OM: Study Shows High Medicare Hospital Readmission Rates for Those w Psych Disabilities

NYAPRS Note: Notable study findings include: * Approximately 1.4 million Medicare fee-for-service beneficiaries over age 65 had SMI; they represented about 6% of all Medicare beneficiaries.

* Of those with SMI, 48% had depression, 47% had psychoses, and 20% had other mood disorders; some had multiple disorders. About 12,000 Medicare beneficiaries had both SMI and addiction.

* 53% of beneficiaries 65 and older with SMI had three or more chronic health conditions, compared to 28% of beneficiaries without SMI. About 59% of dual eligible beneficiaries with SMI had three or more chronic conditions.

* Medicare spent $43,792 per person for beneficiaries with SMI and addiction in 2010. Average spending for all beneficiaries that year was $8,649.

* During 2010, the average number of inpatient stays per-user for beneficiaries with SMI and addiction was nearly double the number for beneficiaries without SMI.

* Most Medicare spending among older beneficiaries with SMI and addiction is for physical health care services, not behavioral health services.

22% Of Medicare Beneficiaries With Severe Mental Illness Readmitted Within 30-Days, 24% of Dual Eligibles

Open Minds April 14, 2013

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In 2010, Medicare beneficiaries over age 65 and diagnosed with a severe mental illness (SMI) had a 30-day hospital readmission rate of 22%; for those who were also eligible for Medicaid, the readmission rate was 24%. The combination of SMI and an addiction disorder increased readmission rates to 32% for Medicare-only beneficiaries and to 37% for dual eligibles. By comparison, the readmission rate was 13% among Medicare-only beneficiaries without SMI or addiction, and 16% among dual eligible beneficiaries without SMI or addiction.

The readmission rates were reported in a DataBrief from the SCAN Foundation, "Medicare Beneficiaries With Severe Mental Illness and Re-Hospitalization Rates." The DataBrief is one of four in a series on Medicare beneficiaries with SMI. The DataBriefs are based on research by Avalere Health, LLC in an analysis of 2010 Medicare data.

Individuals were defined as having SMI if their Medicare claims had one or more International Classification of Diseases Version 9 codes associated with selected SMI in any acute care setting. The selected diagnoses constituting SMI included depression, bipolar disorder, schizophrenia, and other psychotic disorders. A secondary analysis identified beneficiaries with SMI who were treated for an addiction disorder. The analysis was limited to individuals aged 65 years or older who were enrolled in fee-for-service Medicare in 2010, but excludes beneficiaries who died during 2010.

The DataBriefs reported on the prevalence of chronic conditions among Medicare beneficiaries with SMI, hospitalization rates for beneficiaries with SMI, and Medicare spending for beneficiaries with SMI and addiction. Each of the briefs reports the data for Medicare-only beneficiaries and dual eligible beneficiaries with and without SMI and or addiction, and then draws a policy connection. The key finding of all is that compared to beneficiaries without SMI-even dual eligibles without SMI-those with SMI have higher rehospitalization rates, more chronic health conditions, higher hospitalization rates, and higher overall spending. The statistics highlight the clinical complexity of caring for beneficiaries with SMI and addiction.

Additional findings from "Prevalence of Chronic Conditions Among Seniors with Severe Mental Illness" were as follows:

* In 2010, approximately 1.4 million Medicare fee-for-service beneficiaries over age 65 had SMI; they represented about 6% of all Medicare beneficiaries.

* Of those with SMI, 48% had depression, 47% had psychoses, and 20% had other mood disorders; some had multiple disorders. About 12,000 Medicare beneficiaries had both SMI and addiction.

* 53% of beneficiaries 65 and older with SMI had three or more chronic health conditions, compared to 28% of beneficiaries without SMI. About 59% of dual eligible beneficiaries with SMI had three or more chronic conditions.

Additional findings from "Medicare Beneficiaries With Severe Mental Illness and Hospitalization Rates" were as follows:

* During 2010, 20.3 million Medicare-only beneficiaries and 3.1 million dual eligible beneficiaries were hospitalized.

* When their SMI status was factored out, 17% of Medicare-only beneficiaries and 22% of dual eligibles without SMI were hospitalized.

* About 45% of beneficiaries with SMI were hospitalized, and more than 80% of beneficiaries with SMI and addiction were hospitalized.

Additional findings from "Medicare Spending for Beneficiaries with Severe Mental Illness and Substance Use Disorder" were as follows:

* Medicare spent $43,792 per person for beneficiaries with SMI and addiction in 2010. Average spending for all beneficiaries that year was $8,649.

* During 2010, the average number of inpatient stays per-user for beneficiaries with SMI and addiction was nearly double the number for beneficiaries without SMI.

* Dual eligible beneficiaries with SMI and addiction had 3.2 stays; Medicare-only beneficiaries with SMI and addiction had 2.5 stays.

* Dual eligibles with SMI had 2.2 stays, and Medicare-only beneficiaries with SMI had 2.0 stays.

* Dual eligibles without SMI had 1.7 stays, and Medicare-only beneficiaries had 1.5 stays.

The analysis indicated that most Medicare spending among older beneficiaries with SMI and addiction is for physical health care services, not behavioral health services.

The SCAN Foundation noted that it is likely that SMI affects beneficiaries' ability to follow a treatment plan for medical conditions, which results in exacerbations requiring higher cost services, such as hospitalization and rehospitalization.

The SCAN Foundation is dedicated to creating a society in which seniors receive medical treatment and human services that are integrated in the setting most appropriate to their needs. The SCAN Foundation has granted permission forOPEN MINDS to host the four DataBriefs about the impact of SMI on Medicare. The four DataBriefs on Medicare and SMI are also housed online in the SCAN Foundation's DataBriefs library at www.thescanfoundation.org/publications/data-briefs<http://www.thescanfoundation.org/publications/data-briefs> (accessed April 5, 2013).

A link to the full text of "Medicare Beneficiaries With Severe Mental Illness and Re-Hospitalization Rates" may be found in The OPEN MINDS Circle Library at www.openminds.com/library/022213scanfdnmedicaresmirehosp.htm<http://www.openminds.com/library/022213scanfdnmedicaresmirehosp.htm>.

A link to the full text of "Prevalence of Chronic Conditions Among Seniors with Severe Mental Illness" may be found in The OPEN MINDS Circle Library at www.openminds.com/library/022213scanfdnmedicaresmichronic.htm<http://www.openminds.com/library/022213scanfdnmedicaresmichronic.htm>.

A link to the full text of "Medicare Beneficiaries With Severe Mental Illness and Hospitalization Rates" may be found in The OPEN MINDS Circle Library at www.openminds.com/library/022213scanfdnmedicaresmihosp.htm<http://www.openminds.com/library/022213scanfdnmedicaresmihosp.htm>.

A link to the full text of "Medicare Spending for Beneficiaries with Severe Mental Illness and Substance Use Disorder" may be found in The OPEN MINDS Circle Library at www.openminds.com/library/022213scanfdnmedicaresmisudspend.htm<http://www.openminds.com/library/022213scanfdnmedicaresmisudspend.htm>.