News Article Details

Tacoma for now has fewer beds for psychiatric care despite opening of new hospital. Here's why

News Tribune - 8/17/2019

Aug. 17--Wellfound Behavioral Health Hospital's current limits on admissions have put a spotlight on available care for local patients and the cost pressures of providing mental health services.

A settlement agreement in 2018 that allowed another behavioral hospital to be built in Tacoma also allowed for CHI Franciscan to convert its 23-bed psychiatric unit at St. Joseph Medical Center into acute care beds.

Acute care beds in general are used for short-term medical treatment or surgical recovery.

What the agreement didn't address was what would happen in the scenario Wellfound is facing now.

Wellfound, run in a partnership between local health systems MultiCare and CHI Franciscan, is not yet fully operational, in part because it lacks a safety accreditation from the independent, nonprofit Joint Commission.

Among other things, Joint Commission accreditation is needed for the hospital to bill many insurance providers, including Medicaid and Medicare.

Additionally, the hospital placed a temporary hold on admissions to its crisis stabilization unit.

The hospital now is operating with just eight beds out of 120, leaving the city currently with fewer beds for psychiatric care than before terms of the settlement agreement were reached.

The News Tribune reached out to both the State Department of Health and CHI Franciscan to ask what happens to patients who would have otherwise utilized the St. Joseph unit's beds during the wait for Wellfound to be fully operational.

Their answers repeatedly point back to the language of the settlement agreement, which only ties conditions for St. Joseph's bed conversion to Signature Healthcare Services LLC receiving its Certificate of Need for its planned 105-bed Tacoma Behavioral Healthcare Hospital.

CHI Franciscan on Friday did not offer a response to a question as to when it converted the St. Joseph beds to acute care.

Kristin Maki, a public information officer with the State Department of Health, told The News Tribune on Friday via email:

"Under the certificate of need St. Joseph's converted the 23 psych beds to acute care beds. Because St. Joseph's total number of licensed beds did not change, there is no way for us to tell when exactly they made the conversion."

Signature's certificate was issued July 24, according to documents posted online by the state Department of Health.

On Friday, Tacoma hearing examiner Jeff Capell moved the Signature hospital one step closer to its finish line, recommending approval of that property's rezone to the City Council and offered conditional approval of the project's permits, which are tied to council approval of the rezone.

The property, on the south side of South 19th Street at South Proctor Street is just a few blocks west of Wellfound, also on 19th Street.

In the determination, issued Friday, Capell noted that the project's zoning request is more of a "fine-tuning" than an outright change from a previous proposed use of the site as part of a 2006 rezone.

"What has blatantly changed since 2006 is the significantly greater need for mental health care facilities/services, both in Washington and nationwide," the report stated.

Outside of eight beds available for now at Wellfound, there are 64 psychiatric beds to serve the county. They are in four, 16-bed, free-standing psychiatric evaluation and treatment centers. Those sites are operated by four entities: Metropolitan Development Council, Greater Lakes Mental Healthcare, Telecare and Recovery Innovations. All but Telecare are nonprofit.

In response to questions posed to CHI Franciscan about St. Joseph's bed conversion, Cary Evans, vice president of communications and government affairs for CHI Franciscan, issued the following statements:

"The 23 beds in St. Joseph Medical Center's mental health unit were transitioned to acute care beds to help meet the growing need for acute care services in the region."

"Wellfound is doing everything in its power to ensure that it is available to meet the behavioral health needs of our community for the foreseeable future, and CHI Franciscan stands ready to assist the hospital whenever and however possible."

CONVERSION NOT UNUSUAL

The conversion seen at St. Joseph is not an anomaly, or even a recent phenomenon.

A research paper published in The Psychiatric Bulletin in 2014 noted that:

"In the past, a well-run psychiatric in-patient unit could be a modest profit center. The landscape has changed dramatically for general hospitals. The chief financial officer will tell you that the psychiatric units do not perform as well as the medical surgical units. The psychiatric unit occupies space where more lucrative medical surgical services, such as invasive cardiology and advanced surgery patients, could be located."

It went on to say that a "number of hospitals have made the business decision to close their psychiatric units in favor of these more remunerative services. These decisions are not simply evidence of greed. The profit margins of most general hospitals are razor thin, well below what Wall Street would accept for a company. Hospitals need to generate money where they can, and that includes consideration of the opportunity costs of low-performing units."

Shawn Gremminger, senior director of federal relations for Families USA, a Washington, D.C., based nonprofit consumer health advocacy organization, said he's aware of the issue on a national scale.

"There's no question there's been a dramatic drop in psychiatric beds available" for decades, he told The News Tribune on Friday.

He credits the downturn in part to the moves away from institutionalized care and overall changes in behavioral care, "but in the last two decades we've moved from a nice equilibrium in the market to now across the country, there are far too few psychiatric beds."

While not speaking specifically to what's happened in Tacoma, he said, on a national scale, "At least anecdotally, it has everything to do" with the financial realities of treating patients amid weak federal standards for hospitals to meet community benefit requirements.

"Treating folks is complicated -- it's expensive, time-consuming and under-reimbursed, so hospitals without absolute requirement to do that have been getting away from it, and that's causing major problems," Gremminger said. "We should pay more for psychiatric services. It's also difficult to find providers. But you also have to say, 'You guys have a responsibility ... so let's figure out how to take that seriously.'"

While St. Joseph's psychiatric unit was allowed to convert, CHI Franciscan, as a Wellfound partner, ultimately will have contributed to adding more beds through that hospital -- once it is utilizing all of its beds.

Shirley Prasad, policy director of government affairs for the Washington State Hospital Association, said her group is "very much involved and engaged in behavioral health work to increase capacity, not just inpatient but all the step-down programs and providing appropriate care."

She emphasized the general challenge of getting a hospital to a level of full operation.

"One thing we'd stress is that it takes time for facilities to get up and running. It's not easy putting up a hospital, licensing, certification ... you don't just flip a switch and the lights are on. It's more than that."

STILL FULLY LICENSED

Maki of the Department of Health also stated: "To clarify, Wellfound is fully licensed to operate all 120 beds right now. While we encourage facilities to not overextend until they have staff trained and have processes in place to ensure quality care and patient safety, operating with fewer beds is the facility's choice and not a DOH licensing limitation."

The hospital has put a temporary hold on admissions to its six-bed crisis stabilization unit while hospital officials "evaluate processes and procedures and to ensure the highest standard of care is being offered to the community," according to a memo obtained by The News Tribune this week.

That took its operations down to eight beds from an earlier 14 when it first opened in May.

In the announcement of its launch in May, Wellfound said the site would open in phases, "starting with eight inpatient and six crisis-stabilization beds, with more added over time."

The News Tribune reported Aug. 9 that Wellfound had not yet obtained the Joint Commission accreditation and was still only utilizing the 14 beds.

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(c)2019 The News Tribune (Tacoma, Wash.)

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