Fayette's 3% Profits From Behavioral Health
When Fayette County decided to join in with 5 other counties to have Value Behavioral Health administer its
mental/behavioral health funds, not all counties in the Commonwealth chose to follow suit and manage their own
medicaid behavioral health funds.

Even though the state dangled the enticing carrot to counties to keep 3% of profits by joining forces with VBH or
other insurance management companies, some counties chose to leave the medicaid behavioral health insurance
management business headaches up to the state. Better safe than sorry, they thought.

Always, always, counties were aware from the get go that some years might not be profitable, and that, sooner
or later, a county ultimately could end up with a deficit of behavioral health money that would have to be covered
by county funds.

In other words, some counties were scared of the dangling 3% profit carrot, knowing that they could one day
have to raise taxes just to cover inpatient and behavioral health care costs or, somehow, find the funds from
other areas in the county budget.

Fayette's 3% profits from managed behavioral health care, originally were added to the mental health
department's budget and came in handy, no doubt. After a few years, the then county commissioners directed
that the profits be split with its county drug and alcohol unit. To date, the county has always been able to stay in
the black and then some, to reap the 3% profit sum. How much longer this will be true is unknown.

Today's Herald Standard article,
"Uniontown Hospital president challenges Highlands' charges in contract
dispute," raises a few concerns about the administration of Fayette County's medicaid behavioral health funds:

1.) Highlands Hospital and the whole system currently in place has always helped the county stay within its
means and receive the 3% profit.

2.) Paul Bacharach, Uniontown Hospital president, emphasizes in today's paper his facility's creation in recent
years of geriatric services and was critical of Highlands Hospital for being upset that his facility could leave the
Connellsville hospital in a risky financial state. He talks of geriatric services in today's article, but did not state that
the issuance of Uniontown Hospital's provider facility number 4 months ago through VBH will allow Uniontown
Hospital to serve county medicaid recipients from ages 18-55. Commissioner Vince Zapotosky told this editor 4
days ago that he confirmed this information from VBH.

3.) Bacharach seems to have depended on his own staff in 2009 June staff meetings to scatter and inform
Highlands of Uniontown's plan to open a geriatric psychiatric unit. He blames Highlands for still announcing a
plan in October of 2009 to open its own geriatric unit. Why didn't county leaders or staff coordinate or try to
coordinate talks back then between the two hospitals if Bacharach did not?

4.) What Bacharach may not have counted on was that some of his staff asked this editor to meet to discuss the
following concerns they have. Two Uniontown Hospital sources stated that staff from that facility met with
caregivers in the community to familiarize them with the new psychiatric unit. So far, sounds great. Great
outreach and publicity work, right? But
not great is the fact that someone, conveniently, shamefully, took along
multiple blank copies of inpatient 302 psychiatric petitions. Both sources called this "the most unprofessional
stunt to drum up business" and "unethical" acts they've seen pulled in their time working in health care. Yes,
won't get any argument here on those sentiments.

When the validity of these comments was questioned, this editor -- who worked extensively as a county delegate
and is familiar with criteria or grounds for an inpatient psychiatric stay and participated in many mental health
hearings -- was told that contacting a county delegate to initiate an iffy psychiatric inpatient admission -- when
the need isn't always necessary strong -- sometimes is delayed. Till tomorrow? Next week? Till someone has
time to see if he stabilizes? No. Only until a few specific county delegates are known to be working. They, these
two hospital sources say, are known by reputation to approve petitions with little questioning of an individual's
mood and behavior. "These delegates are known not to ask a lot of questions and typically agree to approve the
petition." On the other hand, when met with a patient, undoubtedly in need of an inpatient psychiatric stay, "calls
are not delayed" for a delegate -- even when those by reputation known to ask questions and possibly attempt to
divert a hospitalization are known to be working.

While some of these concerns of staff are noted, others contacted this editor to say that Uniontown Hospital's
psychiatric units operate without incident. After a few emails, one such supporter -- again under the condition of
anonymity -- hesitated, but also did confirm that, indeed, someone, who took a stack of blank petitions to care
givers "to drum up business," was fired. While this editor will not publish the name of the fired individual, I have
asked Bacharach for comment.

No doubt, there's a lot of discussion that needs to be held before both hospitals are comfortable with the other
serving the same age-range medicaid recipients. That may never happen, true. Both hospitals, inevitably, will have
empty beds sooner or later in the psychiatric units.

With that thought in mind, this editor thinks it's time to throw in the towel on managed health care for behavioral
health funds in Fayette County. Yes, drop the 3% dangling carrot and run. Suck up the loss and go on. Even if it
were an isolated case and nobody again at Uniontown Hospital tries to drum up business by dangling stacks of
blank mental health petitions in front of weary caregivers in need of a break or stacking the deck in that facility's
favor to delay delegate calls till one or two always in a hurry to say yes and get off the phone are working,
there's too much at risk for the county to gamble and stay in the black with the 3% carrot dangling game.

Fayette should throw in the towel managing its own behavioral health care dollars. Give the role back to the state
as soon as possible. Although Bacharach may or may not have needed approval from a county administrator or
commissioners, VBH is under contract with the county and will come calling to the county to pay up when the
3% dangling carrot profit gets wiped out and swings into the red.

The odds of the county getting hit in the head by the dangling carrot, losing money and being financially obligated
to pay a new bill just went up.

26 Jul 12
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(Editor's Notes: Commissioner Zapotosky was in touch early today to say that he would not support Uniontown
Hospital's psychiatric unit if commissioner approval is needed. "The big question that I can't get answered is, did
they had (have) to get county commissioners approval." )