A message to the community from Unity Center for Behavioral Health

August 1, 2022

Hospitals and health care systems across the United States continue to face many hurdles, including a significant rise in patients, staffing shortages, financial constraints and supply chain problems.

The pandemic, combined with decades of underfunding for behavioral health care in Oregon, have especially taken a toll here at Unity Center for Behavioral Health. People are struggling with mental health now more than ever before, and finding the resources they need is becoming increasingly difficult.

However, there is light, as well. We are now beginning to see a lot of conversation around mental health and more funding. We are hopeful this continues and that soon, Oregonians will have more resources to turn to.

At Unity Center, we are seeing patients stay at our hospital for much longer periods of time due to a lack of step-down resources, coupled with the fact that the Oregon State Hospital has severely limited access to taking civilly committed patients. These issues place strain on Unity Center, with the primary impact being a lack of in-patient bed space due to increased lengths of stay. This needs to change.

These factors have once again caused a significant annual operating loss at Unity Center. Our hospital partners believe in the mission and model of Unity Center. They continue to pledge their commitment and support for Unity Center. However, there is a limit to the losses our hospital partners can sustain. To improve our financial sustainability, we are working to significantly reduce our current annual operating loss of $24 million.

Throughout the pandemic, we have had to make many adjustments, including hiring travel nurses, providing sign-on bonuses and increasing salaries to remain competitive in our small behavioral health market. These steps were very necessary in order to maintain adequate staffing levels so that we can provide the best care for our patients.

We are working responsibly and diligently to assess the viability and impacts of several cost-saving scenarios. There are three key areas we are focused on:

• The business model of our Psychiatric Emergency Services, or PES
• Medicaid reimbursement rates
• Reducing expenses

Having patients waiting for an extended period of time for a bed at the Oregon State Hospital, and for whom we are under-reimbursed relative to the cost of providing care is still a challenge that has not been resolved, but we are proactively focused on the efforts below.

We must continue to collaborate with the behavioral health community to address the need for increased access to residential treatment facilities, intensive outpatient and day treatment programs, and step-down community services. These pieces of the behavioral health system in Oregon are, in large part, missing. The lack of access to sub-acute care and step-down community services inhibits our ability as a behavioral health community to ensure people have the support and services they need to continue on their path to recovery after leaving an acute care setting.

In addition to our work to increase access to community care resources, we are focused on several strategic financial decisions.

First, we are making changes to the PES business model. We believe in the PES, and it will continue to be an essential part of Unity Center, but we need to improve its financial sustainability.

Second, we are engaging in open and productive conversations with Care Oregon about reimbursement rates for the care we provide at Unity Center to patients covered by Medicaid. We have a positive and collaborative relationship with Care Oregon and are grateful for their willingness to work in partnership to address this challenge. The vast majority of our patients are Medicaid recipients. While behavioral health is poorly reimbursed on the whole, this is especially true for Medicaid reimbursement.

Third, we are looking closely at all of our costs to ensure we are responsibly stewarding the investment our hospital partners have made in Unity Center and the generous gifts of the philanthropic community.

As we move through these changes and seek to better care for people suffering from mental and behavioral health issues, we will continue to make safety our first priority. We are caring for a vulnerable population and take that responsibility very seriously. We expect to have public agencies and the media hold us accountable, and we welcome that accountability.

Thank you for visiting UnityFacts.org, and we invite you to check in with us as we work to improve both our financial sustainability, and also the continuum of mental and behavioral health care in our community.

Sincerely,

Melissa Eckstein, MSSW, MBA, LCSW, president, Unity Center for Behavioral Health