Operating costs for new 25-bed psychiatric hospital in Berlin higher than expected

The state’s new 25-bed psychiatric hospital will cost $20 million a year to operate, according to the Department of Mental Health (DMH).

The annual price tag came as an unpleasant surprise to some legislators, since the state paid only slightly more — $23 million a year — to operate the Vermont State Hospital, which had twice the capacity.

“That’s about what we were paying for a 52 bed hospital,” Appropriations chairwoman, Rep. Martha Heath, D-Westford, observed. “Why?”

DMH’s financial director, Heidi Hall, responded, “It’s a completely different staffing model, so most of those costs are staffing costs.”

DMH Commissioner, Paul Dupre, said the department plans to hire 106 new employees to run the facility.

Heath said the committee will need a “more complete explanation” when department officials return to make the case for their Fiscal Year 2015 budget.

The Vermont Psychiatric Care Hospital in Berlin will be one of four facilities providing Level 1 mental health services for acute care patients in Vermont. The state’s post-Irene, decentralized system currently includes beds at Rutland Regional Medical Center, the Brattleboro Retreat, Fletcher Allen Health Care and the 8-bed Green Mountain Psychiatric Care Center in Morrisville. The latter two facilities will be phased out when the Berlin facility opens. The total current expenditures for Level 1 beds for acute care is about $10 million in fiscal year 2014, according to documents from the department. In addition, it costs $4 million a year to run the 7-bed Middlesex Secure Residential Facility.

The committee also gleaned more details about the timeline for opening the new hospital during a House Appropriations Committee meeting on Wednesday.

Dupre said the hiring process will wrap up by June 15, and the hospital will open on July 15. He doesn’t expect to fill the 25 beds until a month after the opening date — August 15.

“It’s very ambitious,” Dupre told lawmakers. “We try to give you the best case scenario but even under the best case scenario we cant open at 25 [beds] in July.”

The Mental Health Oversight Committee voted to endorse 25 beds (the Shumlin administration has advocated for 16 beds in the past) and exhorted the administration to use the “quickest legislative route” to get the beds in place as early as possible in fiscal year 2015. Lawmakers on the committee advocated for a July 1 opening day for all 25 beds.

Sen. Sally Fox, chair of the oversight committee, said the authorization from the Legislature needs to be expedited because it takes time to hire and train staff. If the Budget Adjustment Act doesn’t pass quickly, she says lawmakers may need to pass a standalone bill.

“We want this decision to be made considering all of the people needing beds, and not based upon budgetary concerns,” Fox wrote in an email.

In a report to the Legislature, the oversight committee said lawmakers had hoped that strengthening the community system statewide would reduce the number of Level 1 beds needed in the mental health system and that wait times for Level 1 beds “would no longer exist.”

“However, the committees do not have enough data to show which community programs warrant a greater investment and which do not,” according to the authors of the report.

The authors go on to say the mental health system is fragile and “too many people are waiting too long in emergency departments or correctional facilities for level 1 admissions.”

In all, the state has 32 level 1 beds. From March to October this year, the average daily census of patients needing intensive psychiatric care has exceeded the number of beds available by as many as 16 patients.

Editor’s note: Anne Galloway contributed to this report. The story was updated at 5:46 a.m. Dec. 5.

Follow Alicia on Twitter @aefreese

Comments

  1. Bob Orleck :

    “That’s about what we were paying for a 52-bed hospital,” Appropriations chairwoman, Rep. Martha Heath, D-Westford, observed. “Why?”

    And why wasn’t this question asked before they authorized it?

  2. Jim Barrett :

    The legislature was surprised???? This is just another example of total incompetence by the gang in Montpelier who think they walk on water. If this legislature and governor don’t have a clue as to actual costs of anything you can imagine the ultimate cost of healthcare but by the time we find pout what the actual costs will be ……..it will be too late.

    • Jim,

      Education financing reform is costing much more than estimated.
      Mental care financing reform is costing much more than estimated.
      Healthcare financing reform will be costing much more than estimated.
      Renewable energy is costing much more than estimated.

      Do you detect a pattern? Is less government, better government?

      Dysfunctional SPEED and Lowell ridge line wind produce energy at 3 – 4 times NE grid prices of 5 c/kWh.

      The price tag for the goal of 90% of ALL energy from expensive in-state renewables, a la SPEED and a la Lowell ridge line wind, by 2050, will be several orders of magnitude greater than estimated. That is the reason no serious estimated costs appear in the 2011 CEP.

      Rah-rah, starry-eyed folks in Montpelier meddling with energy systems make things worse than they would be if left alone.

  3. Paul Lorenzini :

    Government in a microcosm. Double the cost, half the value. Great jobs within the system and less money outside the system. I am sure each of those beds will be worth every penny of $1,000,000 each. A truly great value for the taxpayers.

