Transcript Improving the System

ACUTE-CRISIS PSYCHIATRIC
SERVICES DEVELOPMENT
INITIATIVE
DC Hospital Association
Department of Mental Health
June 30, 2004
DMH PROPOSALS
• SHIFT ALL CIVIL ACUTE CARE TO GENERAL AND
SPECIALTY HOSPITALS
• EXPAND ALTERNATIVES TO HOSPITALIZATION
 CREATE EXTENDED OBSERVATION SERVICES
 EXPAND ASSERTIVE COMMUNITY TREATMENT
 EXPAND CRISIS RESIDENTIAL SERVICES
• EXPAND CRISIS INTERVENTION AND
STABILIZATION THROUGH MOBILE CRISIS SERVICES
• BETTER UTILIZATION OF CARE COORDINATION
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2001 Dixon Court Ordered Plan
“acute care services for both children and adults will be
provided under agreements with a number of willing and
qualified local acute care hospitals.”
“these agreements are important because general hospitals
can be reimbursed for Medicaid-eligible psychiatric
admissions and will very likely be less stigmatizing, and
more likely to result in integrated healthcare and shorter
lengths of stay (based on national statistics) than
emergency admissions to Saint Elizabeths have been.”
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Why provide all acute care for
adults in community hospitals?
• Persons with psychiatric illnesses need first
class medical care
– High incidence of associated medical illnesses
– State psychiatric hospitals not equipped to
provide medical care
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Why provide all acute care for
adults in community hospitals?
Saint Elizabeths and all state and free
standing hospitals are Institutes for Mental
Diseases (IMDs) and are not eligible for
Medicaid for patients between ages 22 and
64
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Why provide all acute care for
adults in community hospitals?
• Patients do better when they integrated health care
• Persons with a mental illness want treatment in the
community--where they go for other medical care
• Persons with a mental illness tend to do better
when they choose the treatment setting
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DMH has prepared for shift
• Access HelpLine (AHL) provides 24/7 care
coordination---AHL takes 900 calls a week and
helps triage and track all new crisis and urgent
referrals, enrolls consumers into the Mental Health
Rehabilitation Services (MHRS) system
• Civil commitment statute has been modernized;
involuntary patients are more easily managed in
community hospitals
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DMH has prepared for shift
• In less than 3 years, a $40 million and growing outpatient
rehabilitation services developed—DMH also operates its
own administration services organization internal to DMH:
certifying providers, managing provider relations,
adjudicating and paying claims, managing transfers,
conducting quality improvement activities,
• 27 community outpatient providers certified by DMH for a
range of community services; most of these providers are
Core Service Agencies meaning they serve as the clinical
home for consumers.
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New Facility at St E’s
• The City is constructing a 292 bed facility that
will accommodate 175 forensic and 117 long term
civil patients
• Size of new facility based on Court Ordered Needs
Assessment conducted in 2001
• 3 buildings to be renovated to accommodate a
larger population if needed
• Construction will be completed in early 2007
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In FY 2005, DMH will contract
for acute care in DCHA Hospitals
• Option 1: Community-wide Purchasing
Plan
• Option 2: Acute Care Network
• Option 3: Hospital Single Purchase Plan
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Option 1: Community-Wide
Purchasing Plan
• DMH purchases psychiatric acute care service
from any hospital who provides care to indigent
persons
• DMH provides prior authorized coverage for up to
15 days based on DMH medical necessity criteria
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Option 2: Acute Care Network
• DMH contracts with 2-4 hospitals who
commit sufficient beds to meet need
• DMH and Hospitals will work closely in a
network approach to assure admissions can
be managed---up to 15 day lengths of stay
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Option 3: Single Hospital Plan
• A single hospital makes a proposal to shift
beds from the Saint Elizabeths complement
to manage the psychiatric acute care
program
• DMH will issue a single contract for days
based on projected need, with an approved
15 day length of stay
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Children’s Crisis System
• Closed DMH Children’s Crisis unit October, 2002
• CNMC had seen 80% of the District’s ER
psychiatric visits for children and youth
• CNMC has a contract to see all children; DMH
supplements CNMC with 2 social workers for
crisis stabilization and continuity of care
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Additional Children’s Services
• 2 Mobile Crisis Teams—2nd one to be added in August,
2004
• Multi Systemic Therapy Teams (MST)—up to 4 teams to
be added this calendar year
• Intensive in-home services—begun in 2002, being
expanded this year
• Preferred provider agreements for Intensive Care
Management—to begin in September, 2004
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Adult Crisis System needs
more….
• District hospital's ED’s at or above capacity
• ED’s poorly connected to the Mental Health
System
• Based on contemporary practice the City needs to
expand crisis alternatives
• DMH and APRA agree to combine efforts to
improve system –”no wrong door”—needed for
persons with substance abuse and psychiatric
problems
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Adult Crisis System needs
more….
• Breakdown in continuity of care of
consumers leaving St Elizabeths and acute
hospitals
• Community Service Agencies certification
requirements include their meeting
emergent, urgent and routine access—
greater compliance needed
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DMH Proposal for Psychiatric
Emergency and Crisis Services
• DMH-Hospital Emergency Departments:
develop cooperative agreements for DMH
to come on site to assist with intervention,
disposition and transport
• Mobile Crisis Teams: expand and become
primary mode of DMH crisis intervention,
24-7
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DMH Proposal for Psychiatric
Emergency and Crisis Services
• Extended Observations Units: expand capacity to serve
persons in crisis for up to 72 hours when hospitalization
not indicated but additional stabilization is needed
• Expand Crisis Residential Capacity by up to 8 beds
• Expand Assertive Community Treatment—double capacity
in FY 2004-2005
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Next Steps
• DMH will solicit interest in Option 1, 2 or 3 this
month with projected start date---OctoberDecember 2004.
• DMH committed to Crisis Expansion beginning in
early 2005 Fiscal Year, will solicit proposals for
expansion in July and August
• DMH will host discussions on Collaboration with
ED’s to begin immediately
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Contact Information
• Marti Knisley
• Director
• Steve Steury
• Chief Clinical Officer
• 202-673-2200
• [email protected]
• 202-673-1939
• [email protected]
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