Advocates of a long-stalled proposal to build a psychiatric hospital in Wilsonville have urged Gov. Kate Brown to let the project move forward, saying the extra beds are needed to meet an increased demand for mental health treatment during the coronavirus pandemic.
Pennsylvania-based giant Universal Health Services has been trying since 2016 to win a “certificate of need” from the Oregon Health Authority for the hospital. The state rejected the idea the following year. But Universal Health, which owns Cedar Hills Hospital in Southwest Portland, a for-profit psychiatric facility, didn’t give up. Last summer it submitted a new application. The state says that application remains incomplete, so the two sides have been haggling over various issues such as how many low-income people the for-profit hospital would serve.
This week several dozen politicians and health care groups rallied behind the project, asking Brown to use her emergency powers to declare that the $47 million hospital is needed in order to address the COVID-19 crisis, allowing construction to begin immediately. The advocates want Brown to waive the certificate of need process. The politicians range from U.S. Democratic Congressman Kurt Schrader, whose district includes Wilsonville, to state Sen. Brian Boquist, R-Dallas, who does not represent Wilsonville and has repeatedly clashed with Brown. Other advocates include the Portland Business Alliance and several health care and housing groups.
In a letter, the advocates said the COVID-19 crisis highlights Oregon’s shortage of treatment facilities for the mentally ill. Many mentally ill typically go to hospital emergency rooms, and some are housed there for days before they are transferred to psychiatric facilities if there is room. But with the Oregon State Hospital and other facilities restricting patient intake due to the coronavirus, the mentally ill are being sidelined, the advocates argued.
“In light of Oregon’s persistent mental health crisis and the expected 18-month length of the COVID-19 pandemic, the need for this facility could not be more clear,” the letter argued. Plus it stressed the economics of the project: “This shovel-ready project would provide a $40 million infusion in private, out-of-state investment at a fragile economic time and create hundreds of construction and health care jobs. It would also provide vital revenues to the state and local governments through the payment of property, income and corporate taxes.” Wilsonville has already granted planning approval of the project. The mayor, Tim Knapp, is a fan. As a for-profit entity, Universal Health would pay property taxes.
But the Oregon Health Authority remains in the midst of reviewing Universal Health’s application and is trying to determine, among other things, whether the facility would address the mental health needs of some of the poorest residents in the Portland metro area: low-income people who are either on or eligible for the Oregon Health Plan.
Brown’s spokeswoman Liz Merah noted the company has not completed its application, and that the Oregon Health Authority needs additional information about how the facility, if built, “would enable us to better respond to the immediate COVID-19 pandemic.”
Oregon Health Authority officials, who are helping to craft the state’s COVID-19 response, have not recommended, as part of that response, that the state waive its certificate of need process for the Wilsonville facility, Merah said.
The Oregon Health Authority declined to comment on the letter. But the agency did note that the company’s application remains under review and is not complete.
The certificate of need process is set out in state law. It is meant to ensure that significant new in-patient health care facilities are reviewed prior to construction to make sure they are needed and to give health care providers, government agencies and the public a chance to comment.
Under her declaration of emergency due to the coronavirus outbreak, Brown can order state agencies to take a wide range of actions to address the crisis. In their letter, supporters of the project asserted that Brown has the authority to waive the certificate of need process.
The project’s review remains entangled in an analysis of who it would serve. The state is critical of Universal’s Health’s only hospital in Portland, Cedar Hills, and in a Jan. 28 letter, quizzed the Pennsylvania-based conglomerate about whether the Wilsonville facility would be run in the same way. The letter, written by Matthew Gilman, facilities planning and safety program manager for the health authority, asked why Cedar Hills takes so many patients from out of state, has such a large number of patients on commercial health insurance and why it has comparatively few low-income patients who are on the Oregon Health Plan. Commercial health insurance typically reimburses providers at higher rates than does the Oregon Health Plan.
Gilman also asked the company “what conditions, if any, would (the company) be willing to accept, to ensure that this new (Wilsonville) facility takes its share of (Oregon Health Plan) eligible patients?”
In an April 8 response, Universal Health said that about half the Cedar Hills patients are on commercial health insurance, about 40% on Medicare, with the remainder on the Oregon Health Plan. It said 20% of Cedar Hills patients are from out of state. Universal Health also questioned the implication that the state could dictate who the hospital would treat and that the hospital had to accept a certain number of Oregon Health Plan patients.
“It is unclear what is meant by ‘its share’,” Universal Health said in its response. “We are unaware of any similar conditions placed upon prior certificate of need applicants.”
Universal Health is a global heavyweight in behavioral health care. It has more than 350 hospitals and other facilities in the United States and the United Kingdom, staffed by more than 87,000 employees. In 2018, the publicly traded company reported a profit of $779 million on revenues of $10.8 billion.
At a hearing in 2017 on the Wilsonville proposal, critics said the most desperate need is for more psychiatric facilities to handle Medicaid patients, not beds for people on commercial insurance plans.
However, Universal Health asserts there is a need for more psychiatric beds across the demographic spectrum, given the steady population growth of the Portland metro area and the anticipated growth in the coming decade. The company said Oregon lags far behind national standards for the number of psychiatric beds in relation to population size.