RESPONDING TO COMMENTARY BY NEW YORK STATE OMH

 

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.