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County, Tri-City agree to bring back psych facility together

REGION — After spending a summer in negotiations, county leaders and health care officials have officially reached an agreement to bring back inpatient psychiatric care to North County together.

On Sept. 10, the County Board of Supervisors unanimously approved of a memorandum of understanding (MOU) between the county and Tri-City Healthcare District to build a new 16-bed inpatient psychiatric health facility. The Tri-City board of directors previously approved the MOU during a special meeting on Aug. 29.

Both the county and Tri-City, which consider themselves partners in this agreement, had to approve of the MOU before it could become official.

The MOU dictates that an approximately $10 million, 16-bed facility will be constructed on land owned by the hospital. Additionally, the hospital will be responsible for staffing and running the facility.

The MOU also established that both Tri-City and the county would evenly split the capital costs to build the psychiatric facility. The county is contributing a no-interest loan to Tri-City, which will pay the loan through cash and in-kind services.

Tri-City is also offering land it owns to build the facility as part of the evenly split costs, which will be appraised to determine the value of that particular contribution.

According to Luke Bergmann, the county’s director of behavioral health, the MOU sets the agreement’s general terms and provides a framework for further negotiations.

The county’s chief administrative officer must present more specific terms about the agreement to the board on or before Jan. 14, 2020.

Bergmann said the negotiations will include an “enhanced Medi-Cal reimbursement rate” that is acceptable to both parties, something that Tri-City wants to see happen.

As The Coast News previously reported, Tri-City Chief External Affairs Officer Aaron Byzak said Medi-Cal has “very poor” reimbursement rates for hospitals. About half of patients in the inpatient behavioral health unit were Medi-Cal patients.

Bergmann said an algorithm to measure average stay lengths at the psychiatric facility will be created to incentivize the hospital to provide better care — not just more bed days for Medi-Cal enrollees.

“The better the patients do, the better the incentive payments can be,” Bergmann told the Board of Supervisors at the Sept. 10 meeting.

The agreement follows months after the Board of Supervisors rejected District 5 Supervisor Jim Desmond’s proposal to build a $14 million inpatient psychiatric facility at Tri-City, and more than a year after Tri-City suspended operation of its 18-bed inpatient behavioral health unit.

“From a regional perspective, it’s imperative that additional psychiatric care facilities be established in North County,” Desmond said.

Desmond noted his office is also working to bring crisis stabilization units online in North County as well. Tri-City’s previous inpatient behavioral health unit had a 12-chair crisis stabilization unit that helped to mitigate the lengths of patient stays in the unit.

Desmond’s proposal in June would have included a crisis stabilization unit, while the new agreement does not.

Bergmann told the board of the county’s goal to shift from focusing on crisis services to focusing on day-to-day chronic care and prevention.

“These kind of home and community-based services, outpatient care and care coordination will keep people with behavioral health conditions more stable for longer periods of time, reducing hospitalizations and the need for expensive crisis interventions,” Bergmann said.

Bergmann than noted the shortage of inpatient beds and stabilization services in North County.

“As we work to build up a chronic care system, we have to maintain beds in neighborhoods where there’s community need for them,” he added.

The county’s negotiations with Tri-City are the first of several negotiations the county is discussing with other healthcare entities such as Palomar Health, UC San Diego Health and Scripps Health with overall goals to improve healthcare and drive down costs. The Tri-City MOU will be used as an example for those other partnerships.