More illness, less money
Community Fairbanks gives annual report on mental health services in Howard County
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Mental health in Howard County and across the country isn’t getting better, and there is less funding to provide treatment. This was the rather gloomy message delivered to the Howard County Board of Commissioners last week.
The board received the annual report from Community Fairbanks Hospital at its Jan. 17 meeting. According to Danielle Majors, director of Community Fairbanks in Kokomo, the local community maxed out what it can receive from the hospital in 2022.
“We continue to be very busy at the clinic,” said Majors. “Our calls for access department experienced record highs in 2022. The trend is that people are not getting healthier. They are having more mental health and addiction concerns. We’ve done everything we can at this point to expand our services to address increased demand.”
Majors explained that Fairbanks filled most of its vacant positions in 2022 and even hired a new psychiatric nurse practitioner to help meet the growing needs of the community. However, it wasn’t enough to keep pace with the growing demand for services. Community Fairbanks served 3,413 clients in 2022, including 1,903 adults and 1,040 youth for mental health concerns. An additional 413 adults and 59 youth received treatment for addictions.
A lack of funding
At the same time, the hospital hemorrhaged money. It had to write off $6.2 million last year due to contractual adjustments, i.e. reductions in revenue due to Medicare/Medicaid compensation limits or negotiated fee reductions for insurers. The hospital wrote off $1.2 million due to charity care and bad debt.
Howard County provided $844,000 in tax funding for mental health center operations last year.
“That money is very much appreciated,” said Majors. “It helps us close that gap between services provided and the money we are losing due to write-offs for people who may not be able to pay for them.”
Commissioner Jack Dodd asked if the contractual write-offs included Medicaid and Medicare reimbursement. George Hurd, vice president of behavioral health for Community Health Network, explained how contractual write-offs are determined.
“We have a customary rate, but some people, because of their insurance type or something like that, don’t pay the full rate,” said Hurd. “That’s part of the write-off. Sometimes, if they are private pay, we’ll reduce the customary rate, and with some people because of income limitations we’ll reduce the customary rate. That’s all part of the contractual write-off.”
Hurd added that the charity care and bad debt are full write-offs rather than rate reductions.
Certain services provided by Fairbanks were completely unreimbursed, including emergency service and crisis line operations, inpatient services to the uninsured, reports generated for Howard County Probation and the Indiana Department of Child Services, community care coordination with treatment and social service stakeholders, trauma and crisis response at community events, and suicide prevention services.
The hospital provided 1,027 crisis assessments and 516 acute care admissions, all not reimbursed, in 2022.
Beyond the standard services
Community Fairbanks also was very involved in community outreach in 2022. In addition to providing intensive treatment services, it participated in a Recovery Works expansion initiative with the Division of Mental Health and Addiction, partnered with the Family Service Administration to provide services at the local domestic violence shelter, continued its leadership on the Howard County Mental Health Coalition, provided psychiatric services to the Robert J. Kinsey Youth Center, and provided services to the Howard County Jail to assist individuals as they transitioned back into the community.
Sarah Graber, Community Fairbanks program manager in Kokomo, explained that the hospital also provided services in ways that the average person might not see.
“We have provided services to the high-risk substance abuse population by partnering with the Howard County Health Department for screening for communicable and sexually transmitted diseases,” said Graber. “We’ve partnered with the Kokomo Housing Authority to help people with mental health or addiction needs locate and obtain permanent housing, partnered with employment agencies to promote work readiness and obtain gainful employment, partnered with educational institutions to promote higher learning.”
The hospital also added new services to the Robert J. Kinsey Youth Center, the Howard County Jail, the local school corporations, the Department of Child Services, and Howard County’s problem-solving courts. And all of it was done for roughly $89 million less than what the hospital received in 2016, according to Hurd.
Still, the clients receiving services were pleased with the level of treatment they received. Majors explained that the hospital surveys its clients to keep tabs on quality of care.
“Feedback informed treatment really helps us gauge how well we are doing in providing services,” said Majors. “Every patient is provided with three questions to rate us on how we are doing. We are really proud of our staff and how they engage with our patients.”
The hospital’s efforts were recognized and appreciated by those who received them. The clients responded, with 91 percent of them saying they felt cared for, heard, and respected. They also said that the hospital worked on the right things with them at a 91-percent rate. And 88 percent of them said that the hospital worked with them on things they wanted to change in their lives.
Substance abuse shifting
When it came to addiction treatment, surprisingly, opioids were not the most common substances abused. The hospital reported that 41 percent of those seeking treatment did so for abuse of stimulants. Opioid abuse comprised 27 percent of those seeking treatment. Alcohol accounted for 22 percent of substance abuse diagnoses, while cannabis (five percent) and cocaine (three percent) were the other major substances abused by those seeking treatment.
“Across our entire health network, stimulant abuse in the past year tripled, compared to opioid use,” said Hurd. “When we looked deeper into it, it wasn’t that people were actively using stimulants and that was what was causing their overdose. It was the fact that most stimulants are now cut with fentanyl. That is what was causing the overdose rate to triple.”
Mental health diagnoses were more diverse in their variation than in substance abuse. For adults, depressive disorders were the most commonly identified at 21 percent. Trauma and stress-related mental health issues were the next most prevalent at 16 percent. Schizophrenic and psychotic disorders accounted for 14 percent of those seeking treatment, followed by anxiety disorders at 10 percent.
Among youth, disruptive and impulse control afflictions led the way with nearly 15 percent of those seeking treatment suffering from the disorders. Depressive and anxiety disorders were the next most prevalent at eight percent each.
Consistent with the recent reform efforts at the Indiana Legislature, I would like to see Community show the services provided based on the Medicare rate instead of their chargemaster rate. It would help the community and the taxpayers understand the funding levels better. For example I know Medicaid depending on the category a patient is in, may be paying less than or equal to Medicare, but what about private insurance?