Behavioral Health is a Significant Factor in Potentially Preventable Hospital Readmissions

Monday, December 9, 2013 - 12:28pm

Mental health conditions and substance abuse disorders are a significant – and complex -- factor in potentially preventable readmissions to Texas hospitals.

The Texas Health and Human Services Commission’s recently released annual report on potentially preventable readmissions among Medicaid beneficiaries found:

• Mental health and substance abuse conditions comprised 9.3 percent of initial admissions but 27.4 percent of PPRs.

• Among the highest PPR rates were those for alcoholic liver disease (15.9 percent), schizophrenia (13.6 percent), bipolar disorders (10 percent) and major depression (9.5 percent).

• For patients admitted with a medical or surgical condition and a secondary mental health or substance abuse diagnosis, the chance of readmission was 70 percent more likely for adults and 90 percent more likely for pediatric patients.

“Hospitals have made tremendous strides in reducing preventable readmissions by implementing innovative follow-up programs and engaging families,” said Dan Stultz, M.D., FACP, FACHE, THA president/CEO. “But while hospitals are penalized for readmissions of patients with behavioral health conditions, successful management of their behavioral health often requires the involvement of multiple individuals and entities outside of the hospital setting.”

Preventable readmissions cost the health care system an estimated $25 billion each year.

Texas Medicaid reduces hospital reimbursement rates based on PPR rates as does the federal Medicare program.

Nearly 170 Texas hospitals are facing reduced Medicare reimbursement rates in 2013-14 because of excess readmissions.


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