More About Health Insurance and Mental Health Care

On Friday I discussed the article in The Dayton Daily News to close Greene Memorial Hospital's psychiatric facilities.  Today there is another health care related article in the DDN, this time about a nonprofit organization from San Fransisco's efforts to push value-based health-care reform for the state's Medicaid program.

The Dayton Daily News isn't exactly a bastion of stellar journalism, so it took me a little bit of interpreting to figure out exactly what this means.  As near as I can tell, "value-based health-care reform" means shifting the bulk of the state's Medicaid contract payments to managed care providers who can prove that they're effectively treating their patients.  So, rather than blindly handing out money, providers will have to be able to prove that they are "adding value" -- i.e., they actually are providing services that are making their patients healthier.

Could it be that this is actually a good idea?  It kind of sounds like it, at least to me.  This article from 2009 in the New England Journal of Medicine  discusses value-based health care system as an effective strategy for health care reform, and makes a pretty good case as to why it's the best way to look at reforming the system.  The author says, and this makes perfect sense, that true financial savings in health care reform are really only achieved in health care reform if it's savings through good outcomes of services -- not through cost-shifting and restricting services.  So if Ohio is truly committed to reform through value-based health care, there really are a lot of potential places to save money and improve the current Medicaid system.

What troubles me about the article is that while the program won't "cost the state money" (the author seems to stress this point a little too vigorously), state officials don't "have quality and savings goals in place to measure success."  Any time I see a governmental goal discussed that doesn't have some sort of assessment method, I get a little worried.  And as to the question of mental health care reform, in my experience, mental health care is so trial-and-error, it may be very hard to quantify mental health treatment as a "value added" treatment--unlike, say, treatments for diabetes or heart disease. 

But, hey, maybe it's still a step in the right direction.  Gotta start somewhere.

Anyhow, I got way off topic. No more boring discussion of health care or health care reform for the rest of the week, I promise.

The "New Reality" is Cuts to Mental Health Care

Sad but true

Yesterday, an article in the Dayton Daily News discussed the closing of the inpatient psychiatric care facilities, as well as cutting back on some outpatient psychiatric services, at Greene Memorial Hospital, a member of the Kettering Health Network.  Patients formerly taken in by Greene Memorial will now be directed to Kettering Behavioral Health Center (the same facility that told me, when I was pregnant and walked in for an evaluation, they could "not ethically" let me leave because I was a threat to myself and my baby...and less than 20 minutes later dismissed me out of hand, because they could not admit me because I was pregnant and pregnancy was considered a medical condition they could not accommodate.  But that's a different story).

A spokesperson for the Kettering Health Network said that "'the new reality is that hospitals will be required to care for more patients with less reimbursement.'"  To get a general idea of how many mental health patients Greene Memorial usually services, the article mentions that they discharged 508 psychiatric patients in the "first 11 months of 2011."  According to US News and World Report, Greene Memorial Hospital has a total of 185 beds across all services, so it's a safe assumption that only a small percentage of these beds are in the psychiatric inpatient unit.  So the bottom line is that the area may be losing only a few total psychiatric inpatient spaces -- but when you've only got a few to start with, every space matters.

What's especially telling is that the amount of bad debt that Greene Memorial faced increased in the past few years, to a whopping 30% -- this while its patient volume actually decreased by 13% (these stats from the same article as I mentioned before).

Here's the naked truth:  mental health care is messy.  As I talked about when I discussed the closing of the Twin Valley Behavioral Health Center and replacement with the new Access Dayton mental health facility, many of the people in the mental health care system are also in some way involved in the courts/legal system -- meaning they have Medicare or Medicaid.  Thus we are right back around to the crux of the problem:  hospitals don't want to treat patients with Medicare, Medicaid, or other similar health insurance.  And it's no mystery why -- it's because the hospital very often doesn't get the reimbursement it needs to keep its services running, which then puts them at a deficit for other services, which messes with their financial solvency, etc. etc.   

I don't usually get real political on here, mainly because if I was pressed to profess an allegiance to any party, I'd say I'm in the Voter Apathy Party and I really just can't be bothered to sift through all the parties' crap to see what I really believe in.  But when I start talking about mental health care, it's a no-brainer.  Our health care system is broken.  It needs to be fixed.  I'm not exactly sure how to do that -- it's like moving a mountain with a teaspoon -- but just because it's a hard job isn't a good enough excuse to not do it.

Almost exactly a year ago, a state trooper  was responding to a disturbance at a trailer park near here (up towards Springfield), and was shot to death in a standoff-then-shootout.  There was much public outcry when it came to light that the shooter been in a shootout almost ten years before, then served two years in a mental institution after being found not guilty by reason of insanity.  Law enforcement called for a more accessible database of offenders found not guilty by reason of insanity, so the officers knew better what kind of situations they were walking in to.  Gee, I have an idea -- let's try to help these ill people so they aren't in another shootout.  I know, crazy -- but just crazy enough to work, maybe?

On a more national scale, one can point to the shooting of Arizona Congresswoman Gabrielle Giffords (and others) almost exactly a year ago, and all the discussion around the fact that the shooter, Jared Loughner, should have been receiving mental health care but wasn't, according to this NPR article, because of the stigma attached to mental illness.

Advocating for mental health care is not just about "taking care of our brothers and sisters," which clearly isn't a good enough reason for many people to take it seriously as a cause (though for those people who consider themselves Christians, it should be).  Mental illness, perhaps more than many other kinds of illness, has far-reaching tentacles that does not stop at the sufferer.  Failure to attain treatment for mental illness can reach far, affecting completely anonymous, innocent bystanders in the most horrific of ways. 

Unfortunately, with the constant closing of mental health facilities like Greene Memorial, Twin Valley Behavioral Health Center, and others all across the nation, I suspect it's going to get worse before it gets better.