Some mental health advocates in Kansas see a silver lining to Osawatomie State Hospital losing its Medicare payments: a chance to redesign a system they say was already strained and underfunded.
The Centers for Medicare and Medicaid Services announced in December it would decertify Osawatomie, meaning the hospital no longer would receive about $1 million in monthly payments from Medicare to care for patients with severe mental illnesses. Federal surveyors pointed to what they called widespread security problems.
Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said the state still is evaluating its options for Osawatomie and hasn’t decided if it will seek recertification. The hospital continues to care for patients, and KDADS is working with community mental health centers as it has since Osawatomie reduced its patient occupancy from 206 to 146 earlier in 2015 because of renovations, she said.
Federal surveyors had required extensive renovations because the design of the rooms and objects in them could give suicidal patients opportunities to harm themselves by hanging or other means.
A ‘decentralized’ system?
Rick Cagan, executive director of the National Alliance on Mental Illness Kansas office, said he hopes that when KDADS considers the cost of recertifying Osawatomie hospital with Medicare it also looks into other ways that money could be used within the state’s mental health system.
“If they are committed to getting their Medicare certification back, there’s a price tag that comes with that,” he said. “In the mental health community, there are ideas about how to better use that money.”
Kansas has two state hospitals to treat people with severe mental illnesses, in Osawatomie and Larned. Cagan said Kansans with mental illness would be better served by a “decentralized” system of smaller regional hospitals, with one or two centers that fulfill the same role that institutions like University of Kansas Medical Center do for physical health.
“The state hospitals really need to be seen as centers of excellence that treat the most serious conditions,” he said.
Eric Harkness, a member of the Kansas Mental Health Coalition board, said he would like to see the state invest in less restrictive treatment settings across Kansas. He suggested it also invest in consumer-run organizations, which are staffed by people who have mental illnesses, to assist others before their conditions “deteriorate drastically.”
“For a number of years, there hasn’t been enough access to inpatient psychiatric beds. One system depends on the other, and they’ve both been under a lot of stress and strain.”- Bill Persinger, CEO of Valeo Behavioral Health Care in Topeka
Others, however, said recertifying Osawatomie should be a priority. Sharon Sawyer, executive director of Rainbow Services Inc., a crisis facility in Kansas City, Kan., said she hoped the state would seek recertification for Osawatomie “as soon as possible.”
Sawyer said Rainbow has seen an increase in patients with more acute symptoms since Osawatomie restricted admissions last year.
Rainbow can stabilize patients in mental health crises for up to 10 days if they receive services voluntarily and don’t pose a danger to others, she said. After that, Rainbow attempts to connect them with outpatient resources.
“We’re a bridge,” she said.
Similar issues in other states
Other states are struggling with similar decisions about how to deliver mental health services.
The second-largest psychiatric hospital in Minnesota may lose $3.5 million in annual Medicare and Medicaid payments after federal inspectors identified safety concerns there. Washington’s largest mental hospital was threatened with a loss of its CMS dollars multiple times last year for similar reasons.
Vermont attempted to decentralize its mental health system after Tropical Storm Irene destroyed its state psychiatric hospital in 2011. Local hospitals say the transition has strained their emergency rooms.
No matter what happens with the Osawatomie certification, the state should invest more in its mental health system, said Bill Persinger, CEO of Valeo Behavioral Health Care in Topeka. Spending has been largely flat for the last four or five years, he said, but had declined by millions in the years before that.
Kansas no longer has as many for-profit and nonprofit hospitals treating people with mental illnesses as it did in the past, Persinger said. That means both state hospitals and community mental health centers have to care for a larger segment of people with mental illnesses, and resources haven’t kept up with need, he said.
“For a number of years, there hasn’t been enough access to inpatient psychiatric beds,” he said. “One system depends on the other, and they’ve both been under a lot of stress and strain.”
Persinger credited KDADS for working with community mental health centers to reduce the effects of the reduced patient count at Osawatomie. But he said over time mental health centers have coped by channeling resources toward crisis situations. Sometimes that comes at the expense of longer-term housing or employment programs that prevent people from returning to a crisis situation, he said.
“Our crisis care system is strained,” he said. “Imagine if, in the realm of physical medicine, we only had an emergency room.”
Cagan agreed that Kansas should invest more in community mental health resources. Doing so could reduce strains on the state hospitals by preventing people’s mental illnesses from progressing to a point where they need that level of care, he said.
“We could take some of the pressure off Osawatomie and Larned if we offered services to people with the most acute needs,” he said.