A Columbia County committee charged with optimizing the county’s health services met May 20th and discussed a controversial topic – whether the county’s Mental Health Clinic, which had been losing money for years, should be privatized to save money.
Members of the Human Services Productivity Committee previously discussed offering the clinic to Columbia Memorial Hospital – a private nonprofit – an offer the hospital declined, according to the committee’s “minutes” – the official summery of the committee meeting.
Columbia County Controller Ron Caponera, a committee member, said he wanted to talk to the hospital again to see if there were ways around the issues that made the hospital decline, according to the minutes.
He also wanted someone from Premier Medical Group – a Poughkeepsie-based for-profit – to come to the next meeting to talk about taking over the clinic, an acquisition the company was interested in, according to the minutes.
The minutes were later posted online and were found by an employee of the clinic, who circulated them to other staff members.
The document caused an uproar, not only because of the threat of privatization, but because of how some members of the committee seemed to blame the clinic’s financial shortfalls squarely on the shoulders of the employees, suggesting they were inefficient, over-paid, and provided sub-par care.
These employees showed up in force to the next two committee meetings, entreating the members not to cut jobs or stop the work the clinic was doing in the community, and offering ideas about new funding streams that could balance the clinic’s budget.
Mental Health Clinic Supervisor Amber Kline, who has worked at the clinic for more than 12 years, said the clinic’s staff was “shocked” to see talk of privatization in writing, “although it’s something that we suspected to have been coming for some time.”
“I think it was hard…to know that there was so much misinformation about us as a department, about the work that we do – it was very disheartening, very hard to see that,” she said. “And to think that that’s what was being put out in the community, and that’s what was being put out into the minds of people that are charged with making decisions about the future of the department.”
In an interview Tuesday, Human Services Productivity Committee Chairman Patrick Grattan said privatization was never on the table.
“That wasn’t under consideration at all at these meetings,” he said when asked if the clinic should be privatized.
“What happened was we met and talked about any number of issues relating to the Human Services Department, and at no time were we sitting there, saying, ‘oh, it’s going to be privatized,’ or, ‘it should be privatized’ or anything like that,’” he said.
When asked about the clinic being offered to Columbia Memorial Hospital, Grattan said this “periodically comes up all the time,” adding the hospital could provide 24/7 inpatient services, something the clinic could not.
Columbia County Board of Supervisors Chairman Matt Murrell said the hospital was never offered the clinic.
“There were conversations that went on, but that was never an actual offer at the time,” he said.
Supervisor Sarah Sterling, another committee member who was present at the May meeting, said she was unaware of the clinic being offered to the hospital.
“I don’t know anything about that offer whatsoever,” she said, suggesting there might have been feelers put out to see if the hospital was interested.
Columbia County Director of Community Services Michael Cole, the lead administrator for the clinic, wrote a letter to the committee June 27 to point out what he called “multiple inaccuracies” in the May meeting’s minutes.
Some of these alleged inaccuracies were simple to set straight. Cole corrected Murrell’s assertion the clinic closed at 5 p.m. every day – it is open until 7 p.m. on Wednesdays and Thursdays – but others, like Cole’s statement that the clinic was losing about $1.6 million a year, not $2.3 million, were rejected.
Caponera, the committee member and county controller, said the $2.3 million figure was correct.
“No, my numbers are good,” he said Wednesday.
Amber Kline said Cole, her boss, was “not advocating for the department at all.”
“His M.O. throughout this process has been very much, ‘it’s labor’s responsibility to figure out the financial sustainability of this clinic.’ and we are pushing back and saying that it needs to be a partnership,” she said. “There needs to be clinic staff… continuing to do the best job generating revenue as they can, but we need the administration to be really exploring all options for sources of revenue…and that’s severely lacking.”
When contacted, Cole referred all questions about the situation to Chairman Murrell.
In the July and August committee meetings, clinic staff offered ideas of how to generate additional revenue, and both the staff and the committee agreed the discussions had been positive and productive.
The clinic often lost money because the staff’s work was not “billable” – it was not reimbursed by other entities, whether they be insurance companies or the state, and the county had to foot the entire bill.
This includes the clinic’s work in the county’s schools. The clinic sends staff members to all the county’s school districts, but the districts do not reimburse the clinic for its work there, so the bill remains in the pocket of the county.
United Public Service Employees Union Regional Coordinator Kathy Wright-Muzio, who represents the clinic’s staff, opined the clinic should accept a wider array of insurances.
The clinic only accepts government-subsidized insurance, such as Medicare, Medicaid, New York’s Essential Plan and Tricare Veterans Insurance (though county employees can use their MVP insurance at the clinic).
Though private insurance usually reimburses mental health clinics at a lower rate than Medicare and Medicaid, Wright-Muzio said accepting private insurance would still help fill the clinic’s financial gap, since it would mean a bigger pool of potential patients.
Private insurance reimbursements could be supplemented “through bonusing and under-insured dollars that are also available out there,” Wright-Muzio said.
The county should be active in applying for grants, she added, which could significantly thin the clinic’s financial gap.
Any enmity between the committee and the clinic appears to be dissolving in the continued discussions.
“We have some really great people,” Supervisor Sterling said of the clinic’s staff. “They work their hearts out.”
The county had started out “on the wrong foot,” she added.
Sterling wanted to continue discussions with the staff to make the clinic run better, she said.
“Personally, I don’t see how privatization would help the situation,” Sterling said.
Chairman Murrell had a similar response when asked if any thoughts of privatization were off the table.
“I think that’s probably a good assessment, yes,” he said.
Mental Health Clinic Supervisor Patrice Lyons, who begins her 30th year as a mental health worker for the county next month, seemed to be happy with the progress made since the meeting minutes were discovered earlier this summer. She said the committee had been “very receptive,” and the clinic’s staff “had an impact” on their thinking on the issue.
However, she also agreed the process was similar to having to justify her job.
“Trying to come up with ideas for management to carry out – in some ways, we’re now management,” she said.
“We bring our ideas to the administration and ask them to carry these things out – it should be their job, I think, to come up with these ideas,” she added.
The Mental Health Clinic provides a variety of psychological services to county residents, including a walk-in clinic in Hudson, a 24/7 crisis hotline, individual and group therapy, and long-term case management. The psychiatrists, psychiatric nurses and nurse practitioners treat everyone from elementary school students to people court-ordered to attend counseling.
As well as the Hudson location, the clinic operates an appointment-only facility just north in Valatie.
Afterword: The Importance of Meetings
“Eight percent of success is showing up.”