Citing financial realities, CHA shifts adolescent services

In recent years, psychiatric service providers across Massachusetts have struggled with payment issues. The reimbursement problem has forced many to revaluate their programs and in some cases, seek new strategies for maintaining quality care, especially for younger patients.

The latest to restructure its services is Cambridge Health Alliance, who on April 3, 2013, announced it would be integrating its child assessment unit with its adolescent assessment unit by the fall. The combined unit comes as a result of both economic realities and on-going societal perceptions.

“I think society has always been reluctant to know how to treat mental illnesses,” says Jay Burke, Ph.D., CHA’s chairman and chief of the department of psychiatry. “And safety net providers like us have had similar problems as other providers in the area with an unfortunate history of poor payments.”

After reviewing the two units, both of which have provided inpatient psychiatric care with 27 beds for ages 3-18, CHA decided to integrate the units to one combined Child & Adolescent Assessment Unit (CAAU). Set to open in October, the renovated unit would include16 beds for patients ages 8-18.

Citing inadequate payments “from all payers for these services,” CHA spokesman David Cecere says the integrated unit allows the organization to care for “the largest number of patients within the constraints of our limited resources.”

“We take great pride in offering behavioral health services to a significant spectrum of ages,” says Cecere. “This move is consistent with the state’s strategy to shift behavioral health care to outpatient, community settings close to where patients live.”

That move signals what Burke calls a proactive effort, one he hopes, in turn, will reduce the number of youth needing hospitalization. Most of the other units in the area, he says, already provide care in an integrated child and adolescent psychiatry unit.

CHA is one of the few acute care hospital in Eastern Massachusetts that still operates two separate units. Seventy percent of its child and adolescent psychiatry inpatients come from outside the area and only about 15 percent are CHA primary care patients.

“Eight percent of our child and adolescent inpatient psychiatry patients are under age eight while the staffing and permanent programmatic needs for this age group are substantial,” Cecere says. “The proposed 8-18 age range that the (new) integrated unit would serve accounts for more than 92 percent of the inpatient and child population we have cared for in the two units during the last two years.”

As CHA expands in other programs, it will maintain its partnerships with other community agencies for inpatient psychiatry services and outpatient psychiatric care, according to Burke. He says state programs have been effective and will continue to provide services that help reduce the need to hospitalize younger children.

“No one wants to reduce access to services,” Burke says. “CHA has maintained its commitment to serving the population within the means we’re provided by the payers, but we all need to advocate for adequate services for children and adults with any of these disorders.”