Patient Casemix Classification for Medicare Psychiatric Prospective Payment

Drozd, Edward; Cromwell, Jerry; Gage, Barbara; Maier, Jan; Greenwald, Leslie; Goldman, Howard H.

doi:10.1176/appi.ajp.163.4.724

Cited by 21 publications

(8 citation statements)

References 15 publications

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“…Six studies were conducted in multiple sites with large sample sizes (Group A) and two studies at a single site with smaller sample sizes (Group B). All studies in Group A were reported in multiple publications (Study 1: Cromwell et al 2004, 2005 a , b ; Cromwell & Maier, 2006; Drozd et al 2006; Study 2: Gaines et al 2003; Eagar et al 2004; Study 3: Hirdes et al 2002; Daniel, 2008; Study 4: Buckingham et al 1998 a , b ; Study 5: Yamauchi, 1997 a , b ; Study 6: Fries et al 1990, 1993). A total of 15 613 patient episodes were included with a range of 42–6554.…”

Section: Resultsmentioning

confidence: 99%

Cost drivers of inpatient mental health care: a systematic review

Wolff

McCrone

Koeser

et al. 2013

Epidemiol Psychiatr Sci

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Aims. New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence. Methods. A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted. Results. The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site. Conclusions. Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.

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Section: Resultsmentioning

confidence: 99%

Cost drivers of inpatient mental health care: a systematic review

Wolff

McCrone

Koeser

et al. 2013

Epidemiol Psychiatr Sci

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“…A razão apontada por Knapp e colaboradores [17] é que as taxas de reembolso nem sempre abrangem todos os custos associados às doenças mentais crónicas. A literatura sugere que o reembolso dos custos de saúde mental baseado num sistema de casemix deve considerar não só o tempo de internamento, mas também o diagnóstico, o grau de apoio social e de assistência nas atividades do dia-a-dia, a severidade da doença, se houve ou não referenciação pelo sistema judicial e a possibilidade de existir um comportamento “perigoso” [18]. Desta forma, Knapp e colaboradores [17] argumentam que nos países onde existam dados suficientes sobre a utilização dos recursos e custos, os GDHs, se bem construídos, podem apresentar-se como um modelo que assegura que recursos suficientes são transferidos para os cuidados secundários e especializados de saúde mental.…”

Section: Modalidades De Pagamento E Incentivos: Teoria E Resultadosunclassified

Sistema português de saúde mental: avaliação crítica do modelo de pagamento aos prestadores

Perelman

Chaves

Gago

et al. 2017

Port J Public Health

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O Plano Nacional de Saúde Mental 2007–2016 aponta várias limitações ao sistema português de saúde mental, como a falta de acesso, os cuidados excessivamente centrados nos hospitais, a falta de recursos e a prevenção insuficiente. Uma das formas de atacar estes problemas é o desenho de um novo modelo de pagamento aos prestadores de cuidados de saúde mental, o que apenas é possível conhecendo em detalhe o modelo atual, os seus pontos fortes e fracos e os incentivos que cria. É isso que fazemos, com especial enfoque nos cuidados de saúde primários e hospitalares, com base nos resultados da literatura teórica e empírica, e na realização de um grupo focal com peritos das áreas da saúde mental e financiamento em Portugal. Concluímos que os cuidados de saúde primários não são incentivados a envolver-se na prevenção e tratamento de perturbações mentais, por beneficiarem da realização de um grande número de consultas de curta duração e do cumprimento de objetivos que negligenciam a saúde mental. Já o pagamento dos hospitais Entidade Pública Empresarial é muito focado no nível de atividade e não na integração de cuidados. É prevista uma remuneração por dias ou episódio de internamento, ou por serviço médico prestado, o que dificulta uma visão global do estado de saúde de cada doente. No entanto, os indicadores definidos para estes prestadores e a ausência de um mecanismo de reembolso de custos privilegia a eficiência na prestação de cuidados. Os cuidados prestados na comunidade, cuja eficácia é defendida pela literatura, são incentivados por uma remuneração que lhes é específica, mas que parece ainda não ter sido atribuída na prática. Em geral, apesar de ter alguns aspetos positivos, o modelo de pagamento aos prestadores de cuidados de saúde mental beneficiará de um novo desenho, que envolva mais os cuidados de saúde primários, que incentive uma visão global do estado de saúde de cada doente e que torne mais efetivo o tratamento na comunidade.

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“…A further problem relevant to the discussion of the amount of explained variance is the relative invariance of the criteria variable treatment duration in our sample (variance coefficient of length of stay = 33%). Due to the fact that the length of stay is just a proxy for resource consumption, maybe the criteria variable “cost” used in the study of Drozd et al [6] is as close as possible to the actual intensity of care provided and is able to exhibit a higher explanation of variance. On the other hand, there is a lack of empirical data on the reliability and validity of the variable cost or per-diem costs.…”

Section: Discussionmentioning

confidence: 99%

“…In the past 20 years, only a few studies have been conducted to develop and evaluate case group concepts for patients with mental disorders in different settings (outpatient, inpatient, and community mental health care) [1,4,5,6,9,11,12,15,18,21,22]. Some of these studies were conducted to refine the main diagnostic categories in the DRG system and they focused on analyses within specific diagnostic groups [1,6,9,15,18,19,21,22]. In contrast to these diagnosis-based approaches, we used an exploratory design by defining patient classes by different patient characteristics, in analogy to the studies of Buckingham et al [4] and Gaines et al [11].…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a case group concept for inpatients with mental disorders in Germany: Using self-report and expert-rated instruments

et al. 2009

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The aim of this study was to evaluate a case-mix system to classify inpatients with mental disorders in Germany by means of self-report and expert-rated instruments. The use of case-mix systems enhances the transparency of performance and cost structure and can thus improve the quality of mental health care. We analysed a consecutive sample of 1677 inpatients with mental disorders from 11 hospitals using regression tree analysis. The model assigns patients to 17 groups, accounting for 17% of the variance for duration of stay. Patients with eating disorders had a longer duration of stay than patients with anxiety disorder, duration of mental illness of less than 3-5 years, lower levels of interpersonal problems and higher occupational position. The results showed that besides diagnosis, variables such as duration of illness and interpersonal problems are important for classifying inpatients with mental disorders. The results of the study should be critically reviewed regarding the empirical results of other studies and the appropriateness of case group concepts for inpatients with mental disorders.

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Patient Casemix Classification for Medicare Psychiatric Prospective Payment

Cited by 21 publications

References 15 publications

Cost drivers of inpatient mental health care: a systematic review

Cost drivers of inpatient mental health care: a systematic review

Sistema português de saúde mental: avaliação crítica do modelo de pagamento aos prestadores

Development and evaluation of a case group concept for inpatients with mental disorders in Germany: Using self-report and expert-rated instruments

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