150668
Trends in Medicare Inpatient Gerosychiatric Care
Tuesday, November 6, 2007: 3:00 PM
Donald R. Hoover
,
Statistics & Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ
Ayse Akincigil, PhD
,
School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ
Ece Kalay
,
Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ
Judith A. Lucas, EdD, RN
,
Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ
James Walkup, PhD
,
Graduate School of Applied and Professional Psychology at Rutgers University, Piscataway, NJ
Jonathan D. Prince, PhD
,
School of Social Work, Rutgers University, New Brunswick, NJ
Stephen Crystal, PhD
,
Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ
OBJECTIVES: Inpatient geropsychiatric care is provided in facilities (general hospital beds, psychiatric hospital units, long stay psychiatric hospitals and skilled nursing facilities (SNFs)) with different characteristics and reimbursement mechanisms. We compared inpatient care from 1992 to 2002. METHODS: 1992 and 2002 Medicare Provider Analysis and Review files identified inpatient stays of elderly (65+ years) Medicare enrollees without HMO coverage. Medicare interim payments and covered days were calculated after adjusting 1992 amounts to 2002 dollars. RESULTS: (See The Table Below) Overall, from 1992 to 2002, mean Medicare expenditures and covered days per geropsychiatric stay declined by $2,254 and 2.8, respectively. But differences between facility types existed. For example, Medicare reimbursements for geropsychiatric SNF stays increased. Numbers of geropsychiatric stays in general and long stay hospital beds declined while numbers of stays in psychiatric units and SNFs increased. DISCUSSION: Recent changes in inpatient geropsychiatric costs, stays, and lengths of stay is complicated by facility type. Overall declines may be explained by cost-cutting strategies, preferences for less restrictive settings, or outpatient treatment advances. It seems likely that expansion of some facility types (such as SNFs) may partially account for decreased use of other facilities. | Geropsychiatric (Excluding Dementias) Inpatient Stay Characteristics | | | Facility Type | Number (%) Stays | Mean Medicare Payment ($) | Mean Medicare Covered Days | | | 1992 | 2002 | 1992 | 2002 | 1992 | 2002 | | ALL | 193,962(100%) | 183,505(100%) | 8,461 | 6,207 | 14.9 | 12.1 | | Gen Hosp | 66,853(34%) | 50,363(27%) | 5,568 | 3,770 | 9.0 | 5.5 | | Psych Unit | 80,818(42%) | 94,851(52%) | 10,838 | 7,462 | 17.5 | 12.5 | | Long Stay | 37,749(19%) | 20,979(11%) | 9,468 | 6,482 | 17.3 | 14.1 | | SNF | 8,542(4%) | 17,312(9%) | 4,153 | 6,375 | 26.0 | 26.2 | |
