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Options for Improving the Texas Options for Improving the Texas

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Options for Improving the Texas - PPT Presentation

Mental Health Hospitals Though Academic Partnerships David Lakey MD Chief Medical Officer Associate Vice Chancellor for Population Health The University of Texas System Senior Vice President for Population Health ID: 791223

mental state capacity health state mental health capacity psychiatric texas hospital medical academic funding forensic residency partnership additional utsw

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Slide1

Options for Improving the Texas Mental Health Hospitals Though Academic Partnerships

David Lakey, M.D.Chief Medical OfficerAssociate Vice Chancellor for Population HealthThe University of Texas SystemSenior Vice President for Population HealthIsadore Roosth ProfessorThe University of Texas Health Science Center- Tyler

June 16, 2016

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Slide2

Key Challenges

Lack of CapacityIncreasing maximum security waiting listDecreased civil capacity due to increasing forensic demandCurrent unmet need estimated to be 570 bedsPopulation growth (1.8% per year) over next 10 years will require an additional 607 bedsHospitals are poorly designed for modern healthcareCurrent condition of hospitalsFive hospitals need to be replaced Lack of consistent funding for depreciation/ repairsCost of replacing hospitalsApproximate cost of replacing a 300 bed mental health hospital is $180-200 million

Increasing medical complexity of patientsLack of integration between physical and mental health Lack of strong partnerships

with academia

Rural facilities are frequently the sole “ industry” of the local community

Recruiting staffIncreasing outside medical care costsRole in disproportionate share hospital (DSH) fundingCurrent mental health hospital system is underfunded

2

Slide3

Potential Goals for a Mental Health Hospital System Redesign

Improved patient outcomes and experienceMaximize the use of resources Address long term operation costsMinimize upfront construction costs when possible through partnershipsServe our patients in settings most conducive to their healingMove civil capacity into the communities in which people resideOptimizing rural capacity for forensic needsExpand and better distribute maximum security capacity Minimize disruption to Texas communities that have invested in and are dependent upon State Mental Health HospitalsEstablish strong academic partnerships to:Enhance and advance careExpand training opportunities for mental health workforceImprove management of hospitals where appropriate

Decrease dependence on future legislatures to secure funds for depreciation/ repairsChange role of DSHS/ HHSC to contract management and oversite instead of direct operations when appropriate

3

Slide4

Deferred Maintenance Funding Requests:

Fiscal Years 2008 - 2017

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Slide5

Texas State Mental Health Hospitals Hospitals requiring replacement

North Texas-Wichita FallsTerrell State HospitalAustin State HospitalRusk State HospitalSan Antonio State HospitalHospitals requiring renovationRio-Grande State CenterNorth Texas-Vernon HospitalBig Spring State HospitalKerrville State HospitalEl Paso Psychiatric CenterWaco Center for Youth5

Slide6

Special Populations in State HospitalsAdolescents

Elderly patients/ Geriatric Psychiatry People with intellectual developmental disorders and mental illnessPeople with medical conditions and mental illnessPeople with a mental illness and a forensic legal status that are involved with the criminal justice system6

Slide7

Models for Academic PartnershipsPsychiatric residency training in state mental health hospitals

Combine psychiatric faculty/ practice plansMake all clinical staff university staffComplete management of the hospitalUniversity ownership of the facility7

Slide8

Examples of Successfully Partnerships with Academia to Operate State Mental Health Hospitals

OhioGeorgiaKentucky8

Slide9

Current Texas Models of Academic Collaboration in Inpatient Mental Health Services

UT HSC-HoustonHarris County Psychiatric Center next slideUT HSC-Tyler30 residential inpatient bedsOpened March 2013Funded by DSHS14 crisis center bedsOpened September 2014

Funded through Local Mental Health Authority21 geriatric psychiatry inpatient bedOpened September 2014

Non-state funded

Good integration of physical and mental health medical care

Psychiatric emergency room is adjacent to regular emergency roomNew psychiatric residency program in partnership with Rusk State Hospital

