Four Ore. Healthcare Providers Team to Open Psychiatric ER
Feb. 05--Four major healthcare providers have signed a letter of intent to open a psychiatric emergency department in Legacy's Northeast Portland building and call it the "Unity Center for Behavioral Health."
The center would provide immediate care to people suffering mental health crises and would respond to the needs identified by U.S. Department of Justice officials, said Legacy Health's behavioral health director Dr. Chris Farentinos. It would accept walk-in patients and patients arriving by ambulance.
Legacy Health, Adventist Health, Kaiser Permanente and Oregon Health Science University have agreed to move their psychiatric inpatient services to the new center at Legacy's Holladay Park campus. The next step will be developing a joint operating agreement detailing the management and operations of the center.
Legacy will pay for remodeling the building, and the other providers will contribute money to operate the center, said Brain Terrett, Legacy Health spokesman. The plan is to have it open late next year.
The remodeling cost is estimated at $45 million. Legacy Health has committed $10 million in real estate value and raised another $21 million in private donations. The $14 million balance must be raised through the community, private foundations and government agencies.
Gov. John Kitzhaber has set aside $1 million in the Oregon Health Authority's budget toward the department's psychiatric care.
While it's not exactly what the Justice Department and Portland police had envisioned, the center addresses a gap in care that now has police serving as first-responders and transporting people in deep psychiatric crisis in the back of their patrol cars, Farentinos has said.
Portland Mayor Charlie Hales praised the latest development.
"This is a great first step," Hales said. "The timing of this letter of intent couldn't be better: It's the first week of the 2015 legislative session, and all of these health-care providers are stepping up and joining the call to open such a facility. We are looking forward to working with everyone -- the Legislature, the county, the hospitals, the CCOs (coordinated care organizations) and other law-enforcement agencies -- to provide a level of parity for our residents who are in mental health crises."
The site is now home to the Legacy Research Institute's labs and state hospital beds. The research institute will move into a building under construction next door, and the state hospital is moving its beds out by May.
The new department would help alleviate the crowding in regional emergency rooms, advocates said.
In the last year, nearly 10,000 patient visits to Legacy Health hospital emergency departments were for behavioral health issues. Every day, the emergency departments hold 10 to 20 patients waiting for psychiatric beds, and the patients end up waiting hours to get psychiatric care, according to Farentinos.
She said the average length of stay now for psychiatric patients in the regular emergency departments is 16 hours, compared with two hours for those suffering physical ailments.
The new psychiatric ER will allow police to call an ambulance and allow emergency medics to assess a person's needs and take the person directly to the center. There, the patients will be treated immediately in a more humane, open living room-type setting by psychiatric experts, Farentinos said.
The center will have inpatient beds for 79 adults and 22 adolescent patients.
It's modeled after a facility in Alameda, California. In Alameda County, 75 percent of the patients who arrive stay less than 23 hours, while the other 25 percent are admitted to in-patient care that can last as long as eight days.
Whether Legacy could bill Medicaid for the crisis stabilization care will play a big role in whether the planned psychiatric ER becomes a reality, health care officials said.
The Alameda model is feasible in California because of a Medicaid code for crisis stabilization that reimburses the facility on an hourly basis, from a minimum of two hours to a maximum of 20 hours.
Legacy studied the model and concluded that a reimbursement rate of $100 an hour would make the psychiatric ER in Portland sustainable. Alameda County's hospital receives $109 an hour.
--Maxine Bernstein
Copyright 2015 - The Oregonian, Portland, Ore.
