Magazine article The Alcoholism Report

Managed Care Relationships Improving but Still Pose Problems, NAPPH Survey Finds

Magazine article The Alcoholism Report

Managed Care Relationships Improving but Still Pose Problems, NAPPH Survey Finds

Article excerpt

The 1991 Utilization Management Survey conducted by the National Association of Private Psychiatric Hospitals (NAPPH) found that utilization management firms are using more qualified reviewers, including clinicians with specific psychiatric and/or substance abuse experience, and communications between private psychiatric hospitals and reviewers have improved. The membership survey found, however, that the care received by patients in private psychistric hospitals is "widely and profoundly affected by managed care," and significant tensions remain as a result of what was termed the "pervasiveness of outside review of hospital-based psychiatric practice."

The survey, released June 7, concluded that remaining problems relate to closely held review criteria, insensitivity to patients' lack of support systems, frequency of reviews, selective scrutiny of treatment for certain illnesses or populations, and the difficulty of delivering high-quality care when a third party is involved in a patient-provider relationship.

"It seems that both managed care and private psychiatric hospitals are more willing to come together to get the job done," said NAPPH President Frederick D. Raine. "The job is quality patient care. These increasing signs of cooperation don't mean we've closed the gap between what providers would like from review companies and what they receive, but they are certainly encouraging."

Raine, who is administrator of the New York Hospital-Cornell Medical Center, Westchester Division, also cited "increasing changes hospitals are making to accommodate intelligent, reasonable outside attempts to make certain dollars are exchanged for good value in the healthcare marketplace."

The 1991 survey -- the fourth conducted by NAPPH in as many years -- was mailed to all 321 NAPPH-member hospitals' utilization review (UR) coordinators this spring. Almost half -- 47% -- responded to the questionnaires designed to determine how hospitals perceive and deal with managed care firms and how such outside review affects care in their facilities.

Some highlights from the 1991 NAPPH survey:

+ Most patient care is managed. Outside preadmission/precertification reviews were required of 78% of patients, 134 NAPPH hospitals reported. A year ago only 70.4% of patients were subject to such requirements. Moreover, the percentage of patients under continued-stay review jumped to 74% from 70.1% in 1990.

+ Virtually all hospitals -- 99% of those responding -- have an organized utilization management function to deal with outside managed care firms. However, of those hospitals with designated contact persons, 97% still encounter reviewers who seek out individuals other than UR staff. Reviewers contact physicians, social workers, medical records staff, members of patients' families, and even patients themselves. In addition to 5,492 hours reported spent by 139 hospital UR coordinators, 3,292 hours a week were reported spent in 127 hospitals by clinicians other than the designated hospital contact -- an average of 25.9 hours per hospital. When combined, the time spent by UR staff and other hospital personnel averages 63 hours a week in the 139 hospitals...or an average of one 1.5 full-time equivalent doing nothing but dealing with outside reviewers.

+ Among the positive findings from the survey was that, while in 1990 nearly 75% of respondents complained that outside review firms "sometimes" or "often" used non-clinician reviewers, by 1991 84% reported working with clinicians sometimes or often. …

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