State-run health care facilities have “significant deficiencies” overall, according to the initial report of a contractor hired to help fix them.
Alvarez & Marsal secured a $2.2 million contract in April to stabilize and manage health care facilities run by the Montana Department of Public Health and Human Services. On Wednesday, DPHHS Director Adam Meier presented the organization’s findings through May to an interim legislative budget committee.
Three veterans homes and the Montana Chemical Dependency Center in Butte were each rated under the designation “challenges exist,” while the mental health care facilities in Boulder, Lewistown and most of the facilities tied to the Montana State Hospital were all found to have “significant deficiencies.”
Overall, the facilities received a “significant deficiencies” rating by Alvarez & Marsal.
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The finding is “not news” for the Montana State Hospital, Meier said. DPHHS has spent months trying to shore up dangerous patient conditions, slow an exodus of long-term psychiatric employees and reduce an over-reliance on more expensive, contracted staff.
The facility lost its federal reimbursement funding from the Centers and Medicare and Medicaid Services after the federal agency found the hospital outside Warm Springs repeatedly failed to maintain minimum health and safety standards, resulting in the deaths of four patients and another who was critically wounded.
Raises have been spread across the facility and the hospital administrator employees identified as a central driver of the staff exodus was relocated to a different facility. But the de-certification by CMS means $8.5 million lost, although the state general fund takes the hit, not the state hospital’s budget. The reliance on contract staff, however, has put the state hospital in an $8 million operating deficit. That’s roughly $1 million more than what DPHHS reported in March.
“I would anticipate seeing a continued need for contract staff, which is a primary driver of the overage in terms of what you’re seeing here within our operating budget,” Meier told the committee Wednesday. “… Hopefully, we do see a drop in rates of contract staff as we kind of come out of the COVID surges that have driven that.”
The Alvarez & Marsal report laid out three key “operational challenges” for the state hospital. That included:
- Limited access to training compliance. The report notes Alvarez & Marsal, which touched down at the facility in early May, is currently working to determine what trainings are required.
- Limited use of existing data for quality improvement initiatives.
- High staff vacancy rate continues, as does the over-reliance on contracted staff.
The report does include a number of “wins” for the facility over the month of May, which includes things like updating hospital policies and improving programs for patients. Cleanliness and active treatment also improved over last month, according to the report, and the number of permanent staff applications and hires ticked up, as well.
The Intensive Behavioral Center in Boulder, as well as the Montana Mental Health Nursing Care Center in Lewistown, were cited in the report for having limited active treatment options for patients. The Boulder facility, however, made five new hires to the facility in May, and the Lewistown facility began increasing activities that had been restricted due to COVID-19 limitations.
“We will have to, you know, invest in more training, more programming, those sorts of things in order to get to the quality that we need to demonstrate, should we seek recertification (for CMS reimbursement funding) or just to generally provide what we expect provided Montanans,” Meier said.