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Will merging the nation’s largest mental health system save money for the County?

Article originally from the LATimes.com. Thanks to Pacific Asian Counseling Services for the notice.
Health agencies may be merged
Supervisor says that the plan would streamline operations and save money.
BY ABBY SEWELL

   Amid a change in top leadership at Los Angeles County, the Board of Supervisors is considering a major overhaul of the way the county provides health services to its 10 million residents.   Supervisor Michael D. Antonovich wants to merge the county’s public health department — which is responsible for preventing and responding to disease outbreaks, running substance abuse programs and inspecting restaurants, nursing homes and other facilities — and a separate mental health agency with the Department of Health Services, which runs county hospitals and clinics.   The proposal has been championed by Mitch Katz, the director of the health services department. Katz is favored by at least some of the supervisors to oversee the consolidated agency.   The county broke off public health services from the larger medical care agency in 2006. At the time, a fiscal crisis in county hospitals raised concerns that other public health programs could be cut.   Antonovich now argues that merging the departments would “break down the bureaucratic barriers facing the county’s patients, identify synergies, streamline operations” and “should result in budgetary savings.” Fred Leaf, a former county health department director and an aide to Antonovich on health issues, said consolidation would lead to a “service delivery system that is more responsive to patient needs and can provide the care more effectively.”   Katz said in an interview that the proposal offers tremendous advantages when integrating care for patients who may have a combination of physical, mental health issues and substance abuse problems. It would also make the county more competitive in vying for managed care contracts under the federal overhaul of healthcare, he said.   He has proposed to board members a management structure for the merger: The three departments would report to a single director and some of the administrative functions would be merged. The three agencies within the new department would retain separate budgets and would each be headed by their own director.   The public health director position is vacant, following the retirement of longtime Director Jonathan Fielding last year.   Fielding said in an interview that before the 2006 split, “public health was pretty much submerged and wasn’t able to advocate for itself.” If the supervisors approve the merger, he said, they should ensure that the directors of all three major divisions have direct access to the county’s elected board members and the county chief executive to advocate for their programs.   Mental health department Director Marv Southard could not be reached for comment, but some mental health advocates expressed concerns.   Brittney Weissman, executive director of the Los Angeles County chapter of the National Alliance on Mental Illness, said mental health issues might take a back seat in the larger health agency. She noted a similar consolidation effort at the state level had been rocky.   “Mental health may not be priority No. 1 in a new health agency, whereas it is of upmost concern to the current Department of Mental Health,” she said.   But Michael Weinstein, head of the AIDS Healthcare Foundation, enthusiastically endorsed the merger plan. He has feuded bitterly with the county public health department for years   — sometimes in court — over contracts and what his group describes as a clunky response to disease control.   Weinstein said that under Katz’s leadership, the health services department has become more open and transparent and has a record of “working closely and cooperatively with community partners.”   A majority of the board appears to support the consolidation. Supervisor Sheila Kuehl, who joined the board in December, said she generally favors the concept, and Supervisor Mark Ridley-Thomas said patients would be best served through an “integrated healthcare delivery system.”   The board could vote to give initial approval to the concept as early as Tuesday. Also on Thursday, interim Chief Executive Officer Sachi Hamai announced as part of a series of personnel and structural changes in her office that she would create an executive position in her office to oversee the potential consolidation of the health agencies. abby.sewell@latimes.com  

GENARO MOLINA Los Angeles Times   PATIENTS WAIT at County-USC Medical Center. Merging public health services with other agencies would reverse a division made during 2006 fiscal crisis.