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Slide10

Harris County Psychiatric Center

276-bed acute care psychiatric hospitalSecond largest academic psychiatric hospital in the countryJoint ownership between the state and countyOperated and staffed by UTHealth Department of PsychiatryTeaching hospital

Funded primarily by the state through a contract between UTHealth

and The Harris Center, the local mental health

authority

The hospital is well designed and in good condition

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Slide11

Potential Risks to Academic InstitutionsPrestige

AccreditationFinancial riskFuture funding levels11

Slide12

Total Costs of Operating HospitalsCurrent operating costs in DSHS budget

Fringe benefits in ERS budgetDeferred maintenance/ depreciation of facilitiesOutside medical costsDebt services for facilityInflationary costs12

Slide13

Ways Academic Partnerships Could Improve Care

Bring telehealth/ telepsychiatry to hospitalsIncrease training opportunities for psychiatry residents and other critical mental health workforceImprove clinical settingImprove coordination with other healthcare providers in communityReduce outside medical costsNursing homes and discharge placementImprove treatment of forensic patients in public psychiatric hospitalsExpand prevention and early treatment programs13

Slide14

Opportunities to Improve Cost EfficiencyBetter designed facilities will lead to more effective use of staff

Potential to decrease length of stayAbility to serve more people with same resourceChallenging due to the shift in forensic capacityMinimize outside medical costsUse of technology such as telehealth14

Slide15

Options to Fund Initial C

onstruction of New State Mental Health HospitalsState Legislature ( GR or Debt) PhilanthropyPublic Private (or Non-profit) PartnershipUniversity –HHS Partnership15

Slide16

UT Institutions Operating Hospitals UT Institutions that currently

operate hospitalsMD Anderson  Cancer Specific MissionUT HSC Houston (HCPC only)UTMBUTSWUTHSC TylerUT Institutions that do not currently operate hospitalsUTHSC SAUT DMS (Austin)UT RGVAll other academic institutions16

Slide17

Criteria for Full Partnership with University of Texas System HospitalsHospitals in poor condition would have to be replaced

Reimbursement would need to include true operating costsThe plan would need to be approved by the University of Texas Board of Regents17

Slide18

Process of Developing the Following OptionsCannon Report and DSHS 10 year plan

Campus toursMeetings between all academic psychiatry chairs in Texas and DSHS/ HHSCDiscussions with Presidents of involved UT Health Science InstitutionsNote: These options have not been approved by the UT Board of Regents18

Slide19

Options

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Slide20

Rusk State Hospital

Potential partnership between UTHSC Tyler and RSHResidency trainingIncorporation of RSH physicians into the UT Practice planManagement of the RSH for the stateCapacity300 bed forensic facilityIncrease maximum security beds to 100 initiallyBuild the remaining 200 forensic beds with the flexibility to

convert them into maximum security if demand increases

Move

current

civil capacity to Tyler and Houston

Funding for new hospital construction

Limited options for public private partnership or philanthropy

Will likely need to be funded by the Texas Legislature

20

Slide21

Austin State Hospital

ChallengeNon-state run mental health beds are limited and some are in poor conditionOptionsPossible role of UT/ DMSIntegrate ASH physicians into the UT practice planExpand psychiatric residency by using ASH as a primary training siteBuild office space for UT psychiatric department on the ASH campusBuild a Brain Institute on sitePossible role of Austin Travis County Integral CareBuild outpatient clinic space on site Possible role of Local CommunityPotential partners include Central Health, City of Austin, Travis County, othersSupplement additional wrap around services such as crisis services, psychiatric emergency room, alcohol and substance abuse servicesFunding

State legislature could fully fund replacement of 300 bed mixed civil/ forensic facilityFund a public –private (non-profit) partnership to build and operate facility based on future funding of full operational/ debt service/ depreciation of facility

Encourage entity to build additional capacity at their expense for third party funding capacity

Encourage entity to have graduate medical education experience

Potential role of philanthropy for Brain InstituteExcess land could be repurposed

