some more about the new CPT coding

Dear Dr. Reske,

I agree with what you said.  I attended the Assembly Executive Committee meeting in Arizona last weekend and I talked about my concerns.  I mentioned that I thought the new system was bad Medicine, bad Law, bad Finances, and bad Politics.  Jay Scully, the APA Medical Director, said the APA is negotiating with the AMA and the CMS and he expects there will be some changes.  He also said he has received 1200 e-mail messges and he told me he considers it to be part of his job to handle them.  I suggest you write directly to him at since I have found his staff to be interested and confident. It was clear from the discussion that  members in various  parts of the country, particularly in some work settings like the new system. In Maryland, where plenty of us still do psychotherapy, a lot of us are upset about what we have been given and how we have been given it.

I have been predicting the codes a patient will need .  I can change the numbers at the end of the session if necessary. I don’t know how the private insurers are going to handle this.  It’s not surprising that some of them are “gaming” the new system.  I don’t participate with any, since I long ago concluded that at least some could not be trusted.

Bruce Hershfield, MD


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what to do about the new CPT codes

I’ve been watching webinars and  I’ve been talking with plenty of people, including my patients, about the new CPT codes for outpatient psychiatrists.  I attended the MPS class on the 12th; Elias Shaya, our President, spoke for almost 3 1/2 hours and I stuck around afterwards til just about 11PM.

I can’t say that I didn’t know anything in the last couple of years about the proposed change, since I’d been at a couple of meetings in NY where the advantages of  the  new system were being praised and I helped review Chester Schmidts’s book, “Procedure Coding Handbook for Psychiatrists”(4th edition) the summer before last.  I didn’t expect to have to learn how to actually implement it so fast, nor did I appreciate all of its many  details.

I think it’s a mess.  It destroys our ability to contract at a set price with our patients.  It distracts us from what we do best–to listen and to empathize and to help our patients see their problems in a new way that they can handle.  It looks to me like it was devised by someone who was not a psychiatrist–like a family physician wondering what it would be like to be one.  The idea that the session can be neatly separated into two distinct sections is an absurdity. (It reminds me of Mark Twain’s criticism of James Fenimore Cooper–that he writes about the forest as though he had never been in one.) My patients almost universally condemn it as “crazy”.

It will drive me to limit my practice more to a “cash on the barrel” system, which saddens me.

I know it comes from the AMA.  Ron Burd, who was the APA’s person on the relevant committee, is a close friend and I admire him greatly.

However, I see this new coding system, with its elaborate checking system and its vulnerability to auditing repercussions, as likely to decrease the supply  of psychiatrists and especially those who trained years ago to listen, empathize, and help patients who desperately need what they have to offer them–listening, empathy, and help.


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Dear Folks,

I have enjoyed corresponding with many of you in the last few weeks

I have been in Maryland since 1974 and I have gotten to know many of you.  I was President of the MPS  about 20 years ago.  I represented you in the Assembly for 8 years, then I was elected to be Area 3 (mid-Atlantic) Deputy Rep, then Area 3 Rep.  From there, I became  Recorder of the Assembly and then Speaker-elect, and then  Speaker.   I have attended almost all the MPS Council meetings since 1981, shortly after I became Chair of “The Maryland Psychiatrist” Editorial Advisory Board. I  have served on  that editorial advisory board since 1979 and I was editor of the publication from 1983-91. I was very honored when you chose me to receive the “Lifetime of Service” award in 2003.

I have worked with many of you in different settings, first at Sheppard-Pratt, then in the state system, where I was CEO of the smallest psychiatric hospital  and then of the largest.  I have had a private practice since 1974 and have done that on a full-time basis since 1993.  I have been on the part-time faculty at Johns Hopkins and I’m still supervising Residents there.  I have also taught Residents from University and Sheppard-Pratt.   For 12 years I had a part-time practice in the York, PA area, and because of that I have been attending meetings of the Central PA Psychiatric Society for the past 17 years. Many of you have been my teachers, students, and friends.  You have told me about your concerns, many of which I’ve experienced myself.  I have benefited greatly from my involvement with the MPS, the CPPS, and the APA.  I can’t imagine what my life would have been like without it

The Assembly continues to transform itself into a year-’round organization, with frequent on-line and telephone communications and a blog that came as a follow-up to the newsletter I created as Recorder.  We are now working on international relations in addition to improving our communication with each  other and our constituents, so that APA members are getting more out of their investment in the Assembly.

I enjoyed the two years I served on the Board, as Speaker-elect and Speaker.  I know virtually all of the current members and candidates.  I learned much about its culture and how to get tasks accomplished.  For example, I co-chaired a work group that established a process for selecting a Minority/Under-represented (M/UR) Trustee.  I’d  like to get on the Board again and to see if I can work with others I know and respect to help resolve some of the many problems confronting us.  With your help, I’m confident we can do an even better job of strengthening our profession and improving the lives of the patients and communities we serve.

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Why I’m running for area 3 trustee

I’ve been in the Assembly for almost 20 years. I’ve been attending MPS Council meetings for over 30 years and CPPS meetings for about 17.  (I had a part-time practice in the York, PA area for 12 years.) I have some understanding  of the many problems we’re facing–and in particular those that are challenging those of us who are treating patients.

I’d like to get back on the Board–where I served as Speaker-elect and Speaker of the Assembly–and to see if I can help resolve a few of them. There appear to be plenty.

Here is a list of what I see coming at me in my solo private practice: learning the new CPT codes and documenting them properly, dealing with lower Medicare rates, getting to know the DSM-V, electrifying my office and putting in e-prescribing, filling out surveys for Medicare, and studying for MOC.  That’s before I earn any money–and several of these changes will cost me some.

I think the APA can do better at protecting its members and the people we serve. I’d like to try.

Please let me know how I can work with you to make our profession stronger and our patients healthier.

Bruce Hershfield

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