missqueena Events, Press Release

The Largest Mental Health Workers’ Strike during the week of January 12, 2015

For immediate release

December 31, 2014
Contact: Justin DeFreitas: (510) 701-1415; jdefreitas@nuhw.org
KAISER PERMANENTE CLINICIANS TO LAUNCH NATION’S LARGEST EVER MENTAL HEALTH WORKERS’ STRIKE JAN. 12 – LOS ANGELES, CA
2,600 Kaiser California mental health clinicians notify state and federal authorities today that they will hold a week-long statewide strike over the HMO’s failure to provide timely, adequate care to patients. Local contacts and information on 35 strike locations and 65 picket lines below.
Additional documents for review:
Why are Kaiser mental health clinicians on strike?
Kaiser does not staff its psychiatry departments with enough mental health clinicians — psychologists, therapists, social workers, and psychiatric nurses — to meet the needs of its patients. Due to this staff shortage, our schedules are booked solid. Patients are forced to wait weeks, even months for treatment. For patients suffering from depression, anxiety, and other debilitating mental conditions, these delays can be insurmountable obstacles.
As mental health clinicians, we have an ethical obligation to advocate for our patients, whose conditions often make it difficult for them to advocate for themselves. For four years we have done all we can to persuade Kaiser officials to correct these ethical and legal violations, to no avail. That’s why Kaiser’s 2,600 California mental health clinicians and more than 700 other Kaiser employees — optical workers and healthcare professionals — are on strike, here in our community and throughout the state. Kaiser is letting our patients down every day, refusing to provide the timely, appropriate care they pay for with their monthly premiums and that Kaiser is required by law to provide.
In 2013, California’s Department of Managed Health Care fined Kaiser
$4 million for systemically understaffing its psychiatry department and falsifying records to conceal long appointment wait times. Yet Kaiser’s systemic violations of state law continue. After an initial diagnostic appointment, our patients frequently must endure waits of 4 to 12 weeks for treatment, making effective, ongoing therapy nearly impossible.
And the situation is getting worse. This year, under the Affordable Care Act, Kaiser’s California enrollment has increased by a quarter million members. Staffing levels, already too low, are not keeping pace with enrollment.
Meanwhile, “nonprofit” Kaiser is enjoying record profits. Kaiser hasmade more than $14 billion since 2009, and this year’s profitsare up 40 percent over last year’s record.
Last month, we presented Kaiser with a commonsense solution:clinician–management committees in each facility that can work together to determine adequate staffing levels and outsourcing needs, with help from a neutral, outside expert if the two sides cannot agree. It’s a simple and effective solution already in place in other health care systems. Once again, Kaiser failed to act.
With soaring profits and a $30 billion cash reserve, Kaiser can afford to invest in its mental health services by recruiting new clinicians, retaining experienced staff, and staffing its clinics in compliance with state law and in accordance with its ethical obligations as
a healthcare provider.
How can you help?
l Join us on the picket line.
l Call or write to
your local and state representatives and educate them on this important issue.
l Call or write to the Kaiser executives listed below and tell them you support our efforts.
Tell them Kaiser should be investing its record profits in its mental health services to ensure that its patients receive the timely, quality care they need and deserve.
KAISER EXECUTIVES
Bernard Tyson
NORTHERN CALIFORNIA
Dr. Robert Pearl
CEO, Permanente Medical Group (510) 987-3141Robert.pearl@kp.org
SOUTHERN CALIFORNIA
Dr. Edward Ellison
Director, Southern California Permanente Medical Group (626) 405-5000 edward.m.ellison @kp.org
35 strike locations and 65 pickets at Kaiser Permanente Facilities  
…National Union of Healthcare Workers.. NUHW 
Please join us on the picket lines next week as mental health workers
strike for better patient care and a decent worker contract.  

Los Angeles area strike locations: 

Media contact Elizabeth White
(310) 391-4785, elizbwhite@msn.com

Monday Jan 12
West Los Angeles Medical Center
6041 Cadillac Ave., West L.A., 90034

Tuesday Jan 13
South Bay Medical Center
25825 Vermont Ave., Harbor City, 90710

Wednesday Jan 14
Downey Medical Center
9333 Imperial Highway, Downey, 90242

Thursday Jan 15
Woodland Hills Medical Center
5601 De Soto Ave., Woodland Hills, 91367

