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Patients who arrive with inadequate insurance coverage are especially vulnerable. At Tufts New England Medical Center, for example, when a psychiatric patient arrives, everything stops for a “wallet biopsy,” said Dr. Matthew Mostofi, the hospital’s vice chairman of emergency medicine.
Insurance coverage often dictates decisions about care for psychiatric patients and the facilities they may be referred to, Mostofi said. “Mental health patients are different,” he said. “They’re treated differently every step of the way.”
In practice, that means doctors often examine the patient’s insurance coverage and make decisions accordingly. Some might be allowed to remain in the hospital’s psychiatric unit, but others must be moved to less expensive facilities. And MassHealth patients — those with lower incomes who are receiving government assistance — have to be evaluated by a team of outside clinicians to determine whether they merit treatment at all.
Officials at Morton Hospital in Taunton last month suggested the outside evaluators were a factor in their much-criticized decision to release Arthur DaRosa shortly before he fatally stabbed two people and injured several others in Taunton. Morton, which is owned by for-profit Steward Health Care System, announced it would no longer use the state-run screening system after the tragedy.
The sharp focus by hospitals on money from insurance reimbursements shouldn’t come as any surprise. A 2015 report by Attorney General Maura Healey found that commercial and MassHealth insurance covered only 61 percent of the cost of delivering care to patients with mental health disorders and substance abuse problems.
Philip W. Johnston, a former state human services secretary who is now chairman of the board at the Blue Cross Blue Shield of Massachusetts Foundation, said insurance reimbursement rates are so low that some hospitals have cut beds reserved for mental health care or have eliminated their psychiatric units altogether.
“Hospital administrators concluded long ago that this is a money-losing proposition,” he said. “One of the most serious problems we face in mental health care in Massachusetts and around the country is patient dumping by financially strapped hospitals.”
But the insurance industry bridles at the idea that its reimbursements are deficient, saying that providers are paid adequately and that hospitals overall have fared better than insurers in recent years.
“We’ve got plans that, in aggregate, have lost money,” said Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans. “So where’s the money going to come from? Are we willing to pay more? . . . We have the highest health costs in the nation.”
Mental illness and murder
A little lengthy read on mental health care in Massachusetts.
Insurance coverage often dictates decisions about care for psychiatric patients and the facilities they may be referred to, Mostofi said. “Mental health patients are different,” he said. “They’re treated differently every step of the way.”
In practice, that means doctors often examine the patient’s insurance coverage and make decisions accordingly. Some might be allowed to remain in the hospital’s psychiatric unit, but others must be moved to less expensive facilities. And MassHealth patients — those with lower incomes who are receiving government assistance — have to be evaluated by a team of outside clinicians to determine whether they merit treatment at all.
Officials at Morton Hospital in Taunton last month suggested the outside evaluators were a factor in their much-criticized decision to release Arthur DaRosa shortly before he fatally stabbed two people and injured several others in Taunton. Morton, which is owned by for-profit Steward Health Care System, announced it would no longer use the state-run screening system after the tragedy.
The sharp focus by hospitals on money from insurance reimbursements shouldn’t come as any surprise. A 2015 report by Attorney General Maura Healey found that commercial and MassHealth insurance covered only 61 percent of the cost of delivering care to patients with mental health disorders and substance abuse problems.
Philip W. Johnston, a former state human services secretary who is now chairman of the board at the Blue Cross Blue Shield of Massachusetts Foundation, said insurance reimbursement rates are so low that some hospitals have cut beds reserved for mental health care or have eliminated their psychiatric units altogether.
“Hospital administrators concluded long ago that this is a money-losing proposition,” he said. “One of the most serious problems we face in mental health care in Massachusetts and around the country is patient dumping by financially strapped hospitals.”
But the insurance industry bridles at the idea that its reimbursements are deficient, saying that providers are paid adequately and that hospitals overall have fared better than insurers in recent years.
“We’ve got plans that, in aggregate, have lost money,” said Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans. “So where’s the money going to come from? Are we willing to pay more? . . . We have the highest health costs in the nation.”
Mental illness and murder
A little lengthy read on mental health care in Massachusetts.
