Montana State Hospital $7.4 million over budget

Monthly contract nurse assistant hours up 700% from January to December

By: - March 17, 2022 2:28 pm

Montana State Hospital at Warm Springs (Photo via Wikimedia Commons | CC-BY-SA 3.0).

The Montana State Hospital is $7.4 million over its budget for the current fiscal year as the Warm Springs facility is forced to supplement state staffers leaving the hospital with significantly more expensive contracted workers.

Figures provided by Department of Public Health and Human Services officials showed contracted workers sometimes make nearly double the hourly amount compared to state workers. For example, a registered nurse at the psychiatric hospital employed by the state makes an hourly wage of $54, compared to $106 when the position is contracted out. The hospital’s total budget for the fiscal year 2022 is $48.8 million, according to DPHHS.

“The majority of it is reliance on contracted staff over state staff,” Kim Aiken, chief financial officer for DPHHS, told a legislative budget committee on Wednesday.

And more data from the department shows an increased reliance on private workers as staff levels have dwindled since 2019. The number of full-time staff decreased from 450 in 2019 to less than 350 by the end of 2021. And by December of 2021, contracted nurse assistants were billed for 16,000 hours in that month compared to just 2,000 in January 2021, a 700 percent increase.

“You have to pay (contract workers) market rate to find them … and that’s where it gets really expensive. Especially having in the last fiscal year two COVID surges,” DPHHS Director Adam Meier told the budget committee. “And then we’re competing with acute care hospitals, who can seek 100 percent FEMA reimbursement for a lot of those same positions. And so that drives up the contract market rate for contracted staff.”

The overall staff vacancy rate at the hospital was 40 percent as of March 8. Registered nurses were the most understaffed position at the hospital, with a 72.5 percent vacancy rate. But with contracted workers, the vacancy is closer to 10 percent, Meier said on Tuesday.

The budget shortfall is a continuation of mounting problems at the hospital, which is at risk of losing its federal funding after a Centers for Medicare and Medicaid investigation found the hospital was out of compliance with federal standards.

Meier was pressed by committee members about the department’s immediate actions to help.

“What is the department doing to put out the fire today because the fire is still there?” said Rep. Mary Caferro, D-Helena.

In response, Meier’s pointed to the department’s cooperation with CMS to do a root-cause analysis of problems at the hospital, its pursuance of a private contractor to review operations at the hospital and other state-run health facilities, and pay raises doled out at the state hospital in recent months.

“We didn’t get here overnight. These have been long-standing issues that have continued to incrementally get worse, as it relates to staffing in particular,” Meier told the committee.

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Keith Schubert
Keith Schubert

Keith Schubert was born and raised in Wisconsin and graduated from the University of Minnesota in 2019. He has worked at the St.Paul Pioneer Press, Milwaukee Journal Sentinel and most recently, the Asbury Park Press, covering everything from local craft fairs to crime and courts to municipal government to the Minnesota state legislature. In his free time, he enjoys cheering on Wisconsin sports teams and exploring small businesses. Keith is no longer a reporter with the Daily Montanan.