October 1st, 2014

Inpatient care to expand

Thanks to several health care providers, Massachusetts will soon experience remarkable growth in inpatient psychiatric care across the state. The news comes at a time when the state has shed more than 40 percent of its publicly-funded psychiatric beds over the past decade, according to a report released in April by the Massachusetts chapter of the National Association for the Mentally Ill.

As part of a plan to invest millions in capital expenses across its system, Steward Health Care, the second largest healthcare system in New England, will increase the number of behavioral health beds by a reported 20 percent by the end of the year. The company has added 40 beds for adults with mental illness or substance abuse disorders and plans to add another 30 this year, according to one report.

In addition, Partners Health Care and Tenet Healthcare will also see expansion in their mental health care facilities, adding 53 and 29 beds, respectively.

Steward, a private, for-profit company, which was established when the Caritas Christi Health Care system was sold to Cerberus Capital Management in 2010, has not publicly released details on where the new beds will be located or what types of staffing increases they will see. They do foresee new roles for psychologists, says company spokesperson Brooke Thurston, vice president of media relations, along with the added capital investment.

“Since 2010, we have invested approximately $25 million in capital expenses (e.g. adding beds, renovated facilities for BH services, etc.) across our system to address the behavioral health needs of the populations we serve,” she says. “In the communities that we serve, a significant number of patients need behavioral health care and that’s why we are making this investment. Many patients arrive in emergency rooms in crisis and we need to ensure that inpatient beds are available to meet their needs.”

According to Thurston, the expansion makes sense because of the way that Steward bills insurance companies. Providing care all along the continuum also helps to keep services in house, thereby reducing costs.

“Steward is an accountable care organization,” she says. “We are paid a lump sum to keep an individual patient healthy and take care of all of his or her health care needs within a given year.

“Our behavioral health expansion is an example of what it means to be an accountable care organization. Financial incentives are appropriately aligned to do the right thing for our patients.”

In a system strapped for funds, it may take a private company turning a profit to get that investment if public funds are not forthcoming.

“Funding for mental health programs has historically been a huge concern,” says Robert Master, M.D., chief executive officer of Commonwealth Care Alliance, a non-profit organization that oversees health care for 16,000 disabled adults. “In recent years, there have been deep cuts to spending on services for children and adults living with serious mental illness. These cuts have led to significant reductions in both hospital and community services for vulnerable individuals with serious mental illness.”

While any additional spending on mental health care would be seen as beneficial, there are those who feel that society’s attention would be better focused on community-based programs. Master points out that the stigma around mental illness has hindered the social progress that would help to alleviate many of the roadblocks to better public funding. Plus, in many cases, he adds, psychiatric patients could often be more appropriately treated in less expensive community programs instead of inpatient care.

“Medicare pays $1,100 for a psychiatric hospital day for what can only be described in too many instances as dehumanizing, impersonal and anything but a ‘therapeutic’ experience,” he says.

Even so, more investment in the system should help remove some of the burden from emergency rooms and free up beds for those most in need, says Solomon Levin, Ph.D., psychologist and co-owner of a private mental health services practice. “In principle, I believe there is a growing need and it will depend on how they structure the care. The need would have to incorporate that for children and adolescent hospital facilities and programs.”

By Catherine Robertson Souter

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