Be­hav­ioral-health or­ga­ni­za­tions can part­ner with hos­pi­tals to re­duce read­mis­sions

Be­hav­ioral-health disorders have a sig­nif­i­cant ef­fect on hos­pi­tal read­mis­sions. But many hos­pi­tals have yet to give them suf­fi­cient at­ten­tion, even as they strive to de­velop bet­ter care-co­or­di­na­tion plans for other chronic con­di­tions.

Modern Healthcare - - COMMENT - By Ray­mond Ta­masi

Tar­get­ing pa­tients with high-risk med­i­cal con­di­tions, cou­pled with more ef­fec­tive be­hav­ioral-health screen­ings, can lead not only to mean­ing­ful men­tal-health im­prove­ments, but also to im­proved med­i­cal out­comes and lower health­care ex­pen­di­tures.

Stud­ies show that pa­tients with sub­stance-abuse and men­tal-health disorders are less likely to com­ply with treat­ment rec­om­men­da­tions and three times more likely to ex­pe­ri­ence re­peated hos­pi­tal ad­mis­sions than pa­tients with­out th­ese is­sues. A 2011 study by the Agency for Health­care Re­search and Qual­ity re­ported that four of the top 10 con­di­tions lead­ing to higher 30-day read­mis­sion rates for Med­i­caid pa­tients were men­tal-health or sub­stance-abuse disorders. And among the pri­vately in­sured, mood disorders were the sec­ond-lead­ing cause for read­mis­sion.

The Hos­pi­tal Read­mis­sion Re­duc­tion Pro­gram, en­acted un­der the Af­ford­able Care Act, fi­nan­cially pe­nal­izes hos­pi­tals for per­ceived “avoid­able” read­mis­sions for Medi­care pa­tients. The CMS es­ti­mates that fi­nan­cial penal­ties for avoid­able hos­pi­tal read­mis­sions will reach $428 mil­lion this year.

De­spite the poorer health out­comes and higher costs as­so­ci­ated with pa­tients who suf­fer with co-mor­bid be­hav­ioral-health disorders, hos­pi­tals and med­i­cal prac­ti­tion­ers have been slow to re­spond to the prob­lem. Stigma, lack of train­ing and un­cer­tainty about how to treat or where to re­fer con­trib­ute to this chal­lenge.

Be­hav­ioral-health­care or­ga­ni­za­tions are well-po­si­tioned to play a more ac­tive role in an in­te­grated-care en­vi­ron­ment and to part­ner with hos­pi­tals to help and thereby re­duce read­mis­sions. It is im­por­tant that providers open a di­a­logue with hos­pi­tals, ac­count­able care or­ga­ni­za­tions and pa­tient-cen­tered med­i­cal homes.

Many sys­tems and ACOs are un­der­stand­ably con­cerned right now with build­ing the in­fra­struc­ture nec­es­sary to deal with other chronic con­di­tions like diabetes and car­dio­vas­cu­lar dis­ease. It is up to be­hav­ioral-health­care or­ga­ni­za­tions to make hos­pi­tals aware of how chronic men­tal and sub­stance­abuse con­di­tions also im­pact read­mis­sion rates, and the pos­i­tive role we can play in help­ing them man­age th­ese com­pli­ca­tions.

With­out men­tal­health screen­ings, pa­tients are of­ten dis­charged with­out pro­vi­sions for ad­e­quate fol­low-up care and with lit­tle at­ten­tion to the so­cial de­ter­mi­nants that com­pro­mise out­comes. At best, a de­pressed or ad­dicted pa­tient might not ad­here to dis­charge in­struc­tions, or may fail to re­fill pre­scrip­tions in a timely man­ner. At worst, if their sub­stance­abuse or men­tal dis­or­der isn’t ad­dressed dur­ing their hos­pi­tal stay, they are dis­charged with a very high risk for re­gres­sion.

Tar­get­ing pa­tients with high-risk med­i­cal con­di­tions, cou­pled with more ef­fec­tive be­hav­ioral-health screen­ings, can lead not only to mean­ing­ful men­tal-health im­prove­ments, but also to im­proved med­i­cal out­comes and lower health­care ex­pen­di­tures.

Gos­nold con­ducted a two-year pi­lot pro­gram with a lo­cal hos­pi­tal to em­bed a nurse and a coun­selor on its med­i­cal­sur­gi­cal floors and in its emer­gency depart­ment. One ben­e­fit of this ar­range­ment was the sup­port our pro­fes­sion­als pro­vided to the med­i­cal staff to help them more ef­fec­tively treat pa­tients with a co-mor­bid sub­stance-abuse dis­or­der. We im­proved the hos­pi­tal’s screen­ing tool, which used lan­guage that was un­likely to yield ac­cu­rate in­for­ma­tion about al­co­hol use. We trained nurs­ing and med­i­cal staff to help them bet­ter iden­tify symp­toms of with­drawal among pa­tients be­ing treated for other med­i­cal con­di­tions. This en­abled prompt phar­ma­co­log­i­cal in­ter­ven­tion that sig­nif­i­cantly re­duced length of stay and ICU trans­fer rates. Part­ner­ing with the hos­pi­tal and med­i­cal providers to treat be­hav­ioral-health and sub­stance-abuse con­di­tions yielded im­me­di­ate ben­e­fits.

Other hos­pi­tal sys­tems across the coun­try are ex­plor­ing in­no­va­tive part­ner­ships with com­mu­nity be­hav­ioral­health providers to ad­dress the is­sue, en­hance care and bet­ter serve pa­tients with mul­ti­ple con­di­tions. The op­por­tu­nity is there. It is up to be­hav­ioral-health­care or­ga­ni­za­tions to forge th­ese re­la­tion­ships to more ef­fec­tively treat pa­tients, re­duce hos­pi­tal read­mis­sions and pos­i­tively af­fect over­all health out­comes. Be­hav­ioral-health or­ga­ni­za­tions and prac­ti­tion­ers must seize this op­por­tu­nity. The re­sult­ing so­lu­tion is a win for all in­volved.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­care.com.

Ray­mond Ta­masi is the CEO of Gos­nold on Cape Cod, an ad­dic­tion and men­tal-health treat­ment provider lo­cated in Fal­mouth, Mass.

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