Mental Health Disorders Complicate Standards for Readmissions

Co-existing psychiatric illness should be considered in assessing hospital readmissions for three common medical conditions used by Medicare and Medicaid to penalize hospitals with “excessive” readmission rates: heart failure, acute myocardial infarction (AMI) and pneumonia, according to a new collaborative study by 11 major U.S. healthcare providers affiliated with the nationwide Mental Health Research Network (MHRN). The study is published in Psychiatric Services.

Hospital readmissions account for a large share of healthcare spending in the United States, including more than $17 billion of Medicare costs each year. In attempting to reduce excessive readmissions — those occurring within 30 days of a patient’s original hospitalization — CMS is expected to add other medical conditions to the three already used as standards.

Psychiatric illness was already known to be highly comorbid with heart failure, AMI and pneumonia.

The study identified more than 160,000 patients who had been admitted to the 11 MHRN-affiliated healthcare centers between January 2009 and December 2011 for any of the three medical conditions targeted by CMS. It was the largest and most geographically diverse investigation of its kind.

Researchers found that patients with psychiatric comorbidities in the previous year were readmitted to the hospital 3 to 5 percent more often within 30 days than those without a psychiatric diagnosis. They also noted that nearly 30 percent of those admitted to the hospital with heart failure, AMI or pneumonia were diagnosed in the previous year as having a mental health condition.

Most important, the study concluded, individuals with a psychiatric concern probably accounted for an even larger proportion of admissions for heart failure, AMI or pneumonia, but because mental health conditions are often not diagnosed, these illnesses weren’t captured in medical records.

The study was conducted by researchers in the Mental Health Research Network (MHRN), a consortium of 13 large healthcare systems with affiliated health insurance plans. The MHRN systems serve over 12.5 million individuals across 15 states with diverse populations. Sites participating in this study and their primary locations included Group Health Cooperative (Washington), Harvard Pilgrim Health Care (Massachusetts), HealthPartners (Minnesota), Henry Ford Health System (Michigan), Kaiser Permanente (Colorado), Kaiser Permanente (Georgia), Kaiser Permanente (Hawaii), Kaiser Permanente Northern (California), Kaiser Permanente Northwest (Oregon), Kaiser Permanente Southern (California), and Baylor Scott & White Health (Texas). Institutional review boards at each site approved data use for this project.

Source: Henry Ford Health System March 25, 2015

Reducing Behavioral Health Readmissions: Integrating Behavioral and Physical Health for a Broad-based Intervention

Reducing Behavioral Health Readmissions: Integrating Behavioral and Physical Health for a Broad-based Intervention presents Carole Taylor, MSN, RN, chief clinical officer, and Shari Hutchison, Manager, Outcomes Department, both with Community Care Behavioral Health Organization, who will share Community Care’s strategies and interventions to reduce both physical health and behavioral health readmissions during this 45-minute webinar on June 11th.

This entry was posted in affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Behavioral Health, Cardiac Care, Care Coordination, Hospital Readmissions, Improving Community Care, Improving Patient Care, Reducing Healthcare Costs and tagged , , , , , , . Bookmark the permalink.
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