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Posted February 3, 2013 | comments Leave a comment

Much has changed, more changes coming in mental health services

Retiring Northwestern Community Services CFO reflects on three decades of service

By Kim Walter

FRONT ROYAL -- Mental health services recently have been brought into focus across the state and country as those benefiting from such services beg for additional funding.

While they argue that there is a need for more services, facilities and employees, David Toth knows that funding now is at least better than it was 34 years ago when he entered the field.

Toth, 67, was the first chief financial officer at Northwestern Community Services in Front Royal in 1979.

"Yep, I was the first one in this position, and I think it's safe to say I stayed a bit longer than I thought I would," he said.

Toth has decided to retire after over three decades with organization, and while he said that it's the right time, that doesn't mean it was an easy decision to make.

"I've been lucky because I work with a great group of people who love what they do, and they work well together ... we support each other, especially the ones who are like me and have been here for so long," he said. "That will be hard to leave."

Toth said now seemed like a good time to step down, mostly because the looming Affordable Care Act raised a lot of questions for him -- questions he still doesn't know the answers to.

"There are so many changes coming down, and I think it will still be some time before people start to understand what it all means," he said.

Toth said the agency has "completely changed" over the years.

When he started in the position, Northwestern Community Services, a public provider of behavioral health services, employed about 50 people and spent $800,000 in its first year.

"Now we spend $14 million a year and have about 250 employees," Toth said.

As when it first opened, Northwestern receives local, state and federal funds, all of which have remained pretty stagnant in the past several years. However, Toth said the biggest change financially has come from fees.

In the first year, Northwestern made about $125,000 from fees, but now gets over $6 million a year. Toth said Medicaid mostly covers the fees.

"The whole focus has changed," he said. "You're like a doctor's office now. We provide a service, keep documentation and they bill you."

The facility is in the process of purchasing an updated electronic medical records system in order to be compliant with the Affordable Care Act.

"It's got to be a certified system so that people can get access to a patient's physical and mental health," Toth said. "It's about serving the whole person."

Thirty-some years ago, Toth said more of a focus was on outpatient care, but now Northwestern offers a variety of services in a variety of places. The facility has locations in Winchester, Shenandoah and Warren counties, as well as day programs, clinics and supportive housing programs.

More contracted doctors and nurses have joined the professional team at Northwestern as well.

"One thing I've heard from our mental health doctors, which I think is the goal of the Affordable Care Act, is that if they're working with a patient who they realize has high blood pressure, it'd be helpful if they could just walk down the hall and have the right kind of doctor check out that issue," Toth said. "Sort of like a one-stop shop ... I think it's a step in the right direction."

Toth said the organization manages to work with patients when it comes to finances so they can receive the necessary help.

"If someone comes in with insurance, we'll accept it, and if they're on Medicaid we can bill for that too, but if not we work it down to their ability to pay," he said. "A client may wind up paying $5 for services. No one is ever turned away because they can't pay."

Because of the recent support for mental health services and the legislative attention it's gathering, Toth said he hopes more funding will be made available. Some waivers are available to patients with developmental disabilities, among other things, but Toth said the process of actually applying for and getting the waivers can be tough, sometimes resulting in people not having the financial support they require.

"I got into this industry not knowing anything about it," he said of mental health services. "But the people we help absolutely benefit from the services they get. I've heard from folks in some of our apartments that they're happy, very appreciative and feel like they have one big family.

"That made me feel good," he continued. "Yeah, accounting is what I do, but it all comes down to the clients and figuring out how we can serve them better."

After he leaves Northwestern, Toth said he will be available if his help is needed. Otherwise, he said he hopes to relax, travel and play some golf.

"I think it's time for me to leave," he said and smiled. "I've learned so much about how different this industry is than I thought. It's not only health care, but it's also governmental. It can get tough will all the documentation and reports, but when you're using public money to serve people, you have to be held accountable."

Contact staff writer Kim Walter at 540-465-5137 ext. 191, or kwalter@nvdaily.com


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