Study of Readmission Rates for Psychiatric Hospitals Draws Scrutiny from NABH

Researchers at University of Florida Health have collaborated with the Health Services Advisory Group on a quality measure to help the Centers for Medicare and Medicaid Services (CMS) to evaluate psychiatric hospitals nationwide.

The measure studies hospital readmission rates for psychiatric patients within 30 days of discharge. More than 700,000 admissions to inpatient psychiatric facilities over a multi-year period were reviewed. Reviewing Medicare claims data, UF College of Pharmacy researchers determined that about 21% of those admissions had unplanned readmissions, with readmission rates at individual facilities ranging from 11% to 35%.

The study, which was published online in December by Medical Care, included assessment of more than 50 risk factors for readmission, such as age and principal type of illness, that could skew results at certain facilities.

“What we are doing is trying to find a way to make the comparisons fair and to see who is really doing a good job of providing psychiatric care and who needs more help,” Amie Goodin, PhD, an assistant professor of pharmaceutical outcomes and policy in the UF College of Pharmacy and co-author of the study, said in a news release.

However, Shawn Coughlin, president and CEO of the National Association for Behavioral Health, says that while his association “fully supports the development of quality indicators and outcome indicators” and it agrees that readmissions are one component of quality, he says there is concern that the study “raises as many questions as it answers.”

Coughlin says NABH’s unease centers on whether the study accurately reflects services that are within the control of its member provider organizations. There are several factors that provider organizations are subject to that they don’t have direct control over, Coughlin tells BHE.

“The challenge is ensuring that the individual has access to the full continuum of services,” Coughlin says. “That is particularly problematic in the Medicare program. This study was focused on the Medicare program and developed for them.

“Medicare doesn’t cover many of the intermediate services that are required for individuals with serious mental illness. … The measures need to be tied to activities that providers are capable of influencing and controlling. Given those caveats, we want to be careful and make sure that if they’re going to impose these measures that, as we’re looking at them, our providers are responsible for those areas within their absolute control. We know the continuum does not exist in all places.”

Consumers can review inpatient psychiatric hospitals’ performance using the CMS Hospital Compare website.