CCMSD looks at senior mental health

Crook County Medical Services District (CCMSD) is gearing up to introduce mental health services for seniors through a program that would see all its costs reimbursed through Medicare.

As this means the program would not cost the district to run, it’s possible that the revenue could in the future be used to fund an additional mental health service for younger age groups.

Senior Solution

The Board of Trustees heard a presentation last week from Kirby Johnson of Senior Life Solutions, a program offered by Psychiatric Medical Care of Tennessee. The intensive outpatient group therapy, according to the company, is designed to meet the needs of older adults experiencing symptoms of depression, anxiety and other mental health challenges that can sometimes be age-related.

“Our company has been going for 20 years,” said Johnson. “We started out with one program in rural Tennessee and at this point, after Buffalo goes live in the next month, we’ll have 136 critical access hospitals that run our Senior Life Solutions program.”

The company focuses exclusively on rural psychiatric care. Geography and travel are often a barrier to care, Johnson said, which is why the program focuses on keeping things in the community.

“It provides local access points for patients and allows them not to leave the community for specialized services,” Johnson said.

Senior Life Solutions is described, he said, as an, “Intensive outpatient program.”

“We serve a small amount of patients very intensively,” he said. “…Sometimes we see our patients three or four, even five times a week because they need that level of intensity.”

Mental health is critical, Johnson said. 60% of aging adults think depression is “just a part of life”, he said, and the program aims to curb that belief.

“When you can’t manage your mind, it’s hard to manage your COP meds or your heart medication, things like that, so the mental health aspect of all of our patients is critical for other facets of their life,” he said.

Program Details

To meet Medicare requirements, group therapy sessions would take place on the Sundance campus. Transportation can be provided to any patient within 30 miles of Sundance, if help is needed.

“We actually recruit and employ a team of medical people to be here and live here and serve the patients face-to-face,” he said.

That on-site team comprises of a social worker, a psych-registered nurse and an LPN nurse-CNA. A psychiatrist acts remotely as the program director.

The team is employed and managed by Senior Life Solutions, rather than CCMSD. The district is, however, involved in the hiring process to ensure they are a good fit.

Responding to concerns from the board that Crook County residents might not respond well to group therapy as people in this area are typically private, Johnson said that individual therapy is also available and the support plan is personalized for all patients.

He also spoke to the fact that group therapy is not as big a deterrent as it might seem.

“You’d be amazed at how many people hear about this program and feel that way initially and then give it a try and you can’t get them to shut up about it,” he said.

This is because the therapy helps participants realize they aren’t the only people having issues and that they belong to a community of others who share their experience, he said.

“I believe in this program because I’ve watched it work and make an impact,” he said.

In fact, Johnson claimed that the company has enjoyed a 98% retention rate on all partner hospitals.

“The only reason our partner hospitals have not renewed agreements with us is because they were purchased from a health system and the hospital was shut down or they lost their Medicare license,” he said.

The program also supports medical staff who, in a rural setting, can find themselves struggling to fill the role of mental health service provider in the absence of an alternative. Johnson spoke of one clinic manager who told him that he was searching the internet to find out more about psychotropic medicines in the middle of appointments with patients.

“The most aggressive compliments I got were from my providers,” he said. “…It’s a big provider satisfier to have a psychiatrist you can call.”

The program also offers family therapy to help loved ones understand what’s happening and how to help, which Johnson said can be important for the patient to successfully improve their quality of life.

The Finances

CCMSD would act as a pass-through agency for this program: though CCMSD initially pays for the expenses of the program, Johnson said, the district is then fully reimbursed by Medicare for those costs.

“To maximize the profitability and the fiscal sustainability of our program, the hospital is actually going to bill all of the facility fees for the service,” Johnson said.

“…Ultimately, we work for you. We set certain expectations, certain standards, certain levels of care, certain hours of operation – it’s a Monday through Friday, 8 a.m. to 4:30 p.m. program.”

Responding to a query from Trustee Brent Fowler about the financial cost for the district, Johnson explained that CCMSD would make money from the program rather than spend money. This, he said, is because Medicare pays for the costs.

If this program both makes the district money and helps the community, Fowler commented, it would be, “the greatest thing in the world”.

Younger Patients

Trustee Mark Erickson commented that Crook County also has a need for mental health services for younger people. He referred to some of the “bad outcomes” that have occurred with youth in this county over recent years and stressed how important he feels it is for CCMSD to provide mental health support to younger age groups.

Erickson also commented that community members have expressed their concern over the departure of clinic provider Kenda Huseby, through whom CCMSD was able to “dabble in that arena”. He expressed his desire to continue offering that support.

“This program only focuses on the aging adults in Crook County and the surrounding areas,” he said.

However, around 100 of the partner hospitals who engage with this program also make use of the company’s more widespread program that can serve all ages.

“It’s separate from this program, but a lot of my partners, CEOs and boards will contract with me for both services because they want to serve everybody in their community,” Johnson said.

He explained that younger people are specifically not included in Senior Life Solutions itself because the challenges faced by the two age groups are so different.

Integrating age groups has actually been tried in the past, he added, but it did not work and actually degraded the outcome for everyone involved.

As the discussion came to a close, next steps were discussed and Johnson stated that he will send a draft three-year agreement for the district to review.