One of my colleagues called me on Tuesday and asked me to look online to see if was true?
“If what is true,” I asked cautiously as I did not want to seem oblivious to everything.
“Universal Health Services just bought Psychiatric Solutions!” I had not heard this news, did a search and confirmed the information. For those of us behavioral health providers in the metropolitan Chicago area, this is huge news. This will consolidate three of the largest freestanding psychiatric hospitals under one corporation. And as a clinician who started my career during the dominance of psychiatric corporate giants like Psychiatric Institute of America (PIA), National Medical Enterprises (NME) and Charter Medical Corporation, I am having flashbacks about why these juggernauts all but disappeared.
During the early 1990’s, I worked at Charter Barclay Hospital in Chicago, one of a chain of premier freestanding psychiatric facilities throughout the country but predominantly in the western and southern regions. Many remember the Charter commercials below that aggressively targeted individuals and families with offers of “free” assessments.
We were trained at the front end to convert calls to assessments and assessments to admissions. We were told never to ask about insurance over the phone. Just get them in, and the service would sell itself.
What we weren’t told was that, once patients were admitted, they would be treated as long as their benefits would cover. The 28 days model was seen as the treatment of choice for rehabilitation from alcohol and drug addictions. Customers were involuntarily hospitalized just because they walked into the locked lobby and realized that they could not just leave when they wanted. Oh, and they had benefits to be exhausted.
Before the turn of the second century, the abuse, fraud and waste began to coagulate into fines and lawsuits and corporations learned that they could no longer exploit the mentally ill and chemically impaired population.
In 2000, I consulted with one of the premier freestanding hospitals to train and develop processes for the front end systems to increase profitability from patient admissions. After six months, I realized that the owner was nostalgic and wanted to recreate the same flawed business model so I bailed before he could resurrect his monster.
As much as I enjoy consultant work and would love to assist in developing real community mental health alternatives offered by private corporations, I realize that profit and greed are enticing and prefer to give helpful advice now before the monster is unearthed.
- pickpocket families and shovel them into medically unnecessary treatments under the guise of providing “free” assessments;
- abuse involuntary commitment procedures that violate basic human rights, freedoms and dignity;
- ignore the continuum of care;
- promise referral sources interventions you cannot support or provide, especially as it conflicts with the needs and wishes of the consumer.
- provide actual and tangible services useful to the community – employment, consumer education, crisis consultations, level-of-care screenings, referral and linkage;
- develop effective and collaborative networks of referral agents, health providers, educators, payors and others who benefit from an expanded customer base;
- offer accessible treatment options from inpatient to support groups;
- recognize that word-of-mouth can make or break any health care provider; and
- hire and train front-line workers to do clinical work with administrative responsibilities, not the other way around.
It is imperative that behavioral health providers like Universal Health Services offer contextual, responsible and truly community oriented care or join the automobile, banking, oil and insurance corporate entities in putting profits before people. And risk that when angry consumers appear with pitchforks and torches, they will not come looking for them.