Monday, February 23, 2009

NC DHHS/ CenterPointe LME/ Old Vinehard Behavior Health colluding to create non-Medicaid psychiatric hospital in eastern NC?

February 23, 2009

RE: Deal being struck between Old Vineyard Behavioral Services/ NC DHHS/ and CenterPointe LME which would create a 14% Medicaid psychiatric beds @ newly proposed $14 million free standing psychiatric hospital

To Whom It May Concern:

Forsyth County Commissioners---those people who are elected by the people and report to the people----- are assumably not very happy on being left out in the cold re: the proposed $14 million expenditure in order to create a free standing psychiatric hospital in eastern NC near Winston Salem, NC.

As per the WSJ article: '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.'

In relation to that matter (read: silencing of the dissenters) It seems that my comment at the WSJ on the newly proposed 50 bed FREE STANDING psychiatric unit in the eastern part of the state have been removed twice now.

If this is the kind of harassment mental health advocates have been subjected to in eastern NC, I can understand why everyone has run for cover. I don't get that in western and central NC via the papers. We may bicker online but our opinions are presented. Let's see if the WSJ will redeem itself by fleshing out the article.

Here is the link to that article with foxmulder's comment sitting below it and evidence that my two comments were removed. It would be useful if people would comment, I believe. I am admittedly piggybacking onto a mental health advocate's e mail list as per an e mail alerting people to these important issues.

At the WSJ website associated with the article which provides incomplete information in terms of WHY would you have a psychiatric unit that allows for only 14% Medicaid beds, one can flag comments. I imagine that my two comments were flagged by the LME employee identified as 'foxmulder.' So, I flagged as inappropriate the comment that is there which I understand was created by someone associated w/ CenterPointe LME, namely 'foxmulder.'

I do not see why foxmulder's comment is OK and my two were not. Indeed, 'foxmulder's' comment was irksome to mental health advocates in that this person stated the following:

"Yet once again, the so called local mental health advocates find something to complain about. Typical."

I'd call that inflammatory. I am asking that it be removed and I have here as per this e mail contacted the writer of the story and I am asking that the journalist investigate WHY one would want to have psychiatric beds AS PART OF rather than APART FROM a general hospital. It seems to me that the journalist would be interested in the statements of an expert, Mike Mayer, below, and as per Doug Trantham, Emergency Services Director at Smoky Mountain Center LME, in western NC.

My comments were not inflammatory. Contrarily, foxmulder's comment IS inflammatory.

Moreover, who is hiding behind this 'foxmulder' ? I assume someone associated w/ the three entities that appear to be striking a deal: NC DHHS; Centerpointe LME; or Old Vineyard Behavioral Health.

My two removed comments were questions about why would you want to have a psychiatric unit where only 14% of the beds were for Medicaid clients when most of the Severe and Persistent Mental Illness patients are Medicaid clients?

I did a bit of research and asked the very gracious, hard working Smoky Mountain Center LME Emergency Service Director Doug Trantham about WHY one would not want to have a free-standing psychiatric unit, unattached from a hospital.

Here is what he told me:

1. He concurs w/ Mike Mayer (see below) that there are good reasons to have psychiatric beds as part of a general hospital: "There are many benefits for a psychiatric unit to be a part of a general hospital. Many of the individuals we serve in psychiatric crisis have serious health problems which must be attended to. In a free standing psychiatric hospital, this can be a big problem. In a general hospital, the ancillary medical services are always available when needed. "

2. Trantham reiterates what Mayer is speaking about below, re: 16 bed unit matter: "Another barrier is something called the IMD exclusion. Free standing psychiatric facilities can not have more than 16 beds and still bill Medicaid. This limits their size and feasibility, since you must have all the same services available for a 16 bed unit, that you do for a 50 bed unit. "


Additionally, here is what Mike Mayer (; at the CRA website), Senior Partner at Community Resource Alliance ( had comments in an e mail to a mental health advocate in eastern NC regarding the same questions but more specific to your situation in eastern NC re: the proposed 50 beds w/ only 14% Medicaid beds.

