CMS to Enhance Access to Care for Severe Mental Illness

Very, very good news indeed.

Application Process for New Emergency Psychiatric Project Begins
Deborah Brauser

August 12, 2011 — The Centers for Medicare and Medicaid Services (CMS) has opened the application process to states who want to be involved with a new project, designed to increase resources and quality of care for patients with serious mental illnesses.

The 3-year Medicaid Emergency Psychiatric Demonstration will provide federal matching funds to individual states for emergency care of Medicaid-covered adults between the ages of 21 and 64 years at private inpatient psychiatric hospitals with at least 17 beds.

"The demonstration defines psychiatric emergencies as expressions of suicidal or homicidal thoughts or gestures resulting in a determination that the patient is dangerous to himself or to others," said a CMS release.

The Patient Protection and Affordable Care Act of 2010 will provide $75 million to the new demonstration to determine whether it will improve access to psychiatric treatment, lower costs, and reduce crowding in general hospital emergency departments (EDs). At the end of the 3-year trial period, the CMS will make recommendations to the US Congress about the feasibility of offering the program nationwide.


more at link:

http://www.medscape.com/viewarticle/747944

even if it helps people. Particularly if it helps people, specifically the non-wealthy.

Perry being what he is.

Even if Texas doesn't sign up, I am glad that mental health is being addressed, finally. Too many people suffer too much.

that are reducing and eliminating medicaid because so many people of all a ges are unable to handle the stress of the madness of the world.

already have no place to go? The acute facilities dump them after a week or so and there is no place for them to go except back home or to the streets.

That should lessen the pressure on current facilities to move patients out too quickly or send them out of ER's without appropriate treatment.

No doubt that lack of services, including housing, for the chronically ill will remain a huge problem, but this is a good start, imo.

We are underpaid (the facilitys' reimbursement), but more money won't help with access. All the beds in the state run at or near capacity over 95% of the time. And those are all private acute beds. The 2 state hospitals are full 100% of the time except for waiting for the incoming to get there when they discharge someone. It isn't like this amount of money is enough to build any beds anywhere.

The situation you describe is national, but one of the biggest issues has been lack of reimbursement for medicaid or medicaid eligible patients. Most freestanding private facilities have made it almost impossible for these patients to access their facilities. As they are for profit facilities, access to funds to pay for these patients will most certainly give them incentive to open more beds.

The problem with access has always been a financial one and has just gotten worse and worse over time.

Do you have a better solution?

all hospitals here are non-profits and this state's version of medicaid pays us for them to be there. Medicaid alone accounts for over 50% of our patients at any given time and often closer to 75%. Then we have the "FreeCare" patients that aren't even eligible for Medicaid. Even if our reimbursement went up by 50% AND we got paid in a timely fashion, we couldn't afford to add more beds. In fact, we recently closed 33% of our adult beds to increase the number of children's inpatient acute beds. What we need is investment in infrastructure such as more hospitals. Quite frankly, even if we added 100 beds (more than most inpatient psych hospitals here have), we'd still have a huge backlog of patients waiting for a bed and often travelling (often in ambulances at the public expense) 200+ miles to get the next open bed. The situation is even worse for the severe chronically ill such as those with schizophrenia/schizoaffective.

hospitals do not take Medicaid at all, so this program is really targeted there.

From the article:

Previously, Medicaid patients had to receive services in settings other than private institutions for psychiatric conditions, such as in EDs. This exclusion has been cited as a contributing factor in increasing "psychiatric boarding."

As reported recently by Medscape Medical News, psychiatric boarding occurs when mentally ill individuals are kept in an ED for several hours or even days as they wait for appropriate health services to become available.

"The Affordable Care Act was clear in its charge that we must continuously strengthen our commitment to parity in mental health, which remains one of the most silent yet pervasive conditions affecting millions of Americans," said Donald M. Berwick, MD, administrator for the CMS, in the same release.



In the states that I am very familiar with, there is no doubt that this will open more beds and relieve ER boarding and the long transports which you describe.

I feel for you and am sorry that this won't directly address the problems in your state.

that they will run into the same situation that we have. A couple years ago, my facility added 10% to our capacity designated as an "observation unit" to take patients directly from police, agencies, outpatient referrals, etc so that they never went to an ED. The idea was to provide 8-24 hours of assessment to decide if they really needed to be inpatient. The sad fact of life was that nearly immediately it became full of acute patients waiting for an inpatient bed and never reduced the ED load in the least. Currently, patients sit in there, usually 3-4 days, but not infrequently longer waiting to get an inpatient bed somewhere.

