The future of the nonprofit WestCare’s community triage center in Las Vegas continues to hang in the balance after the Clark County Commission deferred a decision on Tuesday about whether to provide funding that would allow the facility to continue to operate beyond the end of the month.
The decision to delay action came after Clark County commissioners drilled WestCare representatives on a host of specifics during the Tuesday meeting — including what the case management process is for patients that come into the center, for what reasons the center turns away individuals and why the center has struggled to get certain patients covered under Medicaid — but didn’t get many answers. WestCare, meanwhile, has said that it will keep its center on Maryland Parkway open until the end of May but can’t guarantee it will do so beyond that without additional funding from the state, local government and local hospitals.
Since it opened in 2002, WestCare’s community triage center has been funded as a partnership between the state, local government and hospitals, with each providing about a third of the cost. For the 2016 state fiscal year, the state contributed $1 million and the local governments and hospitals provided $1.7 million in funding and $260,000 in in-kind contributions, for a total of about a $3 million agreement. The aim of the triage center is to reduce the burden on emergency rooms and jails of people with behavioral health issues by providing them another place to go when they’re in crisis.
But, after WestCare’s community triage center in Reno abruptly closed last month, state officials disclosed that there had been issues continuing to fund the centers and that they had been working with WestCare over the last year to try to secure funding. Officials have said that although the state has money ready to be allocated toward the program, it cannot pay out those funds until the partner match is secured.
Julie Kotchevar, who heads the state Division of Public and Behavioral Health, said at a meeting of the Legislature’s interim health-care committee last week that the state needs either confirmation of the match or an actual match to appear before releasing its part of the funding, or “jumping first,” as state Sen. Joe Hardy phrased the question to her.
“We actually did offer to ‘jump first,’ even with verbal confirmation that there’s a possibility of a match, but so far that hasn’t materialized either,” Kotchevar said. “We’re kind of in a sticky place where we’re really trying to be the best partner we can, but the way the funding was structured it really was tying our hands a little bit.”
Clark County, meanwhile, has been reluctant to turn over more money to the facility after an audit earlier this year found that WestCare owed its state and local partners about $1 million. The audit found that certain services provided by the center were reimbursed under Medicaid and therefore did not need to be also paid for by the state and local funding. (WestCare had previously said that it owed the partners in the agreement about $655,000.)
But commissioners on Tuesday expressed varying levels of frustration with WestCare for not providing more details about the services they offer and to whom.
“I don’t think you guys honestly answered anybody’s questions today,” said Commissioner Marilyn Kirkpatrick. “I asked specific questions and I did not get specific answers.”
Kirkpatrick probed WestCare representatives about how much uncompensated care they’re providing, what other private insurance they’re taking and how much time and attention patients are receiving at the clinic, among other questions. She noted that the roughly 4,000 clients that go through the facility in any given year — about 11 patients a day — is far less than the 50 beds the center is required to provide.
“If you look at the math I’m telling you I want to understand what are they getting. Are they getting a two-minute assessment after waiting 12 hours and then moving on?” Kirkpatrick said.
WestCare Executive Vice President Peggy Quigg told the commission that the center typically has about 35 to 38 patients during any given period, but that on some days the center sees as few as 10 or 12 patients. And Ken Ortbals, Westcare’s chief financial officer, said that each patient receives an average of 50 different interactions with staff while they’re at the center.
As far as the funding model, Quigg told the commission that the center “may have gotten a little ahead of” itself when it started trying to move from relying on the state and local grant funding toward getting reimbursed through Medicaid, and that while it wants to continue to decrease the dollars it relies on from the local governments and hospitals, it isn’t quite there yet. She said some people just don’t want to enroll in Medicaid and the center can’t force them to, while others lack the competency to follow through with the paperwork.
Commissioner Chris Giunchigliani expressed an overall concern that the auditors weren’t able to independently verify that WestCare’s reports included accurate figures for the number of clients served. (The audit said that there were “errors and unreliable data integrity on information maintained by WestCare.”)
“Money is one thing, but the quality of what we’re offering for those clients that come in the door that are already desperate, they’re already mentally unstable, that’s not been any part of the discussion that I’ve heard for the last month or so with regard to the center,” Giunchigliani said.
Kirkpatrick asked what guarantee the county has that if they award money to WestCare that it will continue to provide services and not close anyways.
“This is the weeds but this is our responsibility to know the weeds,” Kirkpatrick said. “We can’t be throwing money after money and not getting services to our clients.”
The commissioners asked WestCare to come back before them in two weeks to revisit the issue and to bring additional information with them at that time.
Disclosure: Chris Giunchigliani has donated to The Nevada Independent. You can see a full list of donors here.