I believe these are comments that such an expert would make to anyone interestesd in listening and they so well outline the issues that I am admittedly jumping at the opportunity to blog them.
Mayer suggested that mental health advocates should be concerned that adult patients will continue to be denied to a free standing, non attached to a general hospital, such as Old Vineyard Behavioral Health Services, because the SPMI are dependent on Medicaid. Here are his other comments as passed to me by a mental health advocate in eastern NC as re: the article in the Winston Salem Journal (WSJ):

1. buying existing beds, such as is being proposed re: taking 50 of Broughton (in western NC, Morganton) beds and moving them closer to eastern NC has no construction costs.

2. with buying beds, if JCAHO standards have been met, Medicaid can be billed.

3. under 16 beds (which is size of Haywood Regional Hospital's Behavioral Health Unit which is co-run by Smoky Mountain Center LME, one of the two LME's in western NC) can 'usually', Mayer states, bill Medicaid if free standing but 'not always.'

4. Having access to medical care in the general hospital wherein the psychiatric beds are housed means access to MD's and other staff in the 'event that someone suddenly decides to detox without warning (about 80% inpatient admissions will have substance abuse issues as well', per Mayer.

5. Having access to medical care in the general hospital wherein the psychiatric beds are housed means the ability to handle major medical problems which 'also show up in high numbers for people with Severe and Persistent Mental Ilness (SPMI) problems.

6. Why did the free standing Balsam Center in western NC (Waynesville, NC; managed by Smoky Mountain Center LME w/ Doug Trantham as Emergency Director of SMC LME) close their doors to inpatient treatment? Mayer indicates that the 'financial piece' could not be figured out by SMC LME (comment: that was with Tom McDevitt, an accountant, as CEO, a person w/ mental health experience of about two decades).

7. The difficulties associated with creating psychiatric beds has to do with, according to Mayer, "$ and federal regs and wanting to avoid spending state $'

8. Mayer states that 'the Feds won't pay if there are more than 16 beds'--- (assumably) associated with the free standing psychiatric hospital, non-attached to the general hospital.

9. Mayer states that the following is generally true: ""Federal laws disallows payment for medicaid patients in any free standing psychiatric hospital, not attached to a general hospital. "

He notes exceptions: 'Most free standing psychiatric hospitals cannot make the $$ work if there are less than 16 beds and so the free standing psychiatric hospitals, unattached to the general hospital, are generally larger than 16 beds. The Feds can make an exception, but not usually. In Montana, for instance, re: to a shortage of MD's, they have allowed more leeway, Mayer states.


It seems to me that if Mayer's information is correct, then there is good reason for mental health advocates to be very concerned about spending $14 million on a free standing psychiatric hospital that has a markedly diminished ability to treat Medicaid clients and most SPMI clients are Medicaid clients. Therefore, it appears to be a waste of money to embark on such an endeavor.

A caveat, as per Mayer: 'there are a few providers nationally who have figured out the formula and make the beds open for everyone such as Strategic Behavioral Health.'

Maybe someone should go and ask them some questions.

Maybe someone in eastern NC---like elected officials----as in the GOVERNOR-----should see why NC DHHS/ CenterPointe LME/ and Old Vinehard Behavioral Health are colluding to block mental health advocates, concerned mental health providers, and county commissioners from having a say in this important process.


Blogger advocate4 said...

To clear up any misunderstandings, the proposed $14 million expenditure in order to create a free standing psychiatric hospital in eastern NC near Winston Salem, NC, is an expenditure that is being made by Old Vineyard Behavioral Health. Not the city or state government. Old Vineyard's parent company would invest that money so services could be provided to those that are currently being turned away for lack of space.

6:31 PM  
Blogger concerned said...

If by the way they put their employees in harms way from physical assaults from patients and professionally through intimidation. If these are indicators, then no, I don't agree with them getting the beds. This company is very shady and unprofessional. Therapy there is a joke or non-existent. Talk to any former patient that was there and they will tell you they received little to no therapeutic assistance will there. They are no lying.

3:12 PM  

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