Service Area Strategic Plan
4/24/2014   6:42 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Inpatient Medical Services (720 430 07)
Description

Inpatient Medical Services include medical, dental, and nursing services provided to individuals receiving services in state hospitals and training centers. Inpatient medical services encompass a broad range of interventions, therapies, and laboratory services, but, most predominantly, include the skilled nursing, infirmary services, and acute medical or surgical care provided in state facility medical/surgical units or by referral from state facilities to local acute care hospitals through the Department's special hospitalization program.

Medical/surgical units are available at Eastern State Hospital (ESH) in Williamsburg, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, Western State Hospital (WSH) in Staunton, Central Virginia Training Center (CVTC) in Lynchburg, and the Hiram Davis Medical Center (HDMC) in Dinwiddie.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Inpatient medical services are an integral component of a comprehensive array of services available in state hospitals and training centers. Inpatient services focus on alleviating the symptoms and distress associated with an illness or medical condition. Acute symptom resolution or management is a prerequisite for active and meaningful individual involvement and participation in other state facility services that enable individuals to develop skills and supports needed for success and satisfaction in specific environments and enhance other fundamental life skills needed for successful community living.
  • Describe the Statutory Authority of this Service
    Chapter 3 of Title 37.2 of the Code of Virginia establishes the Department of Behavioral Health and Developmental Services.
    • § 37.2-04 outlines the duties of the Commissioner, including supervising and managing the Department and its state facilities, including inpatient medical services.

    Chapter 7 of Title 37.2 of the Code of Virginia authorizes the Department to perform certain functions related to the operation of state facilities, including inpatient medical services.
    • § 37.2-707 authorizes the Commissioner to employ state facility directors; and
    • § 37.2-711 authorizes the Department and state facilities to exchange consumer-specific information for former and current consumers with CSBs to monitor the delivery, outcome, and effectiveness of services.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals in state facilities receiving local inpatient hospital services through special hospitalization Individuals receiving inpatient medical services in local hospitals through special hospitalization 543 597
Individuals receiving inpatient services provided by Hiram Davis Medical Center Individuals receiving inpatient services provided by Hiram Davis Medical Center 122 150
Individuals receiving inpatient services provided on state hospital medical/surgical units Individuals receiving inpatient services provided on state hospital medical/surgical units 204 468
Individuals receiving inpatient services provided on the Central Virginia Training Center medical/surgical unit Individuals receiving inpatient services provided on the Central Virginia Training Center medical/surgical unit 331 500

Anticipated Changes To Agency Customer Base
o Virginia’s population is increasing, becoming more culturally diverse, and growing older. The customer base for state facility services will change to reflect these demographic trends.

o State facilities will serve proportionately greater numbers of individuals with co-occurring disorders (mental illnesses and substance use disorders, intellectual disability and/or other developmental disabilities), increased individual acuity, and complicated acute and chronic medical needs.

o State facilities will serve proportionately greater numbers of individuals who have some level of involvement with the criminal justice system.

o State facilities will serve proportionately greater numbers of individuals with significant or complex service needs who will require specialized treatment services and ongoing preventive care.

o A growing number of Virginians have either limited or no behavioral health insurance benefits. These individuals will place increasing pressure the public behavioral health and developmental services system.

o Increasing numbers of individuals with severe behavioral disabilities and significant aggressive behavior patterns are being admitted to state facilities. These individuals frequently have had limited access to medical services and may be admitted to state facilities with multiple chronic medical conditions that require treatment during the course of their inpatient stay. They also have the potential to increase the utilization of medical services to treat injuries incurred by other individuals receiving state facility services who may interact with these individuals.
Partners
Partner Description
Diagnostic testing services: Lab, radiology, and specialized diagnostic testing services are provided at local acute care hospitals, local physician’s offices, or specialized diagnostic centers, when such services are not available in the state facility.
Local acute care hospitals: Local acute care hospitals provide medical and surgical services for individuals who require specialized inpatient medical and surgical care not available in state facilities.
Private physicians services: Some individuals receiving inpatient services have private health care coverage. When these individuals require medical or surgical services, the individual may request care from their primary care physician.
Products and Services
  • Factors Impacting the Products and/or Services:
    o Individuals served state hospital civil beds should continue to decline as more community-based crisis intervention services become available. Demand for beds to serve individuals with forensic involvement is likely to continue to increase over time as Virginia's population grows and new commitment criteria are fully implemented. Individuals with a forensic legal status typically have more medical conditions associated with poor health care prior to admission and iatrogenic disorders.

    o Children and adolescents served in state hospitals will continue to have extreme needs or some interaction with criminal justice system. The Department has convened a planning group comprised of families, community providers, advocates, and others, to examine the current and future role of the Commonwealth and private providers in providing acute psychiatric services for children and adolescents and to develop strategies for promoting high-quality community-based care while maintaining a safety net of services for children and adolescents who need acute psychiatric services.

