May 7, 2018
Notes from (1) the Cook County Health and Hospitals meeting presentation on mental health care and substance use April 27, with links to meeting audio excerpts and (2) telepsychiatry.
G. Blakemore talked about the Cook County Inspector General’s 2018 Quarter 1 Report that said that Cook County Health and Hospitals System (CCHHS) failed to follow commercial insurance Payors’ stipulations that resulted in reimbursement denials of at least $170 million in 2016 and 2017 combined.
[The City isn’t the only entity having trouble with its insurance billing. Of course having a single-payer system would eliminate much of the difficulty.]
L. Clark, a psychiatrist working from Provident Hospital and/or Austin Health Center, complained about the absence of a psychiatry department office at Stroger or CCHHS-central.
R. Jackson, spoke for the Board about the CCHHS history and participation in creating the shortage and disparities in mental health services and its responsibility to fix the problem.
A written comment was also submitted to correct misreporting about the level of psychiatry coverage at CDPH centers and recommending that CCHHS telepsychiatry services should supplement not supplant current in-person care.
An audio excerpt of the CCHHS presentation on “Behavioral Health” is here.
It was a positive that CCHHS put mental health and substance abuse issues on the agenda. Unfortunately, the Behavioral Health presentation was given short attention because executives said they had to leave to attend an event with President Preckwinkle. There wasn’t much discussion.
The presentation catalogs CCHHS programs and projects including addressing substance misuse but includes scant information that would tell the public what is actually working. While the content of the CCHHS presentation is still under review, one glaring omission was the absence of reporting on the 2017 outcomes of the Roseland Community Triage Center and the Roseland Behavioral Health Center. Additionally, despite concerns raised by the public at a previous meeting about CountyCare’s low rate of post-hospitalization follow up on persons living with mental illness – an improvement or corrective action plan was not presented. The presentation does list a “BH Hospital Transition Program.”
For example, see the most recent 2016 HealthChoice Illinois Plan Report Card Behavioral Health measure. https://www.illinois.gov/hfs/SiteCollectionDocuments/SampleHealthChoiceIllinoisCookCountyPlanReportCardandTipsSheet121417.pdf or
In the future, CCHHS should review their perinatal depression screening practices and outcomes, too.
CCHHS should report measures by race/ethnicity/language/gender and geography.
No mental health or substance abuse practitioner sat at the CCHHS table to present. CCHHS did report an effort to hire a physician to oversee CCHHS “behavioral” health programs and who “reflects the community.”
CDPH and CCHHS executives have made casual and written statements about CCHHS using telepsychiatry in several different settings: “Telepsychiatry is a common practice — CCHHS has used this in several settings.” See Telepsychiatry Response.pdf from CDPH and CCHHS.
But according to CCHHS staff, the Doctor’s Council, as well as the April 27 CCHHS report on behavioral health, the only place CCHHS has experience using telepsychiatry – where the doctor is speaking directly with the patient – is at Cermak Hospital (a non-voluntary community environment).
CCHHS doesn’t use telepsychiatry on any routine basis for its own clients in its voluntary ambulatory care clinics. Doctors may use teleconferencing to consult with other doctors but they are not using it to connect with patients in CCHHS outside of Cermak. According to the Doctor’s Council, the physicians practicing telepsychiatry at Cermak are CCHHS employees, not Regroup staff. So why is CCHHS pushing Regroup on the City? Does CCHHS’ contract require CCHHS to pay Regroup a minimum amount regardless of CCHHS’ actual use?
It seems that CCHHS uses telepsychiatry as a supplement—as a back up when a psychiatrist is absent rather that as the sole means of providing psychiatry services- — which is unlike the model CDPH has told us it plans to implement at CDPH centers.
(Is there a back-up plan in case of telecommunications or television device failures?)
Initially, the intergovernmental agreement was about telepsychiatry services and use of Cerner electronic medical records. Now it has expanded to include pharmacy and laboratory services. Neither CCHHS nor CDPH have been transparent regarding the scope of pharmacy or laboratory services or what these services entail.
The inclusion of lab, pharmacy, and clinical oversight services in the IGA discussions are a direct result of the Boards communications with CCHHS (and CDPH) including the sharing of the CARF report which critiques the city’s handling of these matters. There have also been written communications to the Commissioner about the handling of prescription medications and the lack of clinical oversight. More cynically, these additions could be an attempt to justify and provide cover for the higher costs for telepsychiatry than usual care.
It certainly raises concern about the quality of services city residents have been receiving in City-run spaces if it is the case that current psychiatrists are not monitoring or ordering lab tests and that CDPH doesn’t have a system in place to ensure that current residents are able to obtain prescription medications when recommended.
CDPH has yet to respond to a request that it identify the licensed professional(s) currently overseeing psychiatric services. CDPH should explain how and whether physician credentialing by CountyCare and managed care plans is influencing the IGA and why CDPH has not made an effort to contract with other MCOs (beside Meridian). (Will a city resident and taxpayer with BCBSIL be able to use the City clinics for psychiatry services in the future?)
Representatives of the therapists’ union met with CDPH management last week to discuss psychiatry services. CDPH doesn’t have a (transparent) start date for beginning telepsychiatry. It seems that they are set on beginning within the next six months and before the end of the calendar year.
Last month, CDPH changed its narrative about posting the psychiatrist job position. This is a positive. Unless, however, there is a plan to do some active outreach, it’s probably just for the sake of form. The City should update the National Health Service Corps websites, too.
Greater Grand Mental Health Center
Greater Lawn Clinic
North River Mental Health Clinic
Neither CCHHS nor CDPH have bothered to ask the community and persons served what we want — a most important and ongoing issue.