Name: Daniel J. Wall
Position: President and CEO, Emma Pendleton Bradley Hospital
Background: Appointed president and CEO of Bradley Hospital in 1993after serving as chief operating officer and chief financial officer since joining the hospital in 1988. He was the vice president of finance at theHospital Association of Rhode Island from 1981 to 1988.
Beyond Cash Donations: How New Forms of Giving Are Transforming Not-for-Profit Accounting
Evolving Funding Landscape for Not-for-Profits Not-for-profit organizations are being asked to do more with less,…
Learn More
Education: Providence College (1970)
Age: 53
Residence: Pawtucket
Founded in 1931, Bradley Hospital in East Providence is the country’s first psychiatric hospital devoted exclusively to children and adolescents. It provides a full continuum of care for young people from infancy to age 22. As an affiliate of Brown University School of Medicine, Bradley is a national center for training and research in child and adolescent psychiatry. It also operates the Bradley School, a fully certified special-education school.
PBN: Describe the services Bradley offers.
WALL: Most of the community really doesn’t know that much about Bradley. Obviously it’s a hospital, but in addition to that, we run a school, we have partial-hospital programs and we have a big outpatient service. We have the Brown University primary training site for child and adolescent psychiatry and we have some significant research and preventative programs going on. So we see ourselves as really a comprehensive psychiatric facility for children, not just an acute-care hospital. We also run three residential homes, in East Greenwich, Warwick and Exeter, where children go to after they leave the hospital setting.
What are the most common illnesses treated here?
It’s very hard to generalize in terms of who the kids are that are here. A child in our services could have a very serious, inpatient stay that could go on for several weeks or longer, where there is a whole cadre of professionals who work with this child. And others have a once-a-month outpatient visit for a child who might be having difficulty in school or some behavior issues. We have a very large developmental disabilities program. These are kids who have physical disabilities as well as psychiatric problems, and they can stay several months in many cases. We are one of only seven or eight programs like that in the country. The other significant part is in two pieces: the child program, which is kids up to 12. Those are kids that have a variety of trauma they’ve experienced, whether it’s sexual, physical, emotional trauma, and their behavior has gotten to the point where they need hospitalization. The third group is adolescents. A lot of clinical depression, children who have attempted or thought about suicide. In most cases, all other interventions – outpatient therapies, partial hospital, specialized schools – have all failed.
Has the inpatient census been going up or down?
The last three years have been pretty constant. We’re licensed for 60 beds, and we’ve been running about 45. Admissions are actually up. When I came here in 1988, we did 375 admissions, I believe. Last year we had 874. Yet the average daily census has dropped by about 15 kids. The simple reason is that they’re in and out faster. That’s what drives this need for alternatives. Where do they go when they leave? They don’t all go home. Some need to go to a residential facility or a partial program or an outpatient program.
What is the breakdown of payer sources?
An excess of 50 percent of our inpatient revenue is Medicaid, both Rhode Island Medicaid money and out of state. When people hear Medicaid, they think poverty. We have those kids, but we also have kids who have exhausted private insurance. So an insurer will cover for 45 days and then (the patient) will convert to Medicaid. The other 50 percent is managed care, which includes a bunch of different companies, including Blue Cross, which has been a significant payer here over the years.
Some outpatient mental-health service providers have complained about trouble with reimbursement for outpatient services. Is that the case here too?
We’ve had trouble. We substantially closed our outpatient program about three years ago because of the drain it was having on the entire hospital. We couldn’t sustain those losses anymore, so we eliminated positions and contracted our outpatient services. We did not eliminate them altogether, though. Now, in the last six months or a year, we’ve been looking at how we can get back into it, because the need is definitely there. The problem with the outpatient reimbursement is that the payers for years have not made a distinction between adult payment and child payment. An hour of psychotherapy for an adult versus a child is a very different thing.
Child psychiatry is more expensive?
Well, there are more pieces to the puzzle. The family that child is living in has to be brought into the therapy situation, which requires a lot more time by the clinician. The third-party payers don’t recognize those additional efforts.
Do you think the shortage of child mental-health services in the state continues to be a problem?
You hear a lot about there being not enough beds. Well, I believe there are enough acute-care beds. We’re licensed for 60 beds and we don’t have 60 kids here every day. What we do have though is a problem with children who end up staying here longer than they need to because there isn’t an adequate place for them to go. It’s because sometimes the patients in the beds need to be moved to a residential level of care or partial level of care, and I think the system has failed to provide those alternatives.
What is the role of the schools?
The school programs are significant – we have over 150 kids in them right now – and they’re paid for by the local cities and towns, through their school districts’ special-ed budgets. We refer to these programs under the umbrella of the Bradley School, which is part of the hospital. We have run these school programs probably since the early 60s, but it was on a small scale, just on this campus. In the last five years we expanded to Portsmouth. We also have a program here on this campus, and we’re putting the third one in South County. These are kids whose behavior or inability to learn has been identified in their local school system. We work with the school psychologist or social worker to put together a specific plan that’s called an IEP, an individual education plan. So each child’s care is individualized and once they are able to figure out what’s going on with them, we get them back to their school systems.
What’s the status of the South County project?
We found a great piece of land on Tower Hill Road across from the government center. We are preparing documents to go out to bid on the project. The school building is budgeted to run about $2.6 million for the building itself. We have a major fundraising campaign, as well as the contribution from Lifespan.
How successful has Bradley’s affiliation with Lifespan been?
We joined Lifespan in ‘96 and we’ve been very happy with that affiliation. We were able to stabilize our finances. Lifespan has provided us some capital dollars that have allowed us to get into some of this diversification and away from acute. The homes that we purchased, and most recently the commitment of a million dollars from Lifespan to get us started on the building of the school in South County.
What about efficiencies?
A lot the infrastructure that we had here – finances, information services, legal, marketing, third-party contracting – the corporate office works with us, but really has the systems to do those things for us. That allows us to focus our money on patient care and get some economies of scales. I believe we are an excellent example of how a relatively small specialty hospital who would be struggling if they weren’t part of system. But in terms of the day-to-day operations and clinical care, that’s left to me and the staff here.
I know Bradley was losing money a few years ago. How’s the hospital’s financial situation now?
What our recent success really has been all about is to get away from that dependence on acute care. The improvements in our finances have been really about diversifying and getting away from the acute piece. We’ve had a good, solid financial performance over the last few years, and that’s directly tied to getting into alternatives, as well as tied to coming a part of Lifespan. Another thing is we have a very stable staff. We have no labor issues and very little turnover. In 2000, we were roughly breakeven, and it’s going to be very similar for 2001.
How many employees does Bradley have?
465 FTEs (full time employees), which equates to about 640 people.
What is the main focus then going forward?
Basically we’ve taken this attitude that we’re going to provide what’s needed. Acute was needed and it still is, but so are a lot more things, like residential and school and intensive outpatient services. We are looking at two more residential homes in the community. We also clearly want to improve the reimbursement environment. I think there’s still a challenge here with the third parties to prove to them that what we can do for children in terms of mental health is a really good investment in the long term. And we want to increase public awareness. As a children’s psychiatric hospital, we’ve become aware that a lot of people don’t know that much about us.
