David Matteodo is executive director of the Massachusetts Association of Behavioral Health Systems (MABHS). A non-profit trade organization that represents the interests of 44 inpatient hospitals and units that provide psychiatric or substance abuse services in the Commonwealth, the MABHS was created in 1989 to advocate for and protect the interests of its members.
The group works with state legislators on bills ranging from those that affect reimbursement rates to placement issues with state-run services.
New England Psychologist’s Catherine Robertson Souter spoke with Matteodo about his role with the organization and the group’s goals and successes and the status of inpatient psychiatric care in the state.
Q: The MABHS was started by several Massachusetts independent psychiatric hospitals. How large is the group you represent now?
A: The organization was formed by freestanding psychiatric hospitals in 1989 and then 15 years ago expanded to include general hospital psychiatric units such as Mass General. We now go from the Berkshires to the Cape and we have a total of about 2,000 beds. We represent the majority of beds in Massachusetts as part of our group and we meet quarterly and so forth.
The purpose of the group is really to create the best environment for our inpatient system. My responsibilities have to do with advocacy and lobbying and analyzing trends in terms of future developments. We want to enhance the business ability for the hospitals to succeed both financially and in terms of serving the patients.
Q: Personally, what led you to take on this role?
A: I have been here for 25 years, starting in 1990. My background includes a master’s in public health and I worked in the State House in the 1980s as assistant budget director of the House Ways and Means Committee. So, this position was really a good match of my skills and interests. What attracted me to the job was the ability to advocate for the mentally ill and people with substance abuse disorders. I testify on 20-25 bills a year and I am involved with virtually everything that impacts behavioral health for both inpatient and outpatient care.
Q: Is this organization unique or do all states have something similar?
A: There is a national association of psychiatric health systems that serves the whole country but I do not know if other states have exactly what we have. It is safe to say that it is not a common thing for states to have an association like this. Many hospitals belong to state-wide hospital associations but here we are a separate entity. We are not part of the Massachusetts Hospital Association although we work closely with them.
Q: What are the current goals of the organization?
A: Right now, we are working on the state budget. This is very current because the governor has proposed his budget which did not include any increases for our hospitals. The House Ways and Means budget is coming out today (4/15) and the Senate will have their budget process in May. Then they will try to resolve differences.
My first job is to try to get rate adjustments from MassHealth because our costs are going up.
We have also filed seven bills this year and there will be hearings on those later this spring, summer or fall depending on when the hearings get going. We will be advocating for those bills as well as monitoring any other legislation that might come up that would impact our hospitals.
Q: What are the seven bills?
A: They basically fall into two categories – reimbursement and access. We have reimbursement bills that have to do with mandating an inflation rate increase every year, full payment for stuck patients and reimbursement for interpreter services. On the access legislation side, we have HB1795, an act to grant medical necessity determinations to the attending clinician versus the reviewer in a managed care firm. We got this provision passed last year for inpatient substance abuse care and we would like to see that happen now as well for psychiatry.
Q: That seems like a major win for substance abuse/mental health care.
A: It was a huge provision in the substance abuse bill. We were able to get three provisions in this law which will be effective October 1. The first states that there will be no prior approval required for admissions. The second is that medical necessity will be determined by the treating clinician and the third major provision is that they get 14 days of service and no utilization review until day 7.
Some of those provisions we would like to see in the mental health area as well. The reason why substance abuse was so prominent in the legislature last year was because Massachusetts, like many other states, has a real problem now with opiates and the legislature felt compelled to take some action in terms of access provisions. Plus, we had made the case that insurance companies were not being as helpful as they could be in that regard.
Q: The same push may not be there for mental health care, though.
A: It will be a difficult fight. Managed care has firm roots in behavioral health and they did not favor the substance abuse legislation. They fought it mightily and the only reason we prevailed is because of the enormous crisis. This will be difficult but given parity and the need for integrated care, the system is gradually changing. We think it is important to get these concepts out before the legislature because behavioral health has been micromanaged for years. It is going to be an uphill climb but it was also an uphill climb for the substance abuse provisions.
Q: Beyond working on legislation, you mentioned that you are also keeping track of trends that may affect member hospitals. What else are you seeing that is of concern?
A: The good news is that the Department of Mental Health hospitals in Massachusetts are now fully operational. There were 52 unfunded and empty beds in the new Worcester State Hospital that are now open. They are also moving patients out of state hospitals that could be better served in the community. Our whole patient flow is impacted by this because if DMH facilities are full, we cannot move patients who need more long-term care from our acute treatment programs. I am happy to say that situation is improving.
The other thing that is of interest in Massachusetts is that there will be a number of new beds soon to open. There are two private hospitals going to open in the southeast part of state. Highpoint will have a little more than 50 beds where they are renovating a new facility in Middleborough. In the New Bedford area, a company which is not part of my group, Acadia, is building a brand new psychiatric hospital with 120 beds. There have also been proposals to develop additional beds at McLean Hospital and at Fort Devens Federal Medical Center in Concord.
Q: It is good to hear positive news about this sector of mental health care.
A: Well, there is still a lot of strain on the system because there is a huge demand for services but the inpatient system is doing its very best to respond to these demands. More people have insurance coverage and parity is slowly changing things. Geriatric psychiatry has been another area of growth.
Unfortunately, people need services often because of drug addiction and substance abuse. The market itself is responding by trying to create new facilities to serve these patients. And, for us, we are working to respond to the increased demand and we need the resources to do that.
By Catherine Robertson Souter