Vermont Mental Health Futures Project: Public Hearings

1
Vermont Mental Health Futures Project Public
Hearings

• Public Hearings
• July 13 and July 20, 2006
• Agency of Human Services
• Fletcher Allen Health Care

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Vermont Could Become National Model

• "Traditionally, Vermont has excelled in clinical
  community care, integrating science into service,
  and adopting new models of care, as well as
  weaving consumer and family involvement into
  every level of the system.
• Its mental health insurance parity law is a
  national model that includes coverage of
  substance abuse.
• The state has a culture of rehabilitation and
  recovery.
• It's an admirable record."
• A Report on America's Health Care System for
  Serious Mental Illness - Grading the States. The
  National Alliance on Mental Illness (NAMI).

3
Present Vermont State Hospital

• Treats Vermonters with acute mental illness
  clinically determined need for inpatient care
• 200 admissions discharges /yr
• One third of admissions Chittenden County
• Length of stay 68 days
• 200 staff
• Budget 18 million

4
Present Vermont State Hospital Who is served?

• 4 Clinical Groups
• Individuals requiring brief, intensive, inpatient
  care
• Individuals requiring more than 30 days of
  intensive inpatient care
• Individuals requiring longer term rehabilitation
• (plan to use community residential)
• Individuals who are now stable
• (plan to use community residential)

5
Vermont State Hospital

• Antiquated facility
• Decertified from Medicare/Medicaid
• Conditional license

6
Futures Planning Process Advisory Committee

• 30 member, multi-stakeholder committee has met
  for more than 2 years
• Monthly meetings, 6 active work groups, all open
  to public
• Developed proposal for system of statewide
  psychiatric care in Vermont
• -- New inpatient programs
• -- New Community programs

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Futures Planning CommitteeRecommendations for
Inpatient Care

• Locate primary acute-care inpatient program at
  Fletcher Allen
• Locate secondary inpatient programs at Rutland
  Regional Medical Center and Brattleboro Retreat

8
Why Fletcher Allen for Primary Program?

• Clinical Advantages
• Financial Advantages

9
Financial Advantages of Co-location at Fletcher
Allen

• IMD ? Medicaid / Medicare Participation
• 50 daily census psychiatric patients
• Psychiatric hospital larger than 16 beds
• Medicaid / Medicare Participation supports 50
  (or more) of operations
• State-operated options
• Forgo federal reimbursement
• 3 or more 16 bed hospitals
• Institutions for Mental Disease

10
Clinical Advantages of Co-location at Fletcher
Allen

• Psychiatric patients have access to the same
  medical resources as other patients
• Psychiatric care benefit from collaboration with
  Vermonts academic health center
• Provide care close to home most VSH admissions
  come from northern Vermont
• Ability to attract and retain top-notch
  physicians

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Current Fletcher Allen Psychiatric Inpatient
Facilities

• Short-term, acute-care unit
• 28 beds (20 single-patient, 8 semi-private)
• Average length of stay is 9-10 days
• Most patients are admitted voluntarily,
  approximately 10-20 are admitted involuntarily
• Patients can be hospitalized for forensic
  evaluation
• Patients primarily come from northwestern
  Vermont, with the majority from Chittenden County

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Fletcher Allen Health Care Mission

• Our mission is to improve the health of the
  people in the communities we serve by integrating
  patient care, education, and research in a caring
  environment.

13
Fletcher Allen Health Care Perspective on
Collaboration

• Our collaboration with the State should strive to
  integrate psychiatric care with acute inpatient
  medical care, community mental health programs,
  neighboring hospitals, and social service
  agencies in our community. Fletcher Allen will
  work with all stakeholders to understand and meet
  needs so as to enhance recovery.

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Fletcher Allen Health Care Guiding Principles of
Collaboration

• 1. This project is a fundamental obligation of
  the State, which must bear the projects capital,
  operating and planning costs and must shoulder
  related responsibilities, including compliance
  with CON and other applicable laws. The project
  should not have a negative impact on FAHC debt
  capacity, its ability to fund other capital
  needs, or its operating budget.

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Fletcher Allen Health Care Guiding Principles of
Collaboration

• 2. The project should be designed, operated and
  funded to achieve high quality care, to comply
  with JCAHO, CMS, and DOJ standards, and must be
  adequately funded by the state to meet these
  standards.

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Fletcher Allen Health Care Guiding Principles of
Collaboration

• 3. Planning and discussion of the project will be
  transparent and inclusive of all stakeholders.
• 4. The project will not compromise, and must be
  consistent with, FAHCs long-term facility plans
  and needs (including its need for future
  inpatient replacement facilities) and all
  relevant land use regulations and agreements.

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Public Input Process

• Burlington Area Outreach
• Certificate of Need regulatory process (phase 1
  2)
• City Permitting Process
• Statewide planning initiative
• Legislative Oversight

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Greater Burlington Area Outreach Plan

• Creation of Burlington Site Review Work Group
• Regular meetings with elected appointed
  officials
• Attend Neighborhood and Planning Assembly
  Meetings
• Briefings for legislative delegation
• Speak out, public comment opportunities City
  Council Meetings
• Weekly email update / website
• Written communications briefs, Q A

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Burlington Site Review Work Group

• Goal Examine the universe of campus siting
  options for new program
• Initial meeting dates
• -- August 8, 22
• -- September 12, 26
• Sign-up sheets available

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Fletcher Allen The Campus Development Parameters

• Zoning Permitting Considerations
• Height, density, parking, aesthetic, air
  pollution, noise, traffic
• Storm Water
• Capacity, off campus offsets
• Memorandum Of Understanding with City of
  Burlington
• Residential character, sliding hill, gardens

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Project Timeline 2006-2012

• 2006
• Public input, begin Phase 1 CON, implement first
  community residential program
• 2007
• Public input, complete Phase 1 CON, begin
  permitting process, begin design work, implement
  additional community programs
• 2008
• Public Input, continue permitting process,
  complete design work, begin Phase 2 CON
• 2009
• Public Input, complete permitting process, CON,
  construction documents contracting

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Project Timeline 2006-2012

• 2010-2011
• Construction (18 24 months), program design,
  staffing models, transition plans, public input,
  licensing
• 2012
• Open new primary inpatient program