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What Happens To County Health Services Without CHS Contract?

Mecklenburg County commissioners voted Tuesday night to phase out the county's contract with Carolinas Healthcare System to provide psychiatric and public health services. But they did give CHS one more chance to come to the bargaining table. Commissioners told the County Manager to see if the hospital chain would be open to mediation, although several of them said they didn't expect that to amount to much. WFAE's Lisa Miller is in the studio to talk about what ending this contract means: Mark Rumsey: Lisa, first how did we get to this point where the county wants to end its contract with CHS? Lisa Miller: This dispute started several months ago. County Manager Harry Jones asked CHS for certain financial and patient information about the psychiatric hospital. That's CMC-Randolph which the county owns, but CHS runs. The county pays the hospital about $20 million a year to help offset the deficit there. Often psychiatric hospitals run a deficit because when patients on Medicaid go there for care, Medicaid often won't pay the whole bill. Anyway, Jones says CHS won't provide the information he asked for. He told that to commissioners again yesterday. JONES: We're paying $20 million right now for a deficit and we don't know if we should only be paying $11 or $10 million, we just don't know. We're not confident. LM: Furthermore, Jones says CHS doesn't need the county's money. He says it has about $1.8 billion held in reserve. CHS says it's provided all the information the contract requires. MR: Now, CHS wants to build a 44-bed psychiatric hospital in Huntersville. How does that enter into the argument? LM: Initially, CHS asked the county's permission to do that. The county wouldn't approve the project. And so CHS ended up going to the General Assembly and asking lawmakers to draft a bill to allow the hospital chain to do so without the county's permission. And it passed. But that only ended up angering county officials more. Hospital officials have said it's a conflict of interest that the county has a contract with them and also is in charge of approving things like adding hospitals. MR: So back to the contract the county wants to end.what else is included in it? Does the county pay for other services? LM: The county pays CHS about $20 million to provide public health services. About half of that money is for school nurses. The rest goes to things like immunization clinics, family planning services, and helping Medicaid patients manage long-term diseases. In fact, CHS employees provide most of the health department's services. So ending the contract would either mean contracting with another provider. The obvious one would be Novant, which owns Presbyterian. (And they were in the room yesterday for the discussion.) Or the county absorbing all those services. The county's Health Director Wynn Mabry, says that's doable, but it would be a challenge. MABRY: Given the right circumstances and your support, we can do this. But as I said before, this isn't just a flip of the switch scenario. It's going to take some very good leaders and managers. LM: He's worried it would be hard to lure some people away from CHS to the county. MR: Now, what would it mean for psychiatric services? LM: That's not clear. County Manager Harry Jones has said he doesn't want to spend $20 million on psychiatric hospitals. He believes CHS will provide that service whether it gets county money or not because it's a non-profit hospital and must fulfill certain obligations. Jones says the county should still think of investing money in other mental health programs. He wants to put together a commission to think about how the county should deliver public health and psychiatric services without a CHS contract.