A month before the 2008 elections, behavioral healthcare providers scored a big win when the Emergency Economic Stabilization Act—best known as the federal bailout of the U.S. financial sector—included legislation that required mental healthcare coverage be the same as medical-surgical coverage when health plans offer both. Four years later, those providers are engaged in another battle, this time over federal funding and financial incentives to implement health information technology.
A few months after the behavioral healthcare community achieved insurance coverage parity, it found itself in a familiar position: left out of the more than $19 billion in incentive payments for providers to adopt meaningful-use standards and health IT included in the American Recovery and Reinvestment Act of 2009 through the Health Information Technology for Economic and Clinical Health, or HITECH, Act. Advocates say the funding will do much to help behavioral health providers not only expand health IT in their hospitals and treatment centers, but also help them address a host of other issues that these complex systems create, such as hiring skilled employees to operate the technology and covering ongoing maintenance costs.
That's why advocates are urging Congress to pass the Behavioral Health Information Technology Act, a bill that Sen. Sheldon Whitehouse (D-R.I.) introduced last year that would authorize psychiatric hospitals, community health centers, clinical psychologists and substance-abuse treatment providers to qualify for financial incentives through the HITECH Act and also participate in regional extension centers and the Beacon communities. This past summer, Rep. Tim Murphy (R-Pa.) introduced a companion bill in the House.
“We don't have as much capital as other parts of healthcare,” says Chuck Ingoglia, senior vice president of public policy and practice improvement at the National Council for Community Behavioral Healthcare. Based in Washington, the council represents 1,950 member organizations that advocate for people with mental illnesses. “That's why passing this legislation would be so important.”
Results from a recent survey by the council support Ingoglia's view. Released in June, the report shows that of the 505 members who responded, 30% chose “upfront financial costs” as the top barrier to health IT implementation, while 12% identified “ongoing maintenance costs” as the biggest problem.
Mel Fetter is president and CEO of Clinton, Mo.-based Compass Health, the parent organization to Pathways Community Health, an operator of community mental health centers that provide a range of services in Missouri and Louisiana.
Fetter says the legislation would do much to help equip mental health facilities for health IT implementation. And it's not just the actual dollars that concern him, but the larger theoretical problem of behavioral healthcare again taking a back seat to other healthcare segments.
“For our Legislature to have thought (electronic health records) are good, but to leave out this part of the health system, makes no sense,” Fetter says.
In Missouri, Pathways operates Royal Oaks Hospital, Windsor, which provides acute inpatient services and partial hospitalization. The system also has six residential treatment locations and 38 outpatient clinics. Fetter says the organization began to implement health IT at the centers about seven years ago, well before there was any movement at the federal level.
“We saw it as a way to improve care across the system, given our multiple locations and large geographic span,” Fetter says. The system—which relies on one software vendor—began to migrate the health IT infrastructure to the hospital last year and it's not yet fully operational. “You'll find in behavioral health, there is a world of software applications directed at behavioral health services, mostly at outpatient care,” he says.
Pathways' initial investment, Fetter says, was $350,000 to $400,000, and the cost to maintain the health IT system is below about $5,000 a month. “On the outpatient setting, the only professionals we can apply for are psychiatrists,” he says. “They are eligible for some funding.”
Adequate funding isn't the only significant roadblock facing behavioral healthcare providers who want to integrate their systems and keep pace with their acute-care peers. In the National Council survey, 9% of respondents identified a lack of dedicated staff to implement technology as a barrier, while 8% identified a lack of skills to properly select technology, and 7% identified a lack of dedicated staff to maintain the systems.
“You find a lot of folks who have been doing this for a long, long time,” Mary Kay Shibley, a registered nurse and behavioral health clinical informaticist at Sharp Healthcare's Sharp Mesa Vista Hospital in San Diego, says about the behavioral healthcare segment. “You tend to have an older workforce, and the drive to be on the cutting edge and implement new technologies isn't always as prevalent as you find in other areas of healthcare.”
Shibley entered the health IT world as a nurse consultant and says it has been useful for the system to have “a clinician who spoke health IT.” The seven-hospital system has four acute-care hospitals and two behavioral health hospitals: Sharp Mesa Vista, a 149-bed free-standing hospital, and Sharp McDonald Center, a 14-bed chemical detox and rehabilitation facility.
“Anything that is coming up for meaningful use, we try to make sure that we're meeting all of the same criteria, so when it happens, we're ready to go,” Shibley says. “We want to be on the same page so we don't try to play catch-up later.”
Shibley offers a reason why federal funding hasn't found its way to the behavioral health segment. “There is cutting-edge cardiology and surgery,” she says. “But there's not cutting-edge behavioral health.”
That's why it's important for behavioral health providers to move to the next level of innovation, she says. One example is the device known as the Motion C5 tablet, which clinicians use instead of clipboards during patient rounds.
“Our patients can be anywhere in the hospital—the patio, in group, at the coffee cart,” says Shibley, who was not able to provide an estimate of how much Sharp has spent on health IT implementation.
As the behavioral healthcare segment lobbies for funding, it also faces another considerable problem within the industry.
“Probably the greatest barrier that we face is the electronic medical-record companies have not created a medical record that is conducive to mental health,” Shibley says. “We have to tweak it for behavioral health, and there are not a lot of behavioral health records out there.”
Mark Covall, president and CEO of the National Association of Psychiatric Health Systems, says that's primarily because medical-surgical treatment is procedure-based, which allows proper documentation to fall into certain boxes or rely on “yes or no” answers.
“In behavioral health, we're not procedure-based, so it's really writing up the summaries of the various therapies you've had; updating a treatment plan,” Covall says. “It's more writing, which makes it more difficult to have a software package that is asking for more specific, finite information—rather than a box.”
Covall says he's pleased with the level of support the two pieces of behavioral IT legislation have on Capitol Hill. Currently, the Senate bill has 17 co-sponsors and the House bill has 27.
Those numbers are important, he explains, because they show how many lawmakers supported the issue during a year when everyone knew that not much legislation would move on Capitol Hill. And it will still be a considerable uphill battle next year, as Congress and the administration—regardless of who occupies the White House—will once again be forced to address the nation's ballooning deficit. But Covall says he is hopeful and says the behavioral health segment is further along than other healthcare groups also not included in the HITECH funding. Those groups include long-term acute-care hospitals and rehabilitation facilities.
“What we hear is that there seems to be a lot of interest in our particular sector,” Covall says. “It's becoming more and more part of the discussion about healthcare overall—the importance of mental health and addiction to overall health,” he adds. “If you look at the number of folks in the (emergency departments) who have some type of substance use or problem, the idea of connecting from an electronic health record would go a long way to addressing this connectivity between behavioral and other medical services and could really make a difference in the movement of electronic health records.”