  4. sandra bettis :

    and this is in addition to the costs for the other facilities now dispersed around the state. plus the construction costs.

  5. Lee Stirling :

    Given that the costs are doubled/bed compared to the previous VT State Hospital, I would therefore expect DMH to put forth measurable benchmarks that can demonstrate patient care that is twice as effective. These can be things like improved patient/staff safety, or reduced stay-time per patient, or reduced recidivism rate. Those, I think would be reasonable expectations of a brand-new facility, with half the capacity of the old, to demonstrate that VT taxpayers aren’t throwing their money down the drain.

  6. Dan Carver :

    “We want this decision to be made considering all of the people needing beds, and not based upon budgetary concerns,” Fox wrote in an email.

    The 52-bed facility costs $442,xxx per year per bed to operate. The new one will cost $ 800,000 per year per bed. The chair’s primary comment is let’s get this done regardless of cost.
    I know this is about mental health, but this type of thinking is crazy!

    Problems: The state has a budget gap. We can’t feed, or house many Vermonters.

    Senator’s solution: Let’s spend $800,000/a year on two dozen people – which will allow 106 of my friends to live very comfortably.

    • Paul Lorenzini :

      We wouldn’t need such a gigantic mental health system if the state would stop driving people nuts!

    • Bob Orleck :

      That’s $800,000 per year per bed. Now I know a hospital is different from a hotel (hotels are nicer and more comfortable, plusher with more common areas).

      Say you stay at a nice 3 star hotel and pay $140 per night. For an entire year that is $51,100 per room and that includes cleaning and laundry and linen service. Add on great meals for another $25,000 per room per year so you have a total out of pocket of $76,100 per room or $5,707,500 for 25 rooms. With this you get exercise room and equipment, indoor and outdoor swimming pool, conference rooms, security, valet parking and the like. So then you hire 5 psychiatrists at $300,000 per year (1 for each 5 patients if facility is full) and 50 other staff people (two for each bed if facility is full) at $50,000 per person per year each. If you spend another $300,000 a year for medications, your grand total for 25 beds is $10,000,000, the very same per bed cost as it was when Waterbury State Hospital had 50 beds available.

      So we can actually do two of these facilities and have that same number of beds at the same cost and that does not even include the inflation that has occurred over the past couple of years.

      I did this example to point out how irresponsible our leaders are in spending our money. They would not know value if it hit them in the head. Do the math and you will see the craziness that is happening here. These folks (Democrats who are not like my or your father’s Democrats of old who were patriotic and practical and honest) are taking us on this dishonest, unsustainable spending binge and have no idea of what they are doing.

      There needs to be watchdogs keeping a daily eye on this Governor and his minions in the legislature before they destroy us all.

      The same thing is happening with healthcare, wind power, you name it. They are padding somebody’s pockets at the expense of us Vermonters. The election is coming up and we need to clean house and by that I mean the House, the Senate and the Governor’s office.

      • Cynthia Gracie :

        I agree this amount seems high, but the old state mental facility was a hell hole.

        You can’t compare the requirements of a psychiatric facility with hotel stays. That seems inhumane.

        Some of these people are acute care individuals who require constant supervision on locked wards. When Irene happened and patients were disbursed throughout Vermont’s psychiatric wards, staff, including psychiatric nurses, were being injured by them. It’s a high risk job that also requires qualified professionals.

        Let’s review this $20 million per year cost. I’d like to see a breakdown soon. But please let us treat these critically ill people humanely and remember that we’re not talking about an animal shelter. Or a hotel!

        • Bob Orleck :

          Cynthia: I am not insensitive to those suffering from mental illness. The reason I used the hotel story was to put into perspective the obscene amount of money being spent and what I thought was the clear message that the managers of our money in supposedly meeting our obligations as citizens to provide for the mentally ill are doing it so poorly that we need not only to hold them accountable but also to remove them and give someone else a chance to do it right.

          Our current Vermont leaders in the legislature and the executive are Democrats but they are not yours or my father’s Democrats. My father was a Democrat who cared for his state, country and individuals. He was a patriot. These leaders are only patriotic to their desire to maintain power and they found a way to fund that by spending us into a state of slavery to the system they control. That is not democracy.

          In addition to their nefarious intentions they are also incompetent and the 25 bed mental health facility is just one example of that. You can oppose these folks and still be for helping those who are less fortunate and hurting in our society. In fact if you approach it from a point of really caring, you can do marvelous things with the power government can exercise. These leaders could care less about that. It’s all about power for their personal benefit and to win elections.

          Lets show them, Democrats, Republicans and Independents that the caper is up.

        • Jim Barrett :

          Your comment is well taken but you need to tell us why the estimate of costs was so low…..why? Who is being held accountable in government? I’ll answer that no one is held accountable and Vermonters are being taken for a sucker!

