R.I. hospitals name top health issues

Access to health care and the need for mental health services are among the most important health issues facing Rhode Island, finds a new Community Health Needs Assessment (CHNA) by the Hospital Association of Rhode Island (HARI).

The Affordable Care Act requires tax-exempt hospitals to conduct CHNAs every three years and submit their findings and implementation plan with their Internal Revenue Service Form 990.

Rhode Island’s 14 hospitals are all non-profits belonging to HARI and collaborated on a comprehensive state-wide assessment between Sept. 2012 and May 2013. Findings will guide community health improvement initiatives, says HARI Senior Vice President Michael Souza. June sessions were scheduled to develop an action plan with the goals of improving access to quality mental health care and raising awareness about diabetes and its management, Souza adds.

The assessment analyzed state data submitted to the Centers for Disease Control Prevention Behavioral Risk Factor Surveillance System survey and other data including mortality and cancer rates and social determinants of health. There were also interviews with community stakeholders and focus groups on mental health.

The greatest concern involved access to care for the uninsured and underinsured and those individuals seeking specialty care. Participants expressed concern that Rhode Island has too few bilingual providers.

Among other needs:

• Mental health status: Limited treatment options for uninsured/underinsured often lead individuals with mental health issues to use hospital emergency rooms. Rhode Islanders report higher incidence of depression (22 percent) than nationally (16.8 percent.) About 38 percent of adults surveyed had at least one day in the past month when their mental health was not good. More than 45 percent indicated poor mental or physical health days keep them from their usual activities, higher than 42 percent nationally.

• Obesity: The majority of Rhode Island adults (62.3 percent) are either overweight or obese. Participants felt reducing obesity would improve other chronic health issues such as heart disease, stroke and diabetes.

• Alcohol use: Rhode Island adults consume more alcohol than national statistics. In the past 30 days, 63 percent reported drinking alcohol at least one day compared to the national benchmark of 55 percent.

Among the 21 focus group participants was Margaret Howard, Ph.D., director of the Postpartum Depression Day Hospital at Women & Infants Hospital in Providence and a clinical professor of psychology at Brown University’s Warren Alpert Medical School. Howard discussed the lack of resources for providing behavioral health care to children and adolescents and by default, their families.

“I think the primary care pediatric community feels some of this frustration most acutely. In their practices, they see kids with physical complaints that are really manifestations of psychological distress.”

Howard voiced concerns over the challenges providers have with low reimbursement rates and a cumbersome insurance process.

“My colleagues in private practice, many of them are opting out of insurance plans simply because the reimbursement is so low and the authorization process … is so time consuming,” she says. “Many psychologists, I think are very conflicted. They want to have their services widely available. I don’t think their intention is to be restrictive. They want to spend more time providing clinical care and less time completing paperwork and justifying their treatment decisions.”

Four Butler Hospital representatives participated including Lisa B. Shea, M.D., associate medical director of quality and regulation and assistant unit chief of the Partial Hospital. She says access problems discourage providers from practicing in Rhode Island.

“It’s hard to recruit mental health professionals particularly psychiatrists to the state because the payments from insurers are less than in neighboring states,” Shea says, “so people are more apt to open up shop in Massachusetts so that’s been a challenge.”

Shea says she is “very impressed” with the assessment process so far. “I felt they really tried to reach out to a diverse group of people and understand what’s going on,” she adds.

“The most important thing they did is they got the conversation started. I think that people are really aware right now of the need to be creative in the delivery of care, the need to integrate primary health care with primary mental health care,” Howard says.