Cuts hit mental health patients
Edinburgh Center cites years of losses
A Waltham outpatient clinic that serves people struggling with severe mental illnesses is slashing its outpatient operations this month, leaving 350 patients to find new care providers and 11 clinicians to find new jobs even as other facilities face the same fate.
“This has been a very difficult decision for our agency,’’ said Ellen Attaliades, chief executive of the Edinburgh Center. “The rate of reimbursement that we receive from the insurance companies doesn’t fully support the cost of running the clinic.’’
Attaliades and others in the mental health field say the downsizing is symptomatic of a larger trend that’s been happening for years.
“I’ve been practicing since 1992. The issue of outpatient rates has been an issue the entire time,’’ said Marie Hobart, president of the Massachusetts Psychiatric Society and medical director for Community Healthlink Inc. in Worcester. “In the past five to 10 years when you look at the rate of inflation and then look at the rates for Medicaid and Medicare in particular, they just have not kept pace with the cost of doing business.’’
The fallout, she said, is that people are finding it increasingly difficult to get treatment for severe and persistent mental health issues, such as schizophrenia, bipolar disorder, and borderline personality disorders, because providers can’t afford to take on the clients.
Hobart said the Massachusetts Psychiatric Society has tried lobbying for mental health funding at the Legislature and governor’s office. “In recent years, it’s fallen on deaf ears,’’ she said.
Attaliades said that both private and public insurers are to blame for dwindling provider payments. “It’s all the insurances. It’s MassHealth and all of the managed-care entities,’’ she said.
A spokeswoman for the state’s Executive Office of Health and Human Services said that given the weak economic climate and the resulting state budget cuts, the agency sees the fact that reimbursement rates haven’t fallen as a positive development. Jennifer Kritz said reimbursement rates have remained flat for about five years.
But at the Edinburgh Center, this has translated to yearly deficits of about $400,000 for the past few years, said Attaliades.
She said that the cost of providing an hour of treatment ranges from $106 to $128. The Edinburgh Center gets back $66.27 an hour from MassHealth, which covers low-income residents, for psychiatric services and $62.71 an hour for counseling. A private contractor used by the state for mental health services reimburses at a slightly higher rate, but it’s still not enough, she said. “If our rates were increased about 40 percent, we’d be able to cover costs,’’ she said.
The other services provided by the Edinburgh Center, such as residential support and inpatient treatments, will not be cut, said Attaliades. She said the outpatient clinic has lost money for years, and if the center didn’t cut back its operation, the other services would be imperiled.
Kritz said the state is committed to working with the Edinburgh Center to ensure their clients aren’t left without services.
Attaliades said her center has provided its clients with the phone numbers of four clinics that have said they’ll take some of the Edinburgh Center’s displaced clients, which is about half the number of clients who are now seen in the outpatient clinic. She said there’s also an emergency crisis team that’s been set up to help clients with the most severe issues.
But Edinburgh clinician Debbie Spitz, one of 11 who will lose jobs, said she’s heard that some clients seeking alternate care have run into difficulties.
“According to feedback from our clients, many clinics have long waits, as much as four months, and some have stopped returning phone calls,’’ said Spitz.
At the Lahey Clinic in Burlington, one of the places recommended by the Edinburgh Center, the facility “has limited ability to safely take on more patients at this time,’’ said spokesman Steven Danehy. “However, the clinic will do what it can’’ for patients in need, he said.
The Somerville Mental Health Association is also on the list of recommended providers, and clinical director Mary Lawler said the agency is able to take on Edinburgh clients.
But, since the recommended clinics pose commuting challenges for clients who don’t drive, many are turning to Riverside Community Care in Newton, which is not on the list of recommended clinics but is closer to Waltham, said Spitz.
Riverside executive vice president Marsha Medalie said the waiting list is “more than a couple months long,” and the clinic is urging former Edinburgh clients to seek treatment elsewhere.
Medalie said Riverside has had to do its own downsizing of outpatient care because of the same problem Edinburgh is facing — insurance reimbursement rates that don’t come close to covering treatment costs. Riverside, which operates seven locations throughout the state, has shuttered its Bellingham clinic and significantly reduced the size of its Wakefield clinic, said Medalie.
The Edinburgh and Riverside facilities are not the only area clinics that have faced cutbacks.
The Wayside Youth & Family Support Network, with facilities in Framingham, Milford and Waltham, had to cut back its outpatient services starting last year for the same reason, said president and CEO Eric Masi.
Megan McKee can be reached at firstname.lastname@example.org.