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THOUSANDS OF THE MOST SEVERELY AND  PERSISTENTLY MENTALLY ILL AND/OR ADDICTED PERSONS IN NORTH TEXAS FACE CUTBACKS IN TREATMENT (beginning November 1).

Below see three responses from leaders in our public mental health system which were sent to the North Texas Behavioral Health Authority Board  (NTBHA) and which express serious concern about the care and treatment of the mentally ill and addicted in North Texas.  

 1.      ”I reviewed VO’s summary of potential medical expense reductions and the reactions from a couple of other providers.  Its hard for me to judge the merits of any of those until I truly understand the magnitude and source of the financial issues.  I do have grave concerns about the value or wisdom of VO’s recommendations that further reduce our ability to meet the communities’ needs in the outpatient programs.  It only seems to reinforce the downward spiral that increases the number of emergencies, crises and bad outcomes for clients.  In order, however, for us to determine which adjustments are the most productive and least destructive, we must start with a common understanding of the actual financial changes from last year.”    ~ J. Randy Routon, Ph.D., Chief Executive Officer, Life Path Systems 

2.       “NorthSTAR is spending less and less real dollars on out patient community based services as each of the last five or more years have gone by. Five years ago we spent more than four years ago, four years more than three years ago, three years ago more than two years ago. Am I not reading this data correctly? We have a  runaway increase in crisis expenditures. It is time to redesign crisis services with the goal to spend less and less dollars while maintaining current out patient expenditures.”  ~ James W. Williams, Director Mental Health, Lakes Regional MHMR Center

3.         “Respectfully, here’s what NTBHA should do instead of approving the cuts, caps and closings:

Ask  VO to propose a crisis services redesign that spends less money on people in clinics, offices and ER’s and more money on clinicians out in the streets with our police

Ask VO to propose a  homeless/justice redesign that incentivizes VO and its provider network to get people off the streets and keep them out of jail

Ask VO to propose an outpatient services redesign that spends more money on the types of services for children, families and adults that address community priorities identified by BHLT

Help VO tie every redesign idea to a NTBHA or BHLT goal and outcome measure

Assure that the redesigns also significantly cut VO’s costs and so help meet its fiscal goals

Help  VO shift its risk-reward curve toward more risk, thereby offering it a greater chance of the reward of achieving its profit goal, through more utilization review and less fixed rates and “cap” agreements.”

 ~ James G. Baker, MD,MBA  Chief Executive Officer  Metrocare Services

Here are the proposed cuts in an already deficiently funded system which are being proposed by value options (VO), the insurance company that runs our public treatment system:

*Proposed cuts, caps and closings for implementation on November 1st and contingent cuts proposed for March 1st are listed below.  Our models show that the November changes represent a 20% cut in outpatient service dollars available, leaving too few doctors and other clinicians for viable treatment programs.  Access and quality will go down.  Crises will go up — and so will homelessness, ER visits, and jail stays.  The proposed March cuts would reduce outpatient service dollars by another 6%.

Cut doctor, hospital and case worker rates by 5% “across-the-board”
Cap the dollars available for emergency room services (23-hour program)
Cap the cost of hospital care
Close Metrocare after-hour clinic
Close Centro de Mi Salud after-hours
Cut out the supported employment that helps patients find jobs
Cut UTSW funding for psychiatrists in training in public sector settings
Cut funding to Transicare for case management and patient transportation
Close The Club (“Dallas drop-in center”)
Close transitional housing (“rental subsidies”) for patients just released from the hospital
Cut low-intensity outpatient services (SP1) case rate to $70 per month
Cap low-intensity outpatient service duration (SP1) at 90 days per patient
Cut physician-only services reimbursement to $40 per month
Cap the number of patients who can get higher-intensity services (SP2 and SP3), in March
Cut Transicare even more, in March
Cut peer services, in March

North Texas Psychiatrists & Psychiatrists in Training – Contact your state legislators (www.capitol.state.tx.us) and/or the NTBHA Board expressing the need to prevent these cuts and to put treatment back in the hands of doctors with other mental health professionals.

 NTBHA can be reached at:   North Texas Behavioral Health Authority, 1201 Richardson Drive, Suite 270, Richardson , TX  75080.   Attention: Alex Smith – Executive Director and Judge Michael Chitty- President NTBHA Board    Tel. 214-366-9407   fax 214-366-9417  or email: bruckdeschel@ntbha.org.

Thank you,
Edgar P. Nace MD     epnace@gmail.com
NTSPP Immediate Past President, Media Chair, & Co-Chair of the Public Psychiatry Committee