As director of the
only specialty children’s mental health agency on Long Island, after reading
the New York State OMH Long Island Field Office (LIFO) News from the Field,
Winter 2015 edition, I was left with few thoughts. In the cover story, From the
Director’s Chair, by LIFO Director Dr. Martha Carlin, she comments on multiple
outpatient clinic closings and acquisitions on Long Island.
Dr. Carlin stated
that the closures “point to a myriad of difficulties among providers, which
impacts on the provision of quality clinical care.” However, nothing was
mentioned in her report about the impact of New York State’s Clinic Reform
policy, which has been the major contributor in advancing clinic closures,
restricting access to care and compromising quality clinical care for New
Yorkers in need of community-based care.
Regarding Dr.
Carlin’s reference to recent closures of mental health clinics at Peninsula
Counseling Center in Nassau and Pederson-Krag in Suffolk, what her commentary
did not address is that both of these long-standing and highly-respected
organizations were acquired by Queens-based PSCH. Then, after only a few years,
PSCH decided to let go of the mental health clinics operated by both of these
esteemed organizations.
Consequently, an
acquisition by a $100 million organization (PSCH) that was implemented and did
not hold, led to a second round of acquisitions. Which begs the questions, what
went wrong? and what has been and will be the impact on consumers?
Some of the ways
that clinics stay afloat in this environment, beyond fundraising, is to
restrict access to care only to consumers with the best insurance rates
(Medicaid), to see consumers for shorter periods of billable time in order to
pack more revenue into a day, to remove salaried employees to save expenses by
eliminating fringe benefits, to not respond to time-consuming and
labor-intensive crisis situations, to cut parents and other relevant family
members out of the clinical equation, and to curtail consistent clinical
supervision and team meetings. In other words: build a factory to maximize
revenues and minimize quality care.
In another article,
in the March 5, 2015 issue of Crain’s Business Health Plus, it was reported
that “Mergers and acquisitions activity among behavioral health nonprofits with
budgets under $25 million is expected to increase substantially this year . . .
given that the state’s Office of Mental Health has made its desire for
consolidation an open secret. From a government perspective, it simplifies the
number of contacts and number of relationships that they need to have. The
unknown is the impact on program services.”
It seems to me that
what is impacting quality clinical care most, are the actions of New York State
that have resulted in restricted access to care and the development of a
business environment that is least conducive to a community-based,
mission-driven clinic. In other words, the focus is on managing cost as opposed
to managing care.
Dr. Carlin stated
that, “although the challenges continue there are many exciting changes
happening within our system which will help better the lives of people we
serve.” She cited telepsychiatry, DSRIP (Delivery System Reform Incentive
Payment Program) and Managed Medicaid as examples.
I do not feel
encouraged by a system that restricts access to care to one population and
dilutes quality care to drive up revenue. Long Islanders – children and
families – who need quality community-based mental health care deserve better.
Andrew
Malekoff is executive director of the nonprofit children's mental health
center, North Shore Child & Family Guidance Center in Roslyn Heights,
NY.