Friday Jan 16
Baldwin Park Medical Center

1011 Baldwin Park Blvd., Baldwin Park, 91706 
EMERYVILLE — Kaiser Permanente’s 2,600 California mental health clinicians — psychologists, therapists, and social workers represented by the National Union of Healthcare Workers — will launch a statewide strike on Monday, January 12, to protest Kaiser’s chronic failure to provide its members with timely, quality mental health care. Kaiser staff will be on 65 picket lines at more than 35 locations throughout the state during the scheduled week-long strike. Notice of the strike was filed today.
More than 700 other Kaiser workers will join the picket lines, including Northern California optical workers and Southern California medical social workers, speech pathologists, audiologists, health educators, and registered dietitians, all of whom also report problems with inadequate staffing.
Despite huge profits — “nonprofit” Kaiser has made more $14 billion since 2009, and this year’s profits of more than $3 billion are up 40 percent over last year’s record— Kaiser Permanente does not staff its psychiatry departments with enough clinicians to treat the ever-growing number of patients seeking mental health care. Kaiser’s systemic understaffing forces patients to endure lengthy waits
for treatment — weeks and even months — in violation of California law and industry standards.

Last year Kaiser was fined $4 million for imposing lengthy and illegal appointment delays on mental health patients. Since then, Kaiser has failed to correct the violations. Compounding the crisis, during the first nine months of 2014, Kaiser added 422,000 new members nationwide, many as a result of the Affordable Care Act.
 
“For patients suffering from depression, anxiety, and other debilitating mental conditions, these delays can be insurmountable obstacles, sometimes leading to tragic outcomes,” said Clement Papazian, a clinical social worker at Kaiser in Oakland and president of NUHW’s Northern California chapter of mental health clinicians. “We don’t want to see patients being ignored. Kaiser’s actions are doing real harm. Even suicides have been linked to Kaiser’s delays and denial of care.”
For more than four years Kaiser has refused to acknowledge the problems caused by its lengthy appointment delays, much less fix them. Having exhausted every other means, Kaiser’s mental health clinicians are adhering to their ethical responsibility to advocate for their patients by conducting a strike aimed at forcing Kaiser to uphold its contractual and ethical obligations to its patients.
Journalists covering this issue are encouraged to review NUHW’s ten-page summary, which provides a history of the crisis, its impact on patients, and evidence of ongoing violations. Here are a few key items:
In 2013, California’s Department of Managed Health Care (DMHC) fined Kaiser $4 million for systemically understaffing its psychiatry department, falsifying patients’ appointment records to conceal long wait times, and providing patients with misleading information regarding the care available to them — a situation nearly identical to the scandal that engulfed the Veterans Affairs Administration last year.
Rather than staff their clinics appropriately, Kaiser merely shifted resources, directing clinicians to see more first-time patients at the expense of returning patients. Healthcare workers at Kaiser facilities report that patients frequently endure waits of between four and twelve weeks for a return appointment, making effective, ongoing treatment nearly impossible.
The situation is getting worse. This year, under the Affordable Care Act, Kaiser’s California enrollment has increased by a quarter million members. Staffing levels, already too low, are not keeping pace with enrollment of new patients. Withholding services while increasing membership is an effective way
to score record profits but it has led to woefully inadequate care, as well as four class-action lawsuits filed by patients and families who say Kaiser’s violations contributed to tragic outcomes, including suicides.
In September, Kaiser implicitly acknowledged the problems by agreeing to pay the DMHC’s $4 million fine. Also, Kaiser revealed plans to outsource Northern California mental health services to Value Options. Kaiser’s mental health clinicians believe outsourcing is necessary as a temporary, stop- gap measure while Kaiser hires enough staff to meet its patients’ needs. However, Kaiser has ignored Value Options’ dubious track record. In July 2009, New Mexico discontinued its use of Value Options because of the company’s denial of services to patients.
In June 2014, California’s Department of Managed Health Care fined Value Options for “repeated deficiencies.” And in July 2014, New York’s attorney general assessed $1.2 million in penalties to Value Options and up to $31 million in restitution to patients for denial of access to mental health care.
In contract bargaining in December, Kaiser’s mental health clinicians presented Kaiser with a commonsense solution: clinician–management committees in each facility that can work together to determine adequate staffing levels and outsourcing needs, with help from a neutral, outside expert
if the two sides cannot agree. It’s a simple and effective solution already in place in other health care systems. But once again, Kaiser failed to act, triggering this statewide strike.
“With soaring profits and a $30 billion reserve, Kaiser needs to step up and lead the way in finally making mental health care a priority in this country,” said NUHW President Sal Rosselli. “The law requires it and Kaiser’s ethical obligations as a health care provider demand it.”