Cynthia Persily, PhD, RN, FAAN
Dr. Persily is the CEO of Highland Hospital in Charleston, WV.
Each week in this space, I try to update our community, partners, and stakeholders about all of the new and exciting happenings at the Highland companies in Charleston. This week is no different, except that I want to update you on something that has been going on at Highland Hospital for the better part of a year—the Medicaid Emergency Psychiatric Demonstration.
The Medicaid Emergency Psychiatric Demonstration project was created as part of the Affordable Care Act. The demonstration provides States with federal Medicaid matching funds to reimburse private psychiatric hospitals for emergency inpatient psychiatric care provided to Medicaid recipients aged 21 to 64 who are experiencing a psychiatric emergency. Currently, federal law prohibits Medicaid from making payments to private psychiatric hospitals for services rendered to Medicaid beneficiaries aged 21 to 64. West Virginia was selected as one of 11 states to participate in this demonstration project as part of the Center for Medicare and Medicaid Services (CMS) Innovation Center. The demonstration will test whether partially eliminating the prohibition against payments to private psychiatric hospitals for services rendered to Medicaid recipients aged 21 to 64 improves psychiatric care for people with mental illness and lowers State Medicaid program costs. Highland has partnered with the state Medicaid office to participate in this demonstration project. But why is this so important?
Because Medicaid beneficiaries aged 21 to 64 may not receive coverage for services, many of them visit general hospitals when they experience a psychiatric episode that requires emergency care. This can place a strain on a general hospital, which may already be struggling with demand in its emergency department and is also frequently not equipped to treat patients with acute psychiatric needs. We know from working with our partners at Charleston Area Medical Center that many of these clients visit the emergency room multiple times for psychiatric complaints. For the Medicaid beneficiary, this may result first in a delay in treatment, and then when treatment is provided, inadequate care for their ongoing psychiatric needs. This demonstration is designed to test whether providing Medicaid reimbursement results in faster, more appropriate care for Medicaid beneficiaries with psychiatric needs and provides relief to general hospitals.
Why talk about this now you might ask? On Wednesday of next week, we will be hosting CMS evaluators for this project to Highland Hospital. They will be here to review our programs and our processes for assuring that adult Medicaid recipients in this demonstration project receive faster and more appropriate care than they might have previously. They will be visiting with our partners at CAMC also to evaluate the impact on their emergency rooms. Anecdotally, we know that our patients who are a part of this initiative receive seamless care—most do not even know that they are a part of this state innovation. What they do know is that they now qualify to receive the best possible care for their psychiatric needs at an acute psychiatric hospital. What could be better than that? We will be welcoming the evaluators to our hospital and hope that they see what we do—a population receiving excellent care, and receiving it in the best possible environment—Highland Hospital!