[A]fter nearly a year of planning and deliberation, University of Vermont Health Network administrators are proposing to build 25 new psychiatric treatment beds at Central Vermont Medical Center in Berlin.
The size of the facility had been a sticking point, largely due to restrictions imposed by federal funding regulations. Running afoul of those regulations could jeopardize Medicaid money for the entire hospital.
But administrators say 25 beds – which would be added to Central Vermont’s 15 existing psychiatric beds – is the right number to keep hospital funding safe while also alleviating pressure on Vermont’s mental health system.
The planned facility “will not meet the entire unmet need in the state,” said Eric Miller, the health network’s general counsel.
Nevertheless, it “will still make a very important difference in (Central Vermont’s), UVM Health Network’s and the state of Vermont’s ability to treat our mental health patients who are currently not getting care in the right place at the right time,” Miller told the Green Mountain Care Board on Wednesday.
Vermont’s mental health system is not keeping up with demand, with recent statistics for federal fiscal year 2018 showing thousands of inpatient admissions and an even larger number of patients waiting for psychiatric inpatient treatment in hospital emergency rooms.
That emergency room logjam has led to regulatory trouble for several Vermont hospitals where inspectors found evidence of mistreatment, assaults and inadequate staffing to handle mental health patients.
In an attempt to jump-start the process of boosting psychiatric inpatient treatment capacity, the care board last year ordered UVM Medical Center to set aside $21 million in fiscal 2017 revenue to “measurably increase inpatient mental health capacity in Vermont.”
Since then, the health network has been working with a consultant and an advisory group to figure out how best to meet the care board’s mandate. The network quickly settled on the Central Vermont Medical Center campus as the right place for new beds, but the size of the proposed facility was up in the air.
That’s because the federal government prohibits the use of Medicaid money for facilities of a certain size that have been classified as “institutions for mental disease.” Vermont has been getting around that restriction due to a waiver agreement, but that’s set to expire in a few years.
The concern was that if too many psychiatric beds were built at CVMC, the entire hospital could be designated an institution for mental disease. That could have cut off the flow of federal Medicaid funding for all Central Vermont patients.
“It is of existential importance that we get this right with respect to the number of beds,” Miller said.
Extensive study – including projections of future hospital occupancy – led to the new 25-bed proposal. That’s fewer than the 29 to 35 beds that a previous health network study said Vermont needs, but it also would mark a significant increase in inpatient treatment.
The newly defined plan doesn’t mean construction is right around the corner. Anna Tempesta Noonan, president and chief operating officer of Central Vermont Medical Center, said the process is expected to take two to three more years.
With the bed size of the facility established, “now we need to really engage in the conversation around what’s that going to look and feel like, what the programming would look like, what the space would look like,” Noonan said.
The network’s schedule is too long for some. Ken Libertoff, former director of the Vermont Association for Mental Health and still a frequent participant in care board issues, said the health network had assembled “a really strong team” that needs to move faster.
Libertoff urged planners to strike “a balance between being incredibly thoughtful and thorough” and “the reality that there’s a crisis here and there’s a sense of urgency.”
“It will only get worse, in my opinion, not better, between now and whenever the new doors open on this facility,” Libertoff said.
Care board Chair Kevin Mullin said he wants the project done “as soon as possible with the best possible results.”
“I think that everybody in the state wishes it could magically happen overnight,” Mullin said. “We know that can’t happen.”
John Brumsted, the health network’s president and chief executive officer, said it’s important to gather community input as administrators move forward with building a new mental health facility.
“We’re not going to take our foot off the gas pedal,” Brumsted said. “We’re going to try to do that balancing act and end up solving this crisis as quickly as we can.”
