By Liora Engel-Smith
An Eastern North Carolina hospital is planning to shut down its inpatient mental health unit next month.
The impending closure of Vidant Beaufort Hospital’s 19-bed unit is the first time in recent memory that a mental health ward receiving state funds through a so-called “three-way contract” is closing, an N.C. Department of Health and Human Services spokeswoman said in an email.
The contracts are a partnership between local hospitals, together with regional state-funded mental health agencies (called LME-MCOs) and the state DHHS. Funding for the contracts is allocated by the General Assembly with the intent of providing short-term psychiatric treatment in local hospitals, keeping people with less serious behavioral health issues out of state facilities. The funds are also meant to help inpatient psychiatric wards like the one at Vidant Beaufort remain open. The contract between the Washington-based facility, the state, and LME-MCO Trillium Health Resources, was worth more than $1.1 million in the state fiscal year which ended in June 2018.
In an email statement last week, Harvey Case, Vidant Beaufort Hospital president, attributed the cause of the planned mid-August closure to “the complexity of delivering health care in rural communities.”
Case also cited other contributing factors, including uncertainties in future payments from the State Health Plan, which covers teachers and government employees and Medicaid transformation, a shift that is slated to turn the $14.6 billion health insurance from a fee-for-service program to one where providers are paid a set monthly fee for providing care to patients.
“Difficult decisions like this are not made in haste,” Case’s statement said. “Vidant is committed to its mission to improve the health and well-being of eastern North Carolina.”
Vidant Beaufort’s three-way contract that expired at the end of June shows the inpatient behavioral health department served people in mental health crisis and those with substance use disorders.
A DHHS spokeswoman said last week that the state received a new two-year contract at the end of that month.
Though Case’s statement does not directly address finances, the hospital, like many other rural facilities, is struggling. According to a consolidated financial statement, the entire Vidant Health system finished the year that ended in Sept. 30, 2018, with $52.5 million in income from operations, but Vidant Beaufort had a $1.6 million loss from operations and a total loss of just under $2 million in that same year, and the facility had the worst profit margin of any hospital in the system.
In an email last week, Vidant Health spokesman Brian Wudkwych declined to discuss the closure or the budget shortfall, but Case’s statement says that residents will have access to acute-care behavioral health services at Vidant’s other facilities.
The nonprofit health system has nine hospitals east of I-95 and, once the unit closes, the nearest inpatient psychiatric beds will be at the system’s flagship hospital, Vidant Medical Center in Greenville, roughly 25 miles west of the facility in Beaufort County.
Mental health experts in the region said some patients in Hyde, Beaufort and the surrounding counties are likely to experience geographic barriers to acute mental health care. “This is just another situation where we’re losing another resource,” said Luana Gibbs, interim health director of Hyde County Health Department. “ … We have to travel at least an hour one way, and if you need (inpatient) mental health services, now you’re going to have to travel about a hundred miles (to Greenville).” In Beaufort County, the Vidant facility is often the first place people in mental health crisis go for help, said Adreanne Turner, executive director of DREAM Provider Care Services Inc., a Washington-based agency that serves adults and adolescents with mental health needs. “Some people do need the medical treatment immediately,” she said. “ … At the hospital, they are able to treat people immediately.” Though the hospital remains open, she said, the mental health unit’s closing may mean people in mental health crisis would spend more time at the emergency department as they await a bed elsewhere. And transferring them to another facility, such as the one in Greenville, may require police assistance if other options aren’t available. But, she said, the role of outpatient mental health providers like DREAM is to help consumers before they reach a crisis point. The challenge, she said, would be to make sure that people in need are aware of the outpatient options available to them. As the hospital in Beaufort County dismantles its inpatient behavioral health department, the full implications of the closure on the local and regional mental health ecosystem remain to be seen. In a 2018 report describing the three-way contracts, the DHHS said that it worked strategically to place three-way beds in areas with historically high numbers of short-term stays in state hospitals. The same document shows that 235 psychiatric patients at Vidant Beaufort were served under the three-way contract in state fiscal year ending June 30, 2018, up from 182 the previous fiscal year. A representative from Trillium Health Resources, the LME-MCO that shares the three-way contract for the unit with Vidant Beaufort, said in a statement last week that the organization learned of the impending closure around the end of June. “We value our partnership with Vidant and understand their need to pursue sustainable clinical practices while serving their local community,” wrote Jennifer Mackethan, Trillium’s communications and marketing director. “Trillium works with providers to change services or locations in their contract as needed, and will continue to hold a contract with Vidant for other locations.” The state, for its part, said last week it will terminate Vidant Beafort’s three-way contract when the hospital discharges the last person who is being served in a three-way bed. A state DHHS spokeswoman said in an email Thursday that the department is “evaluating how to best reallocate unspent funds from Vidant Beaufort’s contract to ensure North Carolinians have access to the care they need.” Republish our articles for free, online or in print, under a Creative Commons license.
Adult bed capacity represents the number of beds a facility is licensed for.
Source: N.C. Department of Health and Human Services Proposed 2020 Medical Facilities Plan.A geographic gap
Next steps?
Vidant was not fothcoming w financial records the general hospital the closed leaving a woman to die with a heart attack. I think management is more concerned with their bonuses that responsibility in the community. The State should approve all hospital closures – not allow them to close “because of losses” without careful review of their books
This is sad news for nc. With mentally ill patients laying in the emergency room for three days waiting for a bed in a psychiatric unit, the last thing we need in eastern nc is the closing of services. Can’t this be relooked and a better solution be created?
We’ve seen this coming for years. The sad truth is that psychiatry is a money-losing specialty. With the business of health care always looking for profit, there is no business case for continuing to provide inpatient psychiatric beds. What makes money for health systems? Cardiac care, cancer care, surgery. Not family medicine, pediatrics, or psychiatry. The State Health Plan used to make up the slack for uninsured and underinsured patients. With the changes proposed for it, and the refusal to expand Medicaid, we are in a really bad place in health care in North Carolina.
This is a tragic loss – and 25 steps backwards!! Mental Health is at an ALL TIME HIGH in conjunction with addiction…. Vidant in Greenville can only hold so many patients as it is currently – how are they to handle this additional overflow?! Patients need help – so many are repeat visitors because they continue to release them to the streets – only to return again & again. They are not actually getting the help they need – but rather a bandaid. Now they’re taking away their bandage – leaving them to bleed out (in theory). Wake up people!! This population is growing fast and attention is in dier need of improvement – NOT elimination! These people are not/can not go to a clinic for assistance – they NEED Real Help – in a facility that is close by and not completely overcrowded….