In short, psych beds are so far below needed capacity that little steps are so insignificant as to be meaningless. Yes, more money is needed, but it needs to be in large enough doses to build entirely new facilities and many of them.

Heck, we only have 30 or so true forensics ("criminally insane") beds in the whole state. Their waiting list is months to years long for an opening. I really don't like having murderers on my wing for extended periods, but that is the case because the state forensic unit is always full. It kind of makes being the only male nurse on my shift a bit more exciting than I'd like it to be sometimes.

All I can say is that this is a demonstration project that has been needed for a long time. If successful at achieving the results it predicts, it is the plan to expand it.

We have to start somewhere. After fighting this battle at all levels of the political spectrum for most of my adult life, I see doing something as a lot better than doing nothing (which has been what has happened).

Not enough? You bet. A good first step? Yes, imo.

but if you really want results, take every member of congress and glue their ass to an inpatient psych nurse for one shift. They will be horrified at what we see, what we deal with, and just how acute patients still are when they are discharged to make room for someone worse off or court-ordered to be accepted. One of the worst feelings I get is when I sign paperwork as "discharged to street".

who take care of psych patients these days.

Keep the faith and pay attention to what the Republicans will try to do to Berwick. If he had his way, he would probably do exactly what you suggest to the members of Congress. Better yet, put them in as patients for a day or two.

:hi:

Heck, with their grandiosity, delusions, and obvious axis II disorders, I could keep most of congress in my facility against their will for weeks, until they were transferred out for being treatment-resistant with little hope of recovery, lol.

Thanks for letting me vent. As rough as it can be dealing with a unit full of folks with severe mental health issues, it is harder for me to deal with what we (the "system") does to them.

you were supposed to notice this.

:shrug:

where private facilities don't accept Medicaid, but in places that already do, it really doesn't appear that it will do anything to help the patients or the facilities. To us, this is just feel-good smoke and mirrors that has no benefit, and allows someone to say "we are working on the problem, see?".

to even begin to address this problem is notable, IMO.

He is the gem of the Obama administration, appointed furtively while Congress was out of session to insure that he had the job. There is no one else like him in this country, imo. And, sadly, the Republicans are probably going to remove him at the end of this term.

Once that happens, you can kiss any further progress in this area goodbye.

I recall a couple of patients that were obviously released way too soon because they didn't have the insurance to keep them there. They ended up back on the street. I assume this because I know they came in homeless. I also watched the 'Monday Morning Cleanup' when they'd clear as many beds as possible for the upcoming week. It was less about seeing that every patient had the proper care they needed and more about just managing the general population.

My new med cocktail would normally require being monitored in a psych ward but I can't afford to do that with the high deductible.

I could go off on a long rant but it would fall on deaf ears. We, the severely mentally ill, are shunned by the "normal" people. No one really gives a fuck.

group of people in this country, imo. No one wears ribbons, has telethons or even speaks up for them.

I hope that what CMS is doing here helps in some way to lighten your load. There are some people who give a fuck, just not many and virtually none in government where the rules get made.

If we need a 3 year study to determine if additional funding is needed for Mental Health care in this country then we don't understand the problem. I appreciate you bringing this news and your responses to others but I'm very cynical when it comes to anything like this.

Without proper outpatient support it's all kinda' 'Cotton Candy'. We need to provide complete care. Not just more beds so we end up doing the same thing that's going on now, just on a larger scale.

The ONE place well over a million people with no insurance can get help for mental illness.

The project will provide money for patients to be treated in private facilities. Formerly, medicaid did not pay for care in private freestanding psychiatric hospitals, so they made it their business to do everything they could to not take these patients (like not having emergency rooms).

This is a huge and much needed step, imo.

Will there be outpatient treatment for the patients after suicidal/homicidal attempts? mental health goes way beyond an ER visit.
I took care of many,many "failed" suicide attempts and accidental overdoses. There is simply NO WHERE ELSE to send them.According to this, psychiatrists will manage these patients as emergent...if their hospital has space.I may be interpreting it incorrectly.
Without outpatient treatment,suicide-attempts tend to repeat..especially if their medicines aren't followed closely.

out patient treatment, housing and other supports will still be problematic.

BUT, it is the first positive step towards addressing the critical problems of overcrowded ER's, lack of in patient beds for acutely ill patients and the prison system being used to provide care to so many mentally ill. Nothing has been done to address this previously and I think it bodes well that CMS is finally taking the issue seriously.