Use of third party vendors reviewed in wake of stabbing spree

By Pamela Berard
July 1st, 2016

The state is conducting a review in the aftermath of a stabbing spree that ended at Silver City Galleria mall in Taunton, Mass., that left three people dead and several others injured.

Family members of the man accused of the stabbings – who was shot and killed during the May 10 incident after reportedly stabbing several individuals, two of whom died – reported that he had been taken by ambulance to Morton Hospital the night before for psychiatric issues and was released early the following morning, the day of the attacks.

In a statement following the incident, Morton Hospital, part of the Steward Health Care System, acknowledged that under federal law, it is barred from acknowledging patient names or disclosing confidential patient information, and that extends to patients whose evaluations and assessments are legally required to be led and conducted by third parties selected through MassHealth.

But the hospital statement indicated, “If the state contracted agency responsible for conducting evaluations in the Emergency Department had requested an admission to a psychiatric bed, there were beds available within the hospital’s network.”

The statement said the hospital “has been advocating for years that the state review and revise its policies that require outside third party vendors to evaluate and determine the course of treatment for Medicaid patients in emergency departments. As we have said in the past, the current policy mandating that the evaluation process must be carried out by a third party state contractor is misguided.”

For several years, we have asked that our hospital and others be allowed to direct these assessments independently through qualified psychiatrists, clinicians and other medical personnel who have been subject to the hospital credentialing process, peer review process and the policies that guide the care of every other patient – and not through an outside state contracted vendor who we do not choose,” the statement continued.

Michelle Hillman, director of communications for the state Executive Office Health and Human Services, said the review of this incident was expected to be completed by the end of June.
In an email response to questions from New England Psychologist, Hillman said Emergency Service Providers (ESP) provides mobile crisis intervention services to Emergency Departments upon request for all uninsured individuals as well as those enrolled in or covered by the following payers: MassHealth plans including the PCC Plan (MBHP), the MassHealth-contracted MCEs and MassHealth fee-for-service or “unmanaged” plans, OneCare, CarePlus, DMH only, Medicare, and Medicare/Medicaid.

Across the state, 21 emergency services programs operating under agreement with MassHealth conduct 136,000 in-person psychiatric clinical assessments of individuals each year in the community and emergency rooms, Hillman said.

On May 12, Morton Hospital issued a second statement, indicating that it had “banned the state selected sub-contractor Norton Emergency Services AKA Taunton/Attleboro Emergency Services (NES/TAES) from evaluating or recommending treatment for any patient at Morton Hospital.”

NES/TAES is subcontracted through MassHealth and is charged by law with the responsibility of evaluating MassHealth patients who enter the Morton Hospital Emergency Department, according to the statement, which indicated that Morton Hospital had informed state agencies of its decision to unilaterally bar NES/TAES from evaluating patients at Morton Hospital.

“Effectively immediately, we will provide our own evaluation services conducted by licensed and credentialed members of our staff who are subject to peer review and direct oversight,” the statement read.

The Morton Hospital statement did not link its decision to, or reference at all, the May 10 event. Hillman said that Morton Hospital “cannot ban the ESP.”

“MassHealth has a longstanding requirement that acute outpatient hospitals ensure and facilitate access to ESP services for MassHealth members. MassHealth managed care entities (MCEs) are required to provide immediate and unrestricted access to ESP services for enrolled members 24/7, wherever a member presents,” Hillman said.

However, Hillman added, “In response to Morton’s request, MassHealth and Morton have implemented a pilot project to temporarily allow Morton to directly provide all assessment and crisis intervention to members who arrive at the Morton ED.”

While he said he does not have enough firsthand knowledge to comment on the specifics of this case, Michael A. Goldberg, Ph.D., director of professional affairs for the Massachusetts Psychological Association, said, “We are concerned about the level of training and qualifications of staff who are evaluating complex high risk patients and hope that the state will review these concerns.”

“Like most policies there are positive and negative consequences of the state’s use of outside vendors to evaluate MassHealth patients presenting for emergency services. It is highly unusual to require a hospital to wait for an outside agency to send professionals, often with lower levels of training than staff personnel, to provide the actual evaluation of a patient.

Having this process for psychiatric services only raises concerns about compliance with the spirit of mental health parity. I am hopeful that the new administration is reviewing this and other longstanding MassHealth policies and will make changes that improve the quality of care for the mentally ill,” Goldberg said.

2 Responses to Use of third party vendors reviewed in wake of stabbing spree

  • July 12th, 2016 at 9:51 am Kathy Herzog posted:

    To be clear, the crisis team from Taunton-Attleboro that has a contract with MBHP to perform risk assessments and so-called “screenings” for inpatient treatment is not a third party provider; rather, they are a team of social workers and LMHC’s who are direct (not vendored) employees of the Department of Mental Health. They are not, as Dr. Goldberg surmises, “outside vendors” who possess “lower levels of training than staff personnel,” but actually highly experienced and seasoned mental health professionals who have a long term working relationship with many of the stake holders in the community, including Morton Hospital. It is likely, on the night in question, that the evaluator who was dispatched to the hospital had been there many times before, and knew the ER physician and other staff there well, and that they had all worked collaboratively on many mental health cases in the past. That does not mean, however, that MBHP’s policy of having all their members evaluated twice (once by the facility they are sent to, and once by a crisis team professional) is a good system of care– it was borne out of a desire to try an save money by limiting inpatient admissions, and not with the intention of improving access to care and treatment. The practice now raises questions about parity in regards to access to healthcare. This is where the focus should be placed– not on the personnel staffing crisis teams.

  • July 12th, 2016 at 9:58 am Kathy Herzog posted:

    Two points: 1) Contrary to what Dr. Goldberg states, the Taunton-Attleboro crisis Team is directly run by DMH and consists of social workers and LMHCs who all have years of experience performing risk assessments (they are certainly do not possess a “lower levels of training than staff personnel). 2) It is highly likely that the crisis team staff person had a long-standing working relationship with the medical staff at Morton Hospital, and that they had all worked on complex psychiatric cases together many times in the past.
    What is more important, but this article somewhat misses, is the fact that MassHealth subscribers are required by MBHP (the carve out for mental health and substance abuse services) to get evaluated twice– once by the facility and once by the crisis team. This creates a lack of parity in regards to access to mental health services.

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