Mental health clinics suffer Services to Md.'s poor are falling victim to reimbursement cuts

January 20, 1998|By Jackie Powder | Jackie Powder,SUN STAFF

Community mental health providers who deliver services to some of Maryland's poorest psychiatric patients say the state's new reimbursement rates are too low and could force some clinics to close.

Providers say they've had to lay off employees and eliminate critical services that are not covered under the new public mental health system. The rates took effect July 1.

"The fees that have been set up for psychiatric clinics are absurdly low," said Spencer Gear, director of Granite House, a psychiatric rehabilitation center in Westminster. "It's put a lot more pressure on providers to churn people through the system [to increase billings]."

The rate structure went into effect as part of the state's plan to move Medicaid patients into managed care programs.

The system calls for mental health services to be handled separately. The state Mental Hygiene Administration hired Maryland Health Partners to oversee the system, including reimbursement and authorizations for services.

"I think there was fat in the system and that the system could benefit from rate reductions," said Fred Chanteau, president of the Affiliated Sante Group, a Montgomery County-based company that runs clinics in Prince George's, St. Mary's and Charles counties. "But I think this went too far."

In response to providers' concerns, the Mental Hygiene Administration has established a committee to study the rates and make recommendations for changes within 90 days.

"Some rates we have may very well be too low," said Oscar Morgan, director of the Mental Hygiene Administration. "We're going to look at all of these issues in conjunction with providers to see if we have to make adjustments."

Meanwhile, providers -- mostly private, nonprofit agencies -- say it will be tough to give quality care under the new guidelines.

"The taxpayers are getting more bang for their buck, but organizations like ours are having to run so lean that it's problematic," Gear said.

Under the old system, community mental health centers usually received funding through a combination of state grants and Medicaid payments.

The new system has an elaborate fee structure for every service, from outpatient counseling to hospitalization. State health officials extended the grants of some agencies until June.

Several clinics in the state will then experience a 30 percent to 50 percent reduction in funding, which will mean "they probably have no choice but to close," said Heidi Bunes, director of the Maryland Psychiatric Society.

'The safety net'

"These are clinics that form part of the safety net the state has in place for people with serious mental illness," she said.

To stay afloat under the new rate structure, Chanteau of Affiliated Sante said he cut $700,000 in expenses.

At ReVisions, a behavioral health care provider in Catonsville, director Scott Graham said he had to lay off his vocational rehabilitation staff.

Graham said his agency probably would generate $100,000 in fees from vocational rehabilitation services under the new system. Previously, he received a $300,000 grant to provide those services.

Several providers say the elimination of reimbursement for case management has affected the quality of services. Case managers help patients apply for social services and other entitlements, and guide patients through the bureaucracy of the public mental health system.

"The case management duties have been absorbed by the staff," Graham said, "so they're probably spending less time doing rehabilitation."

Chanteau said the lower rates mean that doctors have increased caseloads and less time to spend with each patient.

Lower rates, less attention

The old system set the reimbursement rate for all psychiatric clinic services at $81. Under the revised schedule, the reimbursements are $55 for adult individual therapy, $36 for medication management and $34 for group therapy.

"The doctors can't spend the same amount of time with patients," said Chanteau. "They have to see more patients, do more groups. And patients are saying, 'I can't get the attention I deserve.' It creates more of a factory environment."

Providers say the number of patients who don't show up for appointments is high among the poor and chronically mentally ill.

"It's much higher than in an insurance-based practice," Gear said, "and the rates fail to take that into account."

Pub Date: 1/20/98

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