  7. Curtis Sinclair :

    The old VSH had 200 employees. This new one will only have half as many and yet has the same cost due to the staffing model. What is the staffing model? Is there a more efficient staffing model? This needs to be looked into.

  8. Dave Bellini :

    When the VSH Medical Director advised the legislature that the state needed to replace the state hospital with “a centralized four-unit acute care facility with 12-15 beds in each unit, ” the legislature ignored him. When Vermont State Hospital employees advised the legislature they too were ignored.
    .
    There is a need to replace the 54 high need beds with at least 54 beds. Do the Appropriations Committees understand “economy of scale” or do they have to Google it? Do they believe workers that actually do the job? Do they believe the Doctors that work in the field? Now they sound like the old Gomer Pyle character: “Shazam! Well, G-O-L-L-Y !!”
    I think there needs to be competency hearings held on State Street.

  9. Lance Hagen :

    So I did a little digging, and from a report last year (12/3/12) in vtdigger the following

    http://vtdigger.org/2012/12/03/cost-of-states-new-community-mental-health-system-to-jump-20-million-next-year/

    “The major annual operating cost increases stem from the $9 million needed to run the new state hospital and the roughly $3.6 million to operate facilities in Chittenden and Rutland counties.”

    The $9 million is for the new 25-bed psychiatric hospital in Berlin.

    So in 1 year, the estimation has gone from $9 million to $20 million for 25-bed psychiatric hospital in Berlin.

    Totally unbelievable! Where does the state find these financial wizards?

  10. Constance Brown :

    If properly staffed, equipped and run, the new hospital will be eligible for Medicare and Medicaid reimbursement, which the old one was not because it was not accredited.

    • Paul Lorenzini :

      them are free things right?

      • Bob Orleck :

        You got that right Paul. The Feds just print that kind of money so its free right? Yeah, right! What world do these folks come from?

        So if they do qualify for Medicare and Medicaid and the State still has to shell out $20,000,000 what in the heck are they spending that much money on?

  11. Lauren Berrizbeitia :

    Of course it’s more expensive! There has been an attempt to make the new hospital a good place with decent treatment. Good mental health care needs to be priority!

  12. Catherine Davlantes :

    I wonder or I think that there are properties in close proximity to the new psych ward that will be “obtained” for future use. Half way houses is what we are going to see perhaps sooner than later.

  13. Michael Loris :

    According to the article, Commissioner Dupre expects to fill all 25 beds at the Berlin “facility” by August 2014. It also states that although Vermont has 31 Level 1 beds, the daily need has exceeded the number of beds available by 16. The implication is that even when Berlin is full, there will continue to be at least 16 patients waiting.

    CVH (aka CVMC or whatever it’s called this month) has three small buildings next door (C, D and E) which will eventually be torn down, allowing for the inevitable expansion of the psychiatric hospital. The current (and possibly already discarded) thinking is “decentralization”, more than likely a reaction to the horrific conditions at the old centralized hospital in Waterbury. Since everything that goes round comes round, it won’t be long before it dawns on someone that a centralized “facility” makes far more financial sense for such a small number of patients.

    There will be expenses at the Berlin “facility” which are undoubtedly not included in the annual $20 million, and they will have nothing to do with patient care.

    The “butterfly” roofs on the new building will collect snow and ice, and will soon begin leaking. It’s unlikely the state budgeted for constant snow removal and the ongoing roof repairs we can expect in Berlin. In the long run, the only solution will be to redesign and rebuild the roof structure with shed or hip roofs so snow can slide off. Look for this item in the state budget in a few years, with assorted backing and filling by those who originally approved the building’s design.

    The architect responsible for the Berlin complex was apparently unaware that it snows in Vermont, and whoever approved the design of this building at the state level should be fired or dis-elected.

    Another problem that can be expected in Berlin has to do with the remaining plantation of maturing red pines, most of which were removed for construction of the “facility”. When buffer (perimeter) trees of a plantation are removed, the limbless inner trees are defenceless against strong winds. Where will those trees land during a storm? On the building.

    Aesthetically, the Berlin “facility” is one of the two ugliest buildings to have been built in central Vermont in the past year. (The other hideosity is City Eyesore in Barre, with its repulsive Main Street façade of confused brickwork and upside-down cornices).

  14. Anne Donahue :

    There is one question I did not see a single person ask:
    What is the cost per year per bed for any other kind of hospital care?
    Perhaps that would be a more appropriate comparison than hotel rooms.

  15. Bob Orleck :

    Jim: Well said but you left something out. Maybe, just maybe the voters of the state would wake up to the deception and vote these Democrats out next election. I say Democrats because they are in power, these are their programs, it is their fault and these are not your father’s Democrats. So you good Democrats who have voted the party line for years, wake up and realize these are aliens who have taken over your party and unlike your father’s Democratic party, they really do not care for individuals, only money and power. That is the bottom line and we need to turn them out on their bottom line.

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