Trends: Medicare psychiatric admissions, 1987-2004: Does the past offer insights for the future?

Health Affairs

Volumn 27, Issue 4, 2008, Pages 1132-1139

  Cotterill, Philip G ^a  

^a CENTERS FOR MEDICARE AND MEDICAID SERVICES   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BIPOLAR DISORDER; DEMENTIA; HEALTH CARE; HEALTH CARE DELIVERY; HEALTH CARE FACILITY; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH SERVICE; HOSPITAL ADMISSION; HUMAN; LENGTH OF STAY; MEDICARE; MENTAL HEALTH CARE; PATIENT CARE; REVIEW; SCHIZOPHRENIA; AGE DISTRIBUTION; AGED; ARTICLE; ECONOMICS; MENTAL HOSPITAL; MIDDLE AGED; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

AGE DISTRIBUTION; AGED; AGED, 80 AND OVER; HOSPITALS, PSYCHIATRIC; HUMANS; LENGTH OF STAY; MEDICARE; MIDDLE AGED; PATIENT ADMISSION; UNITED STATES;

EID: 48149101638     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.4.1132     Document Type: Review

References (21)

1. See J. Cromwell et al., "Medicare Payment to Psychiatric Facilities: Unfair and Inefficient?" Health Affairs 10, no. 2 (1991): 124-134.
2. Centers for Medicare and Medicaid Services, "Medicare Program; Changes to the Inpatient Hospital Prospective Payment System and Fiscal Year 1988 Rates; Final Rule," Federal Register 52, no. 169 (1 September 1987): 33135-33136.
3. The Clinical Classification Software (CCS), available from the Agency for Healthcare Research and Quality, was used to construct the case-mix groups in Exhibit 1. See Agency for Healthcare Research and Quality, "Clinical Classifications Software (CCS) for ICD-9-CM," http://www.hcup-us.ahrq.gov/ toolssoftware/ccs/ccs.jsp (accessed 12May 2008). Principal International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes in the 2004 Medicare Provider Analysis and Review (MedPAR) claims for people with a psychiatric inpatient stay were the basis for the reported classifications. For the most part, CCS single-level diagnosis groups were used alone (schizophrenia and related conditions) or in combination (alcohol-related mental disorders and substance abuse-related mental disorders). The category "dementia and related conditions" is the sumof the following CCS categories: senility and organic mental disorders; Parkinson's disease; other hereditary and degenerative nervous system disorders; coma, stupor, and brain damage; other nervous system disorders; and late effects of cerebrovascular disease. The "senility" category accounts for about fifty-two percentage points of the almost 65 percent for the oldest age group. CCS multilevel diagnosis categories were used to disaggregate affective disorders into depression, bipolar disorder, and other affective conditions. "Other affective conditions" was included in the residual category, "all other conditions."
4. S. Blackmun, "Is It Depression or Is It Dementia?" Psychiatric Times 15, no. 2 (1998), http://www.psychiatrictimes.com/ p980267.html (accessed 25 March 2008).
5. D. Mechanic, D.D. McAlpine, and M. Olfson, "Changing Patterns of Psychiatric Inpatient Care in the United States, 1988-1994," Archives of General Psychiatry 55, no. 9 (1998): 785-791.
6. More than 92 percent of the cases identified by DRG are in general hospitals paid under the inpatient PPS. For completeness, all cases identified by DRG were included in the "other hospitals" category. Most of the cases not paid under this PPS are in inpatient rehabilitation facilities and long-term care hospitals.
7. Specifically, calculate the difference in the natural logarithm of each variable between two years and divide by the difference in years. Subtracting 1 from this number and multiplying by 100 yields an estimated annual percentage change. Approximating annual rates of change in thismanner assures additivity and avoids the necessity of apportioning interaction effects.
8. Social Security Administration, "Old-Age, Survivors, and Disability Insurance, Benefits in Current-Payment Status, Disabled Workers," Table 5.D6, "Number and Percentage Distribution, by Sex, Diagnostic Group, and Age," Social Security Bulletin, Annual Statistical Supplement, various issues 1988-2003.
9. K. Rupp and D. Stapleton, "Determinants of the Growth in the Social Security Administration's Disability Programs - An Overview," Social Security Bulletin 58, no. 4 (1995): 43-70.
10. Edward D. Berkowitz, George Washington University, "Disability Policy and History: Statement before the Subcommittee on Social Security of the Committee on Ways and Means," 13 July 2000, http://www.ssa.gov/history/ edberkdib.html (accessed 18 March 2008).
11. Henry J. Kaiser Family Foundation, "Trends and Indicators in the Changing Health Care Marketplace," Section 2, Exhibit 2.17, "Enrollment in Medicare Managed Care and Traditional Medicare 1990-2004," 2 February 2005, http://www.kff.org/insurance/7031/ti2004-2-17. cfm (accessed 18 March 2008).
12. In an analysis not reported here, the author found that transfers frommedical-surgical stays to psychiatric stays were not a significant cause of the increased use rate.
13. Medicare Payment Advisory Commission, Report to the Congress: Medicare in Rural America (Washington: MedPAC, 2001), 82-83.
14. J.K. Iglehart, "Managed Care and Mental Health," New England Journal of Medicine 334, no. 2 (1996): 131-135.
15. The number of certified psychiatric units increased from 969 in 1987 to more than 1,400 in 2004. These numbers were derived from the Centers for Medicare and Medicaid Services (CMS) Provider of Services files. It is unknown how many of these new units involved substantial changes in the organization of psychiatric care within the hospital.
16. L. Chan et al., "The Effect of Medicare's Payment System for Rehabilitation Hospitals on Length of Stay, Charges, and Total Payments," New England Journal of Medicine 337, no. 14 (1997): 978-985.
17. U.S. Census Bureau, Population Projections of the United States by Age, Sex, Race, and Hispanic Origin, 1995-2050, 1996, http://www.census.gov/ prod/1/pop/p25-1130/p251130a.pdf (accessed 15 June 2007).
18. CMS, "Medicare Program; Prospective Payment System for Inpatient Psychiatric Facilities; Final Rule," Federal Register 69, no. 219 (15 November 2004): 66920-67015.
19. CMS, "Medicare Program; Revision to Hospital Inpatient Prospective Payment Systems; Final Rule," Federal Register 71, no. 161 (18 August 2006): 47882-47898.
20. Medicare's 190-day lifetime limit on psychiatric inpatient care in a psychiatric hospital, which does not apply to general hospitals, is often cited as a barrier to providing care to the elderly. For example, see C. Lehmann, "Senate Hears Proposals to Remedy Shortage of Geriatric Specialists," Psychiatric News 37, no. 7 (2002), http://pn.psychiatryonline.org/cgi/ content/full/37/7/9 (accessed 28 May 2008).
21. Derived from MedPAR data.