Hospital to decline inpatient psychiatric unit grant

By Allison Arthur of the Leader
Posted 4/26/16

Jefferson Healthcare may return a $1.5 million grant it was awarded to build a seven-bed inpatient psychiatric facility and instead, head in a less costly direction that involves two safe rooms and …

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Hospital to decline inpatient psychiatric unit grant


Jefferson Healthcare may return a $1.5 million grant it was awarded to build a seven-bed inpatient psychiatric facility and instead, head in a less costly direction that involves two safe rooms and telepsychiatric consulting services.

Jefferson Healthcare CEO Mike Glenn told hospital commissioners April 20 that the cost of building a seven-bed unit would be $2 million–$2.5 million on top of the $1.5 million grant and result in annual income losses of $2 million.

After receiving the grant last year from the state Department of Commerce, hospital officials had lobbied for an additional $1 million in capital funding. The hospital was notified recently that its request wasn't in the state's budget.

Hospital Commissioners Jill Buhler, Matt Ready and Kees Kolff thanked Glenn for trying to find a “way to yes,” as Glenn had phrased his hope for the project in early March.

A formal vote on Glenn's recommendation to return the funding is expected at the May 18 board of commissioners meeting. If the board votes to decline the funding in mid-May, Glenn said, it would go back into a fund earmarked for mental health programs, and some other organization could apply. If the board were to wait longer, Glenn said, the money would go into the state's general fund.

Instead of moving forward on the inpatient facility, Glenn proposed construction of a two-bed crisis and stabilization unit, which would include the development of programming and a policy and procedure manual as well as continued partnership with Jefferson Mental Health Services.


Commissioner Buhler said Glenn and others had done a “noble and exhaustive” effort and that hospital officials fought for it, too.

Glenn wondered aloud about the merit of “dangling a $1.5 million grant” in front of small hospitals to build a $4 million inpatient facility that would then result in annual losses of $2 million.

That's when Ready spoke up, saying he, too, applauded the work of hospital officials for “slaving away” to try to make things work. He said the way health care is funded is essentially “criminal.”

As Glenn had explained in March, a concern is Jefferson Healthcare's status as a critical access hospital (CAH). It's a designation that helps keep the rural hospital afloat, bringing in more revenue for care than other hospitals might get. But not so with an inpatient psychiatric unit, officials learned.

And although the state had provided money for startup costs of an inpatient unit, the hospital would have had to spend more than the state gave it not only to design and build the unit, but to pay for staff and maintenance. And with the unit, the hospital wouldn't have received the same level of reimbursement from Medicare as it does now for other services it provides, officials said.

Glenn called it a “penalty,” and said it was unlikely the funding challenges of a critical access hospital would change soon.

He also said that while the state has seen increased funding for mental health projects in the past few years, the state faces a $2 billion–$3 billion shortfall for funding education and so the revenue stream for mental health programs might start to dwindle.

Currently, there are no hospitals in the state with the CAH designation that have inpatient psychiatric units; Jefferson Healthcare would have been the first.


Seeming to sense earlier this year that “getting to yes” was going to be difficult, Glenn and former Chief Nursing Officer Joyce Cardinal visited Olympic Medical Center in Port Angeles, which has two “safe” rooms, which are used for temporary inpatient psychiatric care.

A mental health task force has already started to work on guidelines for the safe rooms as well as a design for converting two existing acute-care units into safe rooms.

The task force includes registered nurses and others on the Jefferson Healthcare staff, but not Dr. Sue Ehrlich, a psychiatrist. Ehrlich divides her time between Jefferson Healthcare and Jefferson Mental Health Services. Officials said she had been consulted, although she hadn't been named to the task force; she could not be reached for comment by Leader press time.

No one from Jefferson Mental Health Services spoke out at the meeting. Glenn said the two entities are continuing to collaborate and may be hiring more help together.

The in-hospital task force also has started to look at telepsychiatric consulting services, including one operated by Swedish Medical Center from 7 a.m. to 7 p.m., and one called InSight Telepsychiatry.

Current Chief Nursing Officer Jackie Mossakowski said that telepsychiatric programs have worked elsewhere.

She said that nurses and staff at Jefferson Healthcare have had concerns about safety and such issues as using restraints to protect patients. A safe room where someone could sit and watch a patient going through a mental health crisis is needed, she said.

Mossakowski said goals for the safe rooms would be: increased resources for staff and patient; consistent care; better treatment options, including using less restraint; and increased consultation to improve medication management and help patients through their crisis.

She said it often takes 24-48 hours to stabilize someone in a crisis.


To bolster the idea of moving from a seven-bed inpatient facility to a unit with two safe rooms, Glenn also noted that the number of acute psychiatric care (APC) clients in Jefferson County has dropped in the past few years and that roughly 1.5-2 patients a day in Jefferson County seek inpatient care.

Steve Workman, an advocate for people with mental health issues, noted that the state was trying to get away from “boarding” people in hospitals and he said that the two safe rooms seemed like “psychiatric boarding enhanced.”

“The enhancements are particularly profound,” responded Glenn, noting that having a psychiatrist available to consult with staff would be an improvement over what the hospital staff has now, which is a shared psychiatrist.

Glenn also said Jefferson Healthcare has been improving its access to care for people in crisis.

In 2012, according to market-share statistics Glenn presented, St. Joseph Hospital in Bellingham, Fairfax Hospital in Kirkland and MultiCare Auburn Medical Center saw 50 percent of patients from Jefferson County who needed inpatient psychiatric care.

In 2014, those hospitals had 22 percent of the patients, and Jefferson Healthcare's “market share” had more than doubled to 22 percent as well, up from the 8 percent the hospital had had two years earlier.

After the meeting, Glenn said that the health care system spent roughly $2,500 to assist in the grant application and spent another $3,000-$5,000 to assist developing the grant and a feasibility study. It is unlikely that money can be recouped.

Glenn also said he expects the room revisions to cost less than $100,000. Glenn said he knew going in that it would be difficult to develop a seven-bed facility, but there was hope it could be pulled off. He said that he, too, was disappointed he couldn't “get to yes.”


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