By Brenda Mooney, Special to AHC Media
DETROIT – Medicare and Medicaid should take into account co-existing psychiatric illness when assessing hospital readmissions for three common medical conditions used to penalize hospitals with "excessive" readmission rates, according to a collaborative study by 11 major U.S. healthcare providers.
The study, published in the journal Psychiatric Services, focuses on readmission rates – an issue of increasing concern to U.S. hospitals since October 2012, when CMS linked readmissions to reimbursement as part of the Affordable Care Act.
"CMS chose three general medical conditions -- heart failure, acute myocardial infarction and pneumonia – as a way of assessing excessive re-hospitalizations and penalizing providers by reducing payment for healthcare services," said lead author Brian K. Ahmedani, PhD, of the Center for Health Policy and Health Services Research at the Henry Ford Health System.
Because excessive hospital readmissions – those occurring within 30 days of the original admission –account for more than $17 billion of Medicare costs each year, CMS is expected to add other diagnoses to the three already used as standards, according to background in the article.
"So to avoid reimbursement penalties, it is very important for healthcare providers across the U.S. to develop effective interventions to reduce 30-day readmissions," Ahmedani explained. "The question is, where to start to provide the most reductions in readmissions at the lowest cost?”
That is why the current study focuses on psychiatric conditions, which are known to be highly comorbid with heart failure, acute myocardial infarction (AMI) and pneumonia, he responded.
For the study, more than 160,000 patients were identified as having been admitted to the 11 Mental Health Research Network-affiliated healthcare centers between January 2009 and December 2011 for any of the three medical conditions targeted by CMS.
“Approximately 18% of all individuals with index inpatient hospitalizations for HF, AMI, and pneumonia were readmitted within 30 days,” according to the results. “The rate of readmission was 5% greater for individuals with a psychiatric comorbidity compared with those without a psychiatric comorbidity (21.7% and 16.5%, respectively, p<.001).”
In fact, according to the researchers, nearly 30% of the patients admitted to the hospital with heart failure, AMI or pneumonia were diagnosed in the previous year as having a mental health condition.
“Because depression, anxiety and substance abuse appeared to be the most common diagnoses among the patients we studied, and because each was associated with increased readmission rates, these disorders may be the most appropriate for healthcare systems to focus their primary screening efforts,” Ahmedani said.