M Health Fairview’s Solution is Not the Answer

M Health Fairview is still threatening to close St. Joseph’s Hospital. This is a hospital that has slightly over 100 beds to treat people with mental illnesses and those with serious substance use disorders. They claim that the loss of money at St. Joe’s is what is forcing them to consider shutting it down. We see only a brief mention of the loss of funds when Fairview merged with the University of Minnesota’s M Health (reported to be $80 million per year in additional spending on the U’s academic physicians.). But hey, let’s blame it on St. Joe’s.

NAMI Minnesota, using data from the Minnesota Department of Health, found that St. Joe’s uncompensated care, charity care and bed debt were definitely not worse than other hospitals such as HCMC, Regions, Abbot and others. Uncompensated care per bed at St. Joe’s in 2018 was $20,151 versus $60,350 at HCMC, $41,938 at Regions and $22,917 at United. The differences were even greater in 2017 with the numbers at St. Joe’s being far lower than other hospitals in the metro, Duluth and Rochester.

In response to the backlash on the possible closure, James Hereford, M Health Fairview’s CEO, wants other health systems to help pay for a stand-alone psychiatric hospital. In the Star Tribune article on March 10, 2020, he is quoted as saying, “People are going to look at this and say, ‘That was really transformative in this market.’ ”

Actually, we’re not. It’s not transformative, it’s a step backward. We have worked hard to integrate mental health and health care. Our heads are connected to the rest of our body. To create a separate psychiatric hospital to provide acute mental health care ignores the fact that people coming into St. Joe’s now have other heath care conditions such as diabetes, heart conditions, and renal failure. We can’t just treat someone’ s head – we need to treat the whole person.

Additionally, such a hospital would be called an IMD – an Institute for Mental Disease – which means that Medicaid would not pay for any treatment provided at this hospital. The IMD exclusion is why Medicaid doesn’t pay for care at Anoka Metro Regional Treatment Center and why our crisis homes and residential facilities are 16 beds.

How would the care be paid for? Hereford has suggested obtaining a Medicaid waiver or having a Medicaid block grant. Waivers are not easy to obtain and there are limitations on the length of stay. Medicaid block grants are out of the question and totally opposed by most organizations in the state of Minnesota. To create a stand-alone hospital with no clear way to pay for care is totally irresponsible.

Hereford also stated in the article that, “We have a broken system for caring for mental health. What the actual inpatient need is, I don’t think anybody can or should speculate, because we don’t know what a highly effective ambulatory system’s impact would be.”

Actually, no. We don’t have a broken system – we’ve never built it. And closing a hospital will push us further away from building one.

While everyone agrees we need to provide earlier intervention, closing a hospital isn’t the way to address it. When health systems focused on improving heart health, they didn’t immediately close down their cardiac units.

While it’s true we don’t know what the exact number of inpatient beds are needed, we do know that we have people boarding in ERs waiting for a bed, people travelling long distances (including to North Dakota) to access a bed, and people ending up in jail or homeless due to the lack of inpatient beds.

It’s disappointing to see the lack of understanding about the needs of people with mental illnesses by one of the larger health care systems. Their solution is not the answer.