Imagine rushing to the emergency room with heart attack symptoms or a major injury and having hospital staff greet you with some variation on this: “Sorry, we don’t have any rooms available for that type of care.”
For Minnesota families with loved ones battling a serious mental illness, this is too often a reality when a crisis strikes and hospital care is not just urgent but potentially lifesaving.
Hospitals have a limited number of inpatient mental health beds, and they’re often filled, leaving patients to try to find another hospital or wait in emergency rooms, sometimes for days, until a bed opens up. One Twin Cities family contacted by an editorial writer once was relegated to an emergency room’s hallway for hours.
The current difficulty of finding care is why reports about St. Joseph’s Hospital’s financial losses and uncertain future are so alarming. The venerable St. Paul institution has 105 inpatient mental health beds, a significant percentage of the roughly 1,300 such beds in the state. The system simply can’t take a hit this size to care capacity.
“We can’t lose these beds,’’ said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness.
On Friday, James Hereford, president and chief executive of Fairview Health, called reports from last fall about St. Joseph’s closure “overblown.” More recent reports that Fairview is seeking out “partnerships” to preserve mental health care there are encouraging, though the move also raises broader questions. Among them: Why is mental health care reimbursed so meagerly compared with other medical care?
And, what do Minnesotans get in return for the special tax treatment provided to the state’s medical centers? Generally, these institutions operate as nonprofit hospitals, and with that comes a valuable property tax exemption. In return, they’re expected to provide a community benefit. Does that mean continuing to provide a critical but unprofitable type of care in an area with poor, vulnerable patients?
State Rep. Tina Liebling, DFL-Rochester, deserves credit for bringing up these expectations at a Minnesota House hearing on Thursday. Hopefully, her committee will continue to explore this issue. From testimony provided, there are few expectations outlined for what constitutes community benefit. Nor is there adequate information about whether taxpayers are getting a good return on their investment in these institutions.
The Star Tribune Editorial Board is sympathetic to the business challenges that medical centers face today. On Friday, Hereford said that St. Joseph’s lost $50 million last year. According to a Feb. 12 Star Tribune story, “Fairview went from an operating income of $86 million in 2018 to a $96 million loss in 2019 — with another loss projected this year.” But its new partnership with the University of Minnesota has also committed it to “an estimated $80 million per year in additional spending on the U’s academic physicians,’’ the story noted. Fairview acquired St. Joseph’s in a 2017 merger with the HealthEast system.
The partnership that Hereford is aiming for involves working with other providers or government entities to shoulder the responsibilities of maintaining mental health care capacity in this location. He said this has been done successfully elsewhere.
How long this would take, how it would work and how willing potential partners would be is unclear. Minnesota’s large nonprofit insurers should also be involved in finding solutions, since low reimbursement for mental health care is fueling the problem. The same holds true for legislators and state health officials, because many mental health patients have their care covered by medical assistance.
Hereford merits praise for working to find a creative solution to maintain the vital care St. Joseph’s provides. But this is also what should be expected of him. A nonprofit health care system’s obligations go beyond the bottom line to providing essential services.