The state is looking for places to send the mental health patients it wants to divert from its two large psychiatric hospitals — particularly crowded Western State Hospital in Lakewood.
In a twist, community hospitals that have rejected taking such patients in the past are now answering the call, in part because of a possible cash influx from the state.
A bill expected to be introduced Friday (Jan. 20) in the Legislature would allow individual community hospitals to contract with the state to serve long-term mental health patients who currently get treatment in the civil wards of Western State and Eastern State hospitals.
The legislation is written by the Washington State Hospital Association, which represents community hospitals, and will be introduced by state Rep. Joe Schmick, a Republican from Colfax.
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“I think the hospitals that are willing to step up and do this are part of the solution” to ongoing mental health troubles in the state, Schmick said. “I applaud them.”
At the moment, the state-owned psychiatric hospitals serve two kinds of involuntarily committed patients: civil and criminal. Criminal, or forensic, patients are those who were committed because they have been charged with or convicted of crimes.
But Democratic Gov. Jay Inslee and many lawmakers want Western State and Eastern State to primarily treat forensic patients as part of an effort to improve safety, quality of care and capacity problems, particularly at Western State.
To accomplish that, Inslee has proposed long-term civil patients receive mental health treatment at a range of settings dispersed throughout the state. Mental health patients are better off getting treatment closer to where they live rather than at the two large centralized locations, many in the Legislature say.
If the hospital association legislation passes, community hospitals will be a new option.
Up until recently, the community hospitals have served short-term mental health patients but resisted taking the more difficult and costly long-term care patients, said state Rep. Eileen Cody, D-West Seattle, who is a co-sponsor of the WSHA’s legislation.
Chelene Whiteaker, the policy director for WSHA, said the change of heart was prompted by a desire to help solve well-known issues at Western State.
Long wait times for admission to the 800-bed hospital in Lakewood have left patients sitting in local hospital emergency rooms or jails without proper treatment, a practice known as “boarding.” And safety issues — exacerbated by cuts to staffing during the Great Recession — have invited federal scrutiny and put millions of federal dollars at risk.
“When there is a crisis, people start thinking differently about services,” Whiteaker said.
Money is a factor, too.
The rate at which community hospitals have been reimbursed by the state for patients hasn’t been enough to cover the costs of serving patients who are involuntarily committed for a longer period of time, Whiteaker said.
Adding new beds to serve involuntarily committed patients requires a lengthy and costly certification process, and treating long-term patients would require upgrades to safety infrastructure for some community hospitals, she said.
In response, Inslee’s budget plan offers a significant pay boost for community hospitals.
Most hospitals would see a 50 percent increase in their reimbursement rate under the governor’s plan, said Ralph Thomas, spokesman for the Office of Financial Management. Inslee booked $9.8 million more in his two-year budget proposal to hike reimbursement rates, and built in a federal match of $18.6 million that comes with the state money.
Schmick also is introducing a bill at the association’s request to waive the certification process over the next two years for hospitals looking to add new psychiatric beds, including involuntarily committed patients. He framed the legislation as an “immediate fix” to help add beds quicker, but said “we’ll have to go back and make sure everything is working,” he said.
For the state, the benefits of contracting are twofold. New beds for civil patients in the community hospitals aids the push to reshape Western State and Eastern State as forensic hospitals.
The state also could save money.
By contracting, Washington expects extra federal dollars that Western State and Eastern State don’t qualify for because they’re too big, said Cody, who chairs the House’s Health Care and Wellness Committee.
Cody said she has been trying to get community hospitals to take long-term mental health patients “for years” to reap the benefits of extra psychiatric beds. She even tried offering an increase in reimbursement rates about a decade ago, but the hospitals wouldn’t budge, she said.
“At that point they just said ‘you couldn’t pay us enough,’ it wasn’t worth it,” she said.
But with the expansion of Medicaid, a government health care program opened to more low-income people under the Affordable Care Act, costs to hospitals have decreased since more people have insurance, Cody said. A law that generally prevents insurers from providing worse health benefits for mental health treatment than medical and surgical care helped, too, she said.
“If (Obamacare) gets repealed and all those people lose insurance then, yeah, it would be a problem,” Cody said.
New psychiatric beds at community hospitals would not be a panacea for the state’s mental health woes.
If the legislation does pass, community hospital involvement will be small, at least at first. Whiteaker estimated two to three hospitals are interested, including Cascade Behavioral Health in Tukwila.
“Right now I think it’s dipping our toe in the water,” she said.
The new 120-bed psychiatric hospital being built by MultiCare and CHI Franciscan in Tacoma is not currently looking to care for long-term mental health patients, said Marce Edwards, a spokeswoman for MultiCare. The hospital is planning to treat short-term psychiatric patients who are both voluntarily and involuntarily committed.
Inslee has proposed funding nine new 16-bed regional hospitals run by the state as another way to build new beds for civil mental health patients in the community.
With additional beds at other types of mental health facilities, Inslee’s plan would add about 1,000 beds overall and steer the vast majority of civil patients away from Western State and Eastern State by 2020.
Cody cautioned legislators might not want to increase the reimbursement rate for community hospitals quite as high as Inslee wants. But there is bipartisan support for moving most civil patients out of Western State.
“It’s a start,” Schmick said of community hospitals taking long-term patients. “I think that what we’re trying to do with this is to not have tunnel vision, but to look broadly and try and look at all venues and avenues for a way to deal with the issues.”