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Pandemic Pushes Providers to Evolve at Precipitous Pace

April 27, 2020
Ron Manderscheid
By Ron Manderscheid, Executive Director, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Our daily world has changed quite dramatically in the past 30 days. Coronavirus continues to spike in different U.S. urban centers. The vast majority of us now are staying in place. Last Friday, we passed the tragic mark of more than 50,000 deaths in the U.S. due to coronavirus. 

This situation is one that is totally unprecedented in our lifetimes, and one that fosters great anxiety and fear in most of us. Now, we all are attempting to adjust to our new realities.

Concurrently, the behavioral healthcare field has undergone lightning-speed change in a matter of just two to three weeks. In that instant, behavioral healthcare has become a virtual field in which most care is delivered via video call platforms, such as Go to Meeting and Zoom, or simply through a phone. This change has occurred because the federal government has expanded use of telecare in both Medicaid and Medicare, and has incentivized expansions in private programs.

To characterize the transition to virtual care, we have accomplished in two to three weeks what would have taken two to three years to accomplish without the coronavirus emergency.

Simultaneously, these rapid changes have led to considerable financial hardship for many mental health and substance use care organizations. Income has dropped because of a reduced volume of office-based care and lower reimbursement rates for virtual care. Simultaneously, payment systems have not fully adapted to the need for much shorter emergency reimbursement cycles.

Stay-in-place mandates now have become much more protracted in most jurisdictions, extending from days into weeks and even months. As this has occurred, the volume of calls to emergency and suicide prevention lines has grown dramatically. Many of those using these services are new clients who have not been seen before in behavioral healthcare settings. (Some field leaders have reported increases in usage up to 80%, with 60% being new clients.) The expectation for the future is that these numbers will increase even more dramatically as the economy is turned on gradually.

In this upheaval, some of our providers in the field do not have the essential personal protection equipment—PPE—needed to protect them when they work in a hospital, residential facility, or jail. Each of these facilities is a hotbed for generating coronavirus outbreaks among staff and patients. Part of the problem is that, even at this late date, behavioral healthcare providers are not recognized as essential health workers in many locales. This is a tragic situation that must be changed.

The newly enacted Payroll Protection Program (PPP) and the Economic Injury Disaster Loan (EIDL) Program have provided some relief to providers’ short-term financial problems. The PPP provides loans up to 2.5 times monthly salaries, with a maximum of $10 million. These loans will become grants after June 1 if all employees remain employed. The EIDL Program provides loans up to $2 million for up to 30 years at low rates of interest. Just last Friday, an additional $350 billion was appropriated for the PPP.

To summarize, we have developed very urgent short-term problems that must be addressed right away. We also have rapidly accelerated longer-term trends which have introduced new problems in their wake. Intense work continues at the national and state levels to address both of these types of problems.

Overall, our entire behavioral health infrastructure—from the federal level, to the state level, to the county level, to the private sector, to the provider and consumer communities—has performed remarkably well under very difficult, unprecedented conditions. We fully expect these difficult conditions to continue for an extended period of time. Hence, great urgency exists to address the problems identified here.

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