The director of one of the state’s largest community mental health centers says the head of the agency that oversees the behavioral health system appears to be making an effort to repair damaged relations with providers.
But he says Kansas Department for Aging and Disability Services Secretary Tim Keck has his work cut out for him.
“I do feel positive about the new secretary,” said Tim DeWeese, director of the Johnson County Mental Health Center. “It seems that he has a genuine desire to take care of the Kansans that need this (mental health) service that are most at risk.”
Republican Gov. Sam Brownback appointed Keck secretary in July after selecting him six months earlier to head the agency on an interim basis.
DeWeese gave his appraisal of Keck while discussing the Kansas mental health system on the most recent edition of the KCUR podcast “Statehouse Blend.”
He said Keck recently traveled to Johnson County to update law enforcement officials and mental health providers on the state’s efforts to regain federal certification of the Osawatomie State Hospital and reopen units that have been renovated to address patient safety concerns raised by federal inspectors.
“He wants to have beds back online by the end of the year,” DeWeese said. “He reported to us they are getting closer to the full staffing levels that they need.”
State officials reduced the hospital’s capacity from 206 beds to 146 beds in April 2015 so they could begin the renovations. Federal officials decertified the facility later that year, an action that has since cost the state approximately $1 million a month in Medicare reimbursements.
Angela de Rocha, a KDADS spokesperson, said the hospital would be ready for re-inspection on Aug. 30. An initial inspection will be done to determine whether the state has corrected the deficiencies that led to decertification. After what de Rocha called “a period of reasonable assurance,” inspectors will return to do a second survey to ensure that the corrective actions have been maintained.
The goal is to gradually restore 60 beds, de Rocha said.
“The expansion of bed space is dependent on staffing and will be done incrementally to ensure that we have the right staffing levels,” de Rocha said. “We will probably bring back 10 to 15 beds at first and then add beds as we add staff and get them trained.”
Pressure on the system
The additional beds are desperately needed to relieve pressure on the system, DeWeese said. On any given day, dozens of Kansans with mental illness deemed to be either a danger to themselves or others are being forced to wait for admission to Osawatomie. Under the best of circumstances, they’re waiting in hospital emergency rooms. But often, they’ve done something to land themselves in jail.
“Right now, we have four people in the Johnson County jail that are in need of hospitalization,” DeWeese said Friday.
Deb Stern, general counsel for the Kansas Hospital Association, said the situation at one large Johnson County hospital is illustrative of the problem. In the first four months of 2015, she said patients waited a total of 318 hours for admission to Osawatomie, with 23 hours the longest wait. But during the first four months of this year, the total number of hours jumped to 1,466, with waits of more than 40 hours common. The longest wait was 128 hours, or more than five days, she said.
“Our emergency rooms, they’re really backed up,” Stern said during a recent symposium at the Statehouse on mental health issues.
Beyond the renovations, Keck has been forced to grapple with longstanding staffing issues that federal inspectors said compromised safety after a patient sexually assaulted a hospital worker.
The hospital was chronically understaffed due to high vacancy and turnover rates caused by low wages and poor working conditions. Employees complained of having to regularly work double shifts.
During a recent interview, Keck said progress also was being made on the staffing front. A vacancy rate that hovered near 35 percent in February had dropped by July to about 21 percent. And what had been a 72 percent staff turnover rate in 2015 was holding steady around 19 percent.
Those improvements, Keck said, are largely attributable to budget increases approved by the Legislature that allowed administrators to give registered nurses a 10 percent raise and mental health technicians an increase of 12 percent.
“Those two pay increases have been a really big help,” Keck said.
OSH not the only problem
The progress Keck is making at Osawatomie is important, DeWeese said. But he said it remains to be seen what, if anything, Keck can do about funding reductions that undercutting the mental health system.
In the 2015 year alone, the cuts totaled $30 million, according to the Association of Community Mental Health Centers of Kansas.
“What we’ve seen are policy decisions that have systematically dismantled the public mental health system,” DeWeese said.
In addition to a recent 4 percent reduction in Medicaid reimbursement rates that Brownback ordered to balance the state budget, the elimination of some key programs has cut deeply into the budgets of community mental health centers.
Mental health providers feel “abandoned” by the state, DeWeese said.
The cuts forced Wyandot Inc. to lay off staff and eliminate services for more than 800 adults and children.
If Keck wants to significantly improve frayed relations, DeWeese said, he will need to help Brownback come up with a plan that providers can support to restore the $56.3 million in Medicaid cuts and lobby the governor to drop his opposition to Medicaid expansion, DeWeese said.
“The state of Kansas has some of the most restrictive Medicaid requirements across the board,” DeWeese said, referring to policies that exclude most poor adults from KanCare, the state’s privatized Medicaid program.
The annual income limits in the 32 states and the District of Columbia that have expanded Medicaid are $16,242 for an individual and $33,465 for a family of four. In Kansas, non-disabled adults with dependent children are eligible only if their annual incomes are below 28 percent of the poverty level, which for a family of four is $9,216 annually. Pregnant women, children and Kansans who are elderly or disabled are eligible under less restrictive income caps.
Advocates of expansion point to a Kansas Hospital Association study that indicates it would generate billions of additional federal dollars for the state. That funding also would reduce the amount of uncompensated care that doctors, hospitals and mental health providers now provide to people who can’t pay their bills.
“Last year, Johnson County Mental Health Center provided something around $6 million in charitable care,” DeWeese said. “If Medicaid was expanded, $3.1 million of that would go away.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.