21

Slide22

Austin State Hospital

300 BedsFlexible DesignPsychiatric ERCrisis Center

Outpatient Clinic

Additional 50+ Beds

Medical School Psychiatry Department

Brain Institute

Possible Comprehensive Mental Health Campus Structure

UT

Dell Medical School

Austin Travis County Integral Care

Local Community

Other DSHS and HHS Administrative Offices

Alcohol and Substance Abuse

S

ervices

22

Slide23

Additional Capacity Options: Harris County

Expand Harris County Psychiatric Center bed capacity by 299 bedsAdditional inpatient bedsShort Term Acute inpatient beds 49 bedsShort Term Sub-Acute Patients 75 bedsCommunity based residential bedsResidential treatment 100 bedsCrisis respite housing 25 bedsSupported housing beds 50 beds23

Slide24

Additional Capacity Options:UTHSC-Tyler

Expand from 30 to 60 residential bedsMixed civil and low risk forensic patientsAdditional capacity can be opened as soon as funding is availableContinue to provide crisis and geriatric psychiatry services at current capacity levelsFunding level will have to include all operating costs and depreciation No additional construction / debt service costs are needed24

Slide25

Additional Capacity Options:Dallas/ UTSW

State-Academic partnership to develop inpatient capacity at UT Southwestern Medical CenterBuild 150 (or larger) bed civil and medical/ geriatric psychiatric facility on UTSW CampusConstruction costs would be incorporated into operating expenseLegislature would need to:Pay for initial debt service this sessionPay for full operating/ debt/ depreciation costs the following sessions

25

Slide26

San Antonio State HospitalChallenge

SASH campus is a significant distances from UTHSC-SACampus also contains the San Antonio State School and TCIDOptionsRebuild SASH on UTHSCSA campusRebuild on current SASH campusFunding plan would need to be developed over next bienniumPotential opportunity for Public-Private/ Non-profit PartnershipMay need funding from Texas Legislature Management planThere is not a desire to manage SASH by UTHSC SA at this timePhysicians could become part of UT Practice planOpportunity to expand residency and other work force training opportunities

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Slide27

Terrell State Hospital OptionsMove 150 civil capacity to UTSW when capacity is constructed

Backfill these 150 beds with forensic capacityImprove residency training opportunities with UTSW and UT Health Science Center TylerPossibility of incorporating clinical staff into UT practice planSecure funding following session for construction of new mostly forensic facility 27

Slide28

Rio Grande State CenterMultiple Components

Small State Mental Health HospitalRenovation costs estimate: $8.2 millionSmall State Supported Living CenterRelatively new outpatient clinicState laboratoryUTRGVCurrently very busy setting up new medical schoolNew psychiatric residency was just accreditedDeveloping residency training opportunities28

Slide29

Academic- LMHA Partnerships

UT SW modelMetrocare pays UTSW for a faculty member to oversee residency training at Metrocare Both Metrocare and UTSW see this as highly successfulUTSW residents with this experience have been much more likely to go into public mental healthOptionProvide funds to incentivize LMHA to replicate this modelApproximately $500,000 per site per yearFunds would support academic faculty member and several residentsOnly entities that demonstrate a partnership between a LMHA and a psychiatric residency program would be eligibleThis strategy has strong support from the academic psychiatric chairs across Texas

29

Slide30

Potential Timeline

85th Legislative sessionSecure state funds to rebuild Rusk State HospitalPurchase 30 additional beds from UTHSC-Tyler (Note: this could occur before session if funds are available)Provide direction to add capacity to UTSWProvide direction to add capacity to HCPCAustin State HospitalSecure funds to rebuild ASH, orDirect HHSC/DSHS to develop RFPConsider funding partnership between Academia and LMHA based on UTSW/ Metrocare experience

30

Slide31

Potential Timeline

86th legislative sessionAustin State HospitalApprove RFPIf no successful applicants for RFP, will need to secure funds from the Texas Legislature San Antonio State Hospital and Terrell State HospitalDetermine plan for funding new SASH and TSH based on lessons learned from ASH and RSHFully fund new capacity at UTSW and HCPCConsider strengthening partnership between UTRGV and RGSC31

Slide32

Thank you!

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