Elderly/Long-term Care

Inpatient treatment for elderly nondementia psychiatric illnesses is shifting into less expensive settings

The elderly account for more than half of Medicare expenditures for inpatient mental health care, including nondementia psychiatric illnesses (NDPI) such as major depression, schizophrenia, and bipolar disorder. Inpatient care for NDPI is shifting into less expensive settings, notably skilled nursing facilities (SNFs), according to this study. This may reflect Medicare cost-cutting strategies, preferences for less restrictive settings, and outpatient treatment advances, suggest the researchers.

Medicare pays for NDPI inpatient care in general hospital units, general hospital psychiatric units, specialized long-stay hospitals treating patients with psychiatric disorders, and SNFs. A research team at the Center for Education and Research on Mental Health Therapeutics at Rutgers University examined length of stay and expenditures by facility type for NDPI among the elderly in 1992 and 2002.

During that period, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (from $8,461 to $6,207) and covered days per stay declined by 2.8 (from 14.9 to 12.1). The number of inpatient stays with a primary NDPI diagnosis declined from 193,962 in 1992 to 183,505 in 2002, a time when use of SNF facilities for NDPI care increased. Large portions of all inpatient NDPI stays were in psychiatric units of general hospitals, rising from 41.7 percent to 51.7 percent between 1992 and 2002.

During the 10-year period, the portion of all elderly NDPI stays in general hospital beds declined from 34.5 to 27.4 percent and in long-stay units declined from 19.5 to 11.3 percent. During the same time, the number of annual elderly NDPI stays rose from 8,542 to 17,312 in SNFs, where stays are typically longer but are reimbursed at lower rates. In contrast to a decline in Medicare reimbursement at the other three facility types, mean Medicare reimbursements to SNFs per elderly NDPI stay jumped by about $2,000 from 1992 to 2002.

The study was supported in part by a grant from the Agency for Healthcare Research and Quality (HS16097) to the Center for Education and Research on Mental Health Therapeutics at Rutgers University. For more information on the Center for Education and Research on Therapeutics (CERTs) program, please visit http://www.ahrq.gov/clinic/certsovr.htm.

See "Medicare inpatient treatment of elderly non-dementia psychiatric illnesses 1992-2002; length of stay and expenditures by facility type," by Donald R. Hoover, Ph.D., Ayse Akincigil, Ph.D., Jonathan D. Prince, Ph.D., and others, in Administration and Policy in Mental Health 35, pp. 231-240, 2008.

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