by Scott McIntyre on Tuesday, February 16, 2010
3Iowa’s already-struggling mental health care system has taken another hit , as Ellsworth Municipal Hospital (EMH) in Iowa Falls announced that, within the next two months, it would be closing its inpatient behavioral health service and its chemical dependency program.
This was not an easy decision for EMH leaders to make. Only a handful of mental health programs like these exist in Iowa and the services at EMH are heavily used by patients from all over the state. In fact, only 15 percent of the hospital’s inpatient behavioral health patients come from Hardin County. This is no surprise; after all, 83 of Iowa’s 99 counties are considered mental health professional shortage areas. With only about seven practicing psychiatrists for every 100,000 residents, Iowa ranks 47th in the nation for access to mental health care.
In Iowa Falls, EMH has done all it could to keep its inpatient program functioning. The hospital streamlined the program, reduced staff and discontinued its transportation program. But because of lagging reimbursement, particularly from Medicare and Medicaid, the program has been a drain on overall hospital finances. This is a problem for all Iowa hospitals offering behavioral health services, but the impact is much greater for small facilities like EMH, which do not have the patient volume to make up for the losses. This is why only a handful of these small hospitals offer any kind of behavioral health program (inpatient or outpatient).
The good news for people in and around centrally located Hardin County is that inpatient behavioral health services in Des Moines and Waterloo are relatively close by. For much of the rest of Iowa, particularly in the western half of the state, the distances are much greater.
What needs to be done? IHA is advocating for programs that would attract more psychiatrists to the state, such as student loan repayment programs. Expanding telemedicine services through high-speed Internet would allow more patients to utilitize online counseling rather than having to travel to urban areas where behavioral health programs and practitioners are concentrated. IHA has been steadfast in pushing to keep the state’s mental health institutes in Cherokee, Clarinda, Independence and Mount Pleasant open – Iowa needs more access to mental health services, not less.
IHA also continuously advocates for increasing Medicare and Medicaid payments to hospitals and doctors. Hospitals lose millions of dollars each year because these programs do not cover the full cost of care.
I was saddened by this news. I, too, have had numerous contacts with state legislators, representatives from the Dept. of Human Services and Magellan Behavioral Care of Iowa, and received the same responses. It seems unconsionable that those entrusted to develop public policy turn a blind eye to the not-for-profit Iowa-based organizations that provide services to Iowans in need, and that employ Iowans in good jobs, and remain unconcerned about these closures. Yet, they think it is good policy to contract with a for-profit company that distributes $4 million annually in extraordinary dividends, earns a $1 million bonus annually (recall the legislators’ reactions to other much smaller bonuses paid by the State of Iowa) on top of the contractual $13-14 million annual compensation, and has earned untold millions of dollars on unspent claims funds and community reinvestment funds over the past 15 years. How much interest can be earned off unspent funds that generally run about $35 million and has been as high as $51 million? How many services could have been provided to Iowans in need who instead wait on lists to be served? How many Iowa providers might still be in business if a few of these unspent dollars had been used to defray the cost of services? Wake up legislators and follow the money.
I would like to add to Neil Fagan’s excellent response that those individuals covered by Magellan, due to the chronicity of many mental illnesses, also comprise a higher percentage of those needing more prolonged hospitalizations to attain stability and often require higher levels of supervision and hospital resources. The adults covered by Magellan are often disabled and suffer from other comorbidities such as traumatic brain injuries and/or multiple physical ailments, again increasing the intensity of services they require.
While I am saddened by the recent events, one must weigh how sustainable these programs are with Iowa’s deficit issues along with the costs on society when we are NOT assisting these people. While the Des Moines and Waterloo locations are still open there is no mention of the current capacity constraints of these facilities as well as the one closing in Iowa Falls. Are the two facities left behind able to handle the volume of patients effectively? In many similar situations, the cost to society of not assisting these people is far more expensive then helping them.