How are you trying to meet the demand for mental healthcare?
Campos: This is something we’ve been struggling with for many years. COVID-19 merely magnified the need for mental health services and truly exposed the gaps in the system. One of our solutions is to meet with community-based mental health providers on a monthly basis and create processes for warm handoffs and follow-up appointments. We also have agreements for tele-psych visits for inpatients and ED patients. These tele-psych services are rarely utilized but can help our providers diagnose and manage acute or crisis cases as quickly as possible. Our state hospital association is also working to develop systems for interfacility transfers of mental health patients, to alleviate the stress on local EMS.
Jacobson: We recently announced a joint venture between Milwaukee County and three other health systems to build a new mental health emergency center. Opening in September, the facility is for children and adults experiencing a mental health crisis.
At Froedtert Hospital, our academic medical center, we are in the process of building our new complexity intervention unit, an acute-care medical unit designed and staffed to provide specialized care for patients who have both an active medical and co-morbid psychiatric condition requiring an inpatient level of medical care.
For our clinicians and staff, we’ve implemented a number of changes to support growing mental health needs, including enhanced employee assistance program services and mental health engagement, which includes establishing a successful partnership with Spring Health, physically having two EAP staffers on-site at all appropriate facilities 24/7 and redesigning underutilized nonclinical spaces for respite rooms.
Ryu: We are expanding our capacity to take care of the growing needs in our community, on the inpatient side but also outpatient. One example is what we’ve done with addiction services, as we’ve grown our medication-assisted therapy sites and bolstered programs at our Geisinger Marworth Treatment Center. Another example is our programs integrating behavioral health with primary care at many of our clinics, especially within pediatrics. All of this being said, we still have a lot of work to do to further the buildout of our comprehensive services.
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What are your highest-priority policy recommendations?
Campos: As a rural health hospital administrator, I’m really concerned with threats to long-standing rural hospital programs, especially Medicare’s Low Volume Adjustment. Rural hospitals often operate on negative operating margins and rely on special programs and supplemental payments to keep their doors open. The new Rural Emergency Hospital designation may help some hospitals, but it’s my experience that emergency departments are not money-makers, and a 5% increase in reimbursement for ED services will not make them profitable, nor perhaps even viable. Creative hospital design allows for nurses and other staff in rural hospitals to cover both the ED and inpatient services. Providing inpatient services for low-acuity cases that would otherwise be transferred hours away is one way to make up the costs of the ED. At least that’s the case in my community.
Ultimately, I think the country needs to decide if emergency care and inpatient care are to be provided in rural areas at all, and if so, we need to find a way to finance rural hospitals so that they aren’t just barely surviving month to month, or constantly trying to develop niche programs to supplement their revenue.
Jacobson: Two top issues come to mind. The first is we need to continue the reimbursement model for telehealth that was amended during the early part of the pandemic. This issue will be critical to maintain the positive progress we’ve made in this space.
Second, we need our largest payer—Medicare—to acknowledge the impact of wage inflation within the annual increase, which has not occurred within their current proposal.
Ryu: We are big supporters of any policy that continues to accelerate the move to value-based care. Through so many of our clinical programs, we have seen firsthand that value-based payment models make it easier to deliver the kind of all-inclusive care that so many people can benefit from. It allows us to focus on total health, including wellness and prevention, and moving care upstream and making it as convenient as possible. By doing this, we know patients can fully realize the benefits of the Triple Aim—quality, experience and affordability.
How have new surprise billing regulations affected your organization, and what’s ahead?
Campos: My organization is really small and does not contract with many specialists. The only care providers that may be impacted by the new surprise billing regulations are our tele-radiologists. However, we haven’t had any feedback regarding any out-of-network issues from the providers or from our patients, who are notified at the time of imaging that they should expect a bill directly from the radiologists.
Jacobson: The No Surprises Act rule requires healthcare providers to issue a good-faith estimate to all uninsured and underinsured patients in writing no later than one business day after the scheduling date, if scheduled three days prior to the service, or three business days after the scheduling date, if scheduled at least 10 days prior to the service. With this in place, the number of estimates that we are required to provide has increased dramatically due to the requirement of providing estimates to all self-pay patients.
As an example, we have created more than 300 shoppable templates for each of our three larger hospitals and additional templates for our clinics, community hospitals and ambulatory surgery centers. We have over 1,200 templates available across the health system. This regulation requires a great deal of work to offer increased transparency and we are committed to making these tools as user-friendly as possible for our patients.
Ryu: We have spent significant time and effort building online, self-service estimate tools along with systems to provide estimates to our patients. Yet, while price transparency rules might be a first step, they often fall short of providing patients with true out-of-pocket costs.