving gifts, entertainment, travel, honoraria, or anything of value to physicians or public officials. Violators would be subject to a $5,000 fine and up to 2 years in jail. In a statement, Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers Association, said that licensing was unnecessary because the Food and Drug Administration already regulates promotional and educational materials and that the legislation is wrongheaded because it “seeks to impose criminal penalties on what should be viewed as the important sharing of information between pharmaceutical companies and physicians regarding the risks and benefits of medicines.”
Young Adults Lack Insurance
Adults aged 19–29 are one of the largest groups without health insurance, according to a study sponsored by the Commonwealth Fund. The number of people in that age category who were uninsured rose to 13.7 million in 2004, up 2.5 million since 2000. Although they make up only 17% of the nonelderly population, this group accounts for 30% of the nonelderly uninsured, noted Sara R. Collins, Ph.D., senior program officer at the Commonwealth Fund, and colleagues. Low-income, Hispanic, and African American patients in this age group were at higher risk of being uninsured compared with whites, the authors noted. Many of the patients had insurance until they were 18, but were dropped the following year from either their parents' private policies or public programs. Full-time college students–who often continue to be covered under their parents' private policies–are the most likely patients in this age group to maintain their insurance coverage. “Health insurance coverage of young adults would be improved by system-wide changes to expand access to and stabilize coverage among the general population,” the authors concluded. “This is a relatively low-cost group to insure: Young adults generally are healthier than older adults and therefore have far lower per capita health care expenditures.”