Inpatient Redesign and Downsizing October Update ”Knock 0n Wood – So Far , So Good”

1. Inpatient Redesign and Downsizing October Update ”Knock 0n Wood – So Far , So Good”

2. Historical Context • Need to save $7.1 M in GR by - • Closing ED and acute care capacity state-wide • Placing 120 Voluntary patients in the community • Opportunity to - • Focus state operated inpatient services on individuals whose psychiatric and legal status require long-term inpatient treatment • Continue historical efforts to have acute services operated in the private sector

3. Historical Context (con.) • Opportunity to (con.) • Utilize newer and safer beds for minimum security FSH patients • Use $6.6M in savings to develop enhanced community options for the voluntary patients • Request the replacement of FSH with a newer and smaller campus • Avoid $72M for construction of new SORTS beds

4. So Where are We Today?

5. Acute Care & Emergency Rooms • Emergency Rooms • MPC closed its ER on 7/15/10 • SMMHC closed its ER on 8/15/10 • Acute Care Wards • MPC closed 1 acute & 1 intermediate ward on 7/15/10 • SMMHC closed all 3 acute wards on 8/15/10 • Have 1 acute ward remaining at MPC through April, 2011

6. Acute Care & Emergency Rooms (con.) • Mitigation of Impact • Set aside $5M in savings, $3M in the Southeast and $2M in the East for each region to implement mitigation strategies • Released funds on October 07, 2010 • Nature of Regional Plans • Urgent Care • Same –day/next-day appointments • Mobile outreach deployment to crisis, including ED • Expanded hours and staffing

7. Acute Care & Emergency Rooms (con.) • Nature of Plans (con.) • Crisis Stabilization • Clinic based intensive treatment • Community based wrap-around • Emergency Diversion/Rapid Reintegration • Intensive Residential – crisis diversion/step-down • Enhanced inpatient/outpatient coordination - improved connectivity with CMHCs, use of peer specialists • Crisis Stabilization Unit: pending submission of plan from the Eastern Region

8. Transfers Across Facilities • Reminder: reducing FSH from 471 to 292 beds requires a lot of “shifting around” to wards vacated by the closure of acute care beds • Moves that Have Already Taken Place • 28 Patients in the Incompetent Stand Trial Program from SLPRC to MPC 7/15/10 • 33 patients from FSH to SLPRC, closing 1 Guhleman Forensic Center (GFC) ward on 8/15/10 • 27 patients from FSH to SMMHC, closing 2nd GFC ward on 9/15/10

9. Transfers Across Facilities (con.) • Moves that Will Take Place Within a Month • 17 patients from Hearnes Psychiatric Center (HPC) to SMMHC, AND • 25 IST patients from HPC to the Center of Behavior Medicine on 11/1/10, enabling the closure of 1 HPC ward by the end of the month • 23 patients will be moved from SORTS Farmington to the new SORTS Fulton ward on 11/1/10

10. Transfers Across Facilities (con.) • Moves that Will Take Place between November, 2010 and April, 2011, dependent upon the successful placement of 120+ Voluntary patients • Approximately 40 - 45 patients will move from GFC and HPC to SMMHC • Approximately 40 – 45 patients will move from GFC and HPC to SLPRC • Close remaining acute ward at MPC in April, and move 10 – 12 IST patients from HPC and SMMHC • Will enable the closure of 2 GFC wards and the remaining 2 wards at HPC

11. Placement of Voluntary Patients • Focus: non-forensic, voluntary patients • Assumption Behind $6.6M Budget • 100 individuals getting $275/day - $100K annually • Rest get placed “as usual” • How do the Financials Work? • 93% are Medicaid eligible • 50% of the services are federally reimbursable (only $50K of GR) • 7% non-Medicaid eligible

12. Placement of Voluntary Patients (con.) • Placement Options • Psychiatric Independent Supported Living (PISL) • 2 – 4 bed homes • Intensive Residential Treatment Services • 5 – 16 bed congregate living environments • Clustered Apartments • In common • On site services/supports & community services • Use of Intensive CPR to fund

13. Placement of Voluntary Patients (con.) So Where are We? • Identified 128 individuals • Legal Status • 106 have guardians, 22 do not • 55% are non-Forensic • 25 are Permanently Incompetent to Proceed (PIST) • 33 are Not Guilty by Reason of Mental Disease (NGRI) • 126 are Medicaid Eligible • 33 are discharged, 16 with $275 rate

14. Placement of Voluntary Patients (con.) Major Impediments • Guardian Consents • Limited provider interest in Clustered Apartments • Need to work out some of the details about the rate and billing process

15. Consumer Impacts • Loss of Emergency Room and Acute Care • Plus • Ability to access beds in community hospitals with higher rates of reimbursement • Improved integration health & behavioral health • Minus • Loss of bed capacity, with potential for negative clinical outcomes • Challenges to community hospital operations and staffing

16. Consumer Impacts (con.) • Transfers - Impacting 255 patients • Plus • Fulton State Hospital patients have access to newer beds • Potential for new Fulton State Hospital • Minus • Disruption of treatment alliance with existing treatment teams, challenges to family visitation • Discharge challenges back to Central Region

17. Consumer Impacts (con.) • Discharge - Impacting 120+ patients • Plus • Room for transfers • Opportunity to develop a richer array of services and supports, with continuum of care • Minus • Will it work?? • Public, guardian & family concerns regarding patient and public safety

18. Employee Impacts • Each of the aforementioned impact our workforce • Plus • Able to save FTE at SLPRC & SMMHC and gain 38 FTE at CBM • Able to save 50 FTE at FSH with SORTS addition • Lay-off of only 4 at MPC thru September • Potential for new FSH • Minus • Fulton State Hospital loses 232.5 FTE and MPC loses 71 FTE • Substantial re-training needs for each facility due to changing populations served

19. Any Questions?