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Mental-health unit is proposed
Emergency department needs state OK
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Published: February 21, 2009
Triad residents dealing with an emergency mental-health episode could have a new option for treatment by January 2011 if the state approves an application for a 24-hour psychiatric-emergency department.
But local mental-health advocates are concerned that some adult patients will continue to be denied service at Old Vineyard Behavioral Health Services because they are dependent on Medicaid.
Old Vineyard said yesterday that it has filed an application for a certificate of need with the N.C. Division of Health Service Regulation. Also participating in the application is CenterPoint Human Services.
The application is for a two-story, 48,000-square-foot building at 3637 Old Vineyard Road. Old Vineyard also wants 50 beds to be transferred from Broughton Hospital in Morganton.
The cost is about $14 million. The state agency is expected to make its decision by May 1.
Old Vineyard currently has 111 beds, 57 of which are dedicated to psychiatric residential beds for ages 12 to 17, and 54 are for acute mental-health care.
A written public-comment period will end March 3. A public hearing will be held at 1 p.m. March 20 at the Forsyth County Public Library, 660 W. Fifth St., in Winston-Salem.
The transfer of the 50 beds, which includes 12 dedicated to a geriatric unit, has been approved by the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. These beds will be available to patients statewide, not just CenterPoint's territory of Forsyth, Davie and Stokes counties.
The beds at Broughton are not being used, according to Dr. Michael Lancaster, the chief of clinical policy with the state mental-health agency.
"They are essentially paper beds since they are no longer occupied by patients," Lancaster said. "The transferring of these beds will not decrease capacity at state hospitals.
"Rather, they will bring these beds closer to the community of the people needing the assistance."
Rob McCartney, the chief executive of Old Vineyard, said that the psychiatric-emergency department is needed because the center "has no more space to put any more beds, and we typically have a high occupancy rate."
Local advocates are concerned that the transfer of the 50 beds will be of limited use to adults ages 21 to 64 who depend on Medicaid to pay their bills. Specialized psychiatric operations, such as Old Vineyard, are not allowed to bill Medicaid for services, according to federal law.
That leaves patients in that 21- to 64-year-old category going either to the emergency departments at such community hospitals as Forsyth Medical Center and Wake Forest University Baptist Medical Center, or to state hospitals for treatment.
"For me to understand if this is a positive move or not, much more information is needed," said Judy Briggs, the chief executive of Carolina Behavioral Health Alliance LLC of Winston-Salem, a provider of mental- health services.
"Why would we be transferring 50 state hospital beds to a for-profit, free-standing hospital that is not eligible to bill for adult Medicaid?" Briggs asked. "Most crisis patients are adults with severe and persistent mental illnesses and are Medicaid-eligible.
"Will patients need to be medically cleared through our community-hospital emergency room before accessing the psychiatric emergency room?" she said.
According to the N.C. Division of Health Service Regulation, on average the cost of services for 54 percent of the potential 50 new patients would be paid for through private insurance. Another 21 percent would be paid by Medicare, primarily the patients in the geriatric unit, and about 8 percent specifically by Blue Cross and Blue Shield of North Carolina.
Fourteen percent -- or 11 patients -- could be Medicaid-dependent, including adults in the affected age group. That cost is picked up by CenterPoint or the state on a contract basis.
Lancaster cautioned that the percentages related to the proposed 50 beds could go up and down depending on how many beds are open on any given time.
CenterPoint, Forsyth Medical Center and the N.C. Division of Health and Human Services said yesterday that they have entered into a contract to expand local access to short-term acute inpatient care for CenterPoint patients. Under the contract, the organizations will treat patients whose mental-health needs can be dealt with during a short hospital stay of less than seven days.
Up to eight additional beds will be available to manage these patients at Forsyth.
Andy Hagler, the executive director of the Mental Health Association of Forsyth County, said he welcomes the CON application for adding another layer of local services.
"If the 50-bed facility at Old Vineyard can admit those, for example, who are uninsured or on Medicare, etc., then those between 21 and 64 on Medicaid can perhaps be admitted to the local hospitals," Hagler said.
"In other words, freeing up inpatient services for one group -- uninsured, Medicare patients -- can allow other facilities to open up more beds, capacity for those, for example, on Medicaid."
■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.
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