    o Individuals with more severe and complicated behavioral health disorders and more varied and complicated medical needs that are currently not met in the community will increase the demand for expensive medical services in certain regions.

    o Demand for inpatient services will increase as individuals served in state training center grow older and develop acute and chronic medical conditions associated with aging.

    o Increased emphasis on medical screening to ensure that complex medical problems of individuals are addressed in local hospitals prior to their admission to a state facility could offset increased demand for facility medical/surgical units and reduce the costs associated with outpatient medical services and special hospitalizations in local acute care hospitals purchased by state facilities.

    o Clinical, environmental, and administrative standards set by the Centers for Medicaid and Medicare (CMS) and by the Joint Commission are likely to continue to become more complex, burdensome, and more expensive to oversee and implement.
  • Anticipated Changes to the Products and/or Services
    o The Department will monitor bed utilization in medical/surgical units to determine the most cost effective means of providing medical/surgical and skilled nursing services.
  • Listing of Products and/or Services
    • Inpatient medical services include: physician services; nursing services; skilled nursing care; pathology lab; radiology; EEG/EKG; dental services and dental anesthesiology; speech and audiology; physical, occupational, and recreational therapy; ophthalmology services; respiratory therapy; psychology services; medical supplies; anddetoxification
    • Special hospitalization (purchase of medical care from local hospitals)
Finance
  • Financial Overview
    This service area is funded with 50 percent general funds and 50 percent non-general funds. Non-general funds are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to patient care.

    The information on these tables is presented at the service area level. However, funding by fund source is appropriated at a higher program level. This results in the allocation of the non-general fund amounts to the various service areas within the program level in accordance with reasonable allocation methodology. This methodology has been applied and is represented in these amounts.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $21,915,724 $20,042,646    $21,915,724 $20,042,646
    Change To Base -$1,759,821 $0    -$1,759,821 $0
               
    Service Area Total   $20,155,903  $20,042,646     $20,155,903  $20,042,646 
Service Area Objectives
 
  • Offer or arrange for medical care appropriate to the individualized needs of facility patients and residents.
    Objective Description
    State hospitals and training centers vary in their ability to provide general medical or surgical care to patients and residents. Medical and surgical services may be provided within the facility, in a local hospital, or in a referral facility. The proper assessment of an individual's medical status at admission to a state facility and proper assessment of any changes in this status during his hospitalization or stay in a training center are critical in making a determination about the most appropriate locus of inpatient medical services. Pressure ulcers are lesions caused by unrelieved pressure that results in damage to the underlying tissue(s). Many long-term medical care patients will experience pressure ulcers, but, for the most part, these ulcers are avoidable. The majority of Hiram Davis Medical Center patients who have pressure ulcers developed these ulcers before they were admitted to the center. Appropriate treatment that heals or improves the severity of those pressure ulcers that do occur is commonly used as a measurement of the quality of care provided to long-term medical care patients.
    Alignment to Agency Goals
    • Agency Goal: Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.
    • Agency Goal: Obtain sufficient numbers of professional, direct care, administrative, and support staff with appropriate skills and expertise to deliver quality care.
    Objective Strategies
    • Offer quality medical care in facility medical/surgical units that meets CMS and Joint Commission requirements.
    • Maintain sufficient numbers of trained staff on each facility medical/surgical unit to ensure services are appropriate to the populations served and sufficient to provide quality care.
    • Implement a career path for direct service associates to improve recruitment and retention efforts.
    • Provide funds to assure health care and special hospitalization needs are met for individuals receiving services in state hospitals or training centers.
    • Continue partnerships with local hospitals to assure continuity of treatment for individuals receiving state facility services who require medical and surgical treatment that is not available at the state facility.
    • Monitor the known or postulated causal factors for pressure sores.
    • Monitor the cost effectiveness of continuing to provide medical/surgical services and develop plans, as necessary, to change services or close units when other alternatives are determined to be more cost effective.
    • Support the efforts of the OIG to monitor the progress of state facilities in improving quality of care.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percentage of pressure ulcers that heal within three months of the start of treatment
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      77
      Date:
      6/30/2009

      Measure Baseline Description: Percentage of pressure ulcers healed within three months of the start of treatment

      Measure Target Value:
      82
      Date:
      6/30/2012

      Measure Target Description: Percentage of pressure ulcers healed within three months of the start of treatment

      Data Source and Calculation: Source: The facility will report its pressure ulcer data to the Office of Facility Operations. Calculation: Number of ulcers that heal within three months of the start of treatment divided by the total number of ulcers treated.


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