Magazine article Clinical Psychiatry News

MedPAC Probes High Cost of Inpatient Care

Magazine article Clinical Psychiatry News

MedPAC Probes High Cost of Inpatient Care

Article excerpt

WASHINGTON -- Are inpatient psychiatric facilities being paid enough by Medicare? A government advisory group is trying to figure that out, but answering that question is raising other questions, too.

Dana Kelley, a staff member of the Medicare Payment Advisory Commission (MedPAC), noted at a recent commission meeting that the number of Medicare beneficiaries who were treated for mental illness decreased from 483,000 in 2004--when the new inpatient prospective payment system was implemented--to 455,000 in 2007, a drop of 5.7%.

If only beneficiaries in the fee-for-ser-vice program are included, the decrease was 2%, she added.

Several factors might be affecting the volume of patients in inpatient psychiatric facilities (IPFs), including improved access -to psychotropic drugs under the Medicare drug benefit, reductions in beneficiary cost sharing for outpatient mental health services, and the use of partial hospitalization programs, Ms. Kelley said. But despite the drops in patient numbers, Medicare inpatient mental health spending increased during the same time period, from $3.5 billion to $3.8 billion.

Slightly more than half of Medicare mental health inpatients in 2007 were treated in "scatter beds" that were not part of a designated mental health unit, Ms. Kelley said.

However, the distribution of diagnoses for scatter bed patients was different from the overall inpatient distribution, with one-fourth of the scatter bed patients being treated for degenerative nervous system disorders (see chart). She also noted a change in the bed distribution in for-profit versus nonprofit mental health facilities:

The total number of beds in nonprofit facilities dropped by 11% from 2004 to 2007, compared with a 12% increase in the number of for-profit beds and a 5% increase in the number of beds in government facilities. …

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