August 2012 If you have an Emergency Department, you are in the Behavioral Health Business…

August 2012

If you have an Emergency Department, you are in the

Behavioral Health Business…..

Retrieved from http://mediagallery.usatoday.com/G373

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The question is:

How do you deal effectively with the need in your community?

If you have an ED…

Number of people turning 65 each day

Average Life Expectancy in 2010

Reduction in State and local behavioral health funding from 2009 to 2012

The percentage increase of patients presenting in your ED with behavioral health diagnosis from 2006 - 2009

Average wait for psychiatric patients in ED

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10,000

78.3

$1.6B

20%

8 hours

Some Numbers:

Adults with comorbid behavioral health and medical conditions

Patients discharged from community hospitals with a behavioral health primary diagnosis in 2009

Percentage of community hospitals with an organized inpatient behavioral health unit

Reduction in hospital based units from 2008-2010

Number of hospitals with emergency departments

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Some Numbers:

17%

2.0 M+

27

10%

4,850


National Trends:Increased funding pressure on State and local behavioral health resourcesHospital based behavioral health beds trending down Increased number of behavioral health emergenciesIncreased demand for treatment services for older adults with co-occurring physical conditions and behavioral health needsIntegration of behavioral health and medical treatmentIncreased demand for consultation and liaison services Increased use of multi-disciplinary team approachImpact of National Health Reform

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Overall Trend:

Utilization is increasing, capacity decreasing, impacting all aspects of your hospital and it is not going to get better anytime soon…

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Key issues facing most hospital ED’s:

Lack of BH resources to triage and assess patients

Lack of separate space to treat patients

Lack of Psychiatrists to provide evaluations

Lack of referral options

Repeat customers

Increased length of stay in ED

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Resulting Impact:

Extended wait times for all patients in ED

Increased diversion days or patients left without being seen

BH patients disruptive to care for others

Increased cost for security, sitters, etc.

Med/Surg beds used for most severe patients

Increased Re-admission rates

Basically a throughput issue across the house…

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Options:

Extend the continuum

Behavioral Health ED/Access Center

Observation beds

Behavioral Health specific track

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What could a reduction in the BH patient ALOS in ED mean to a hospital….

Total ED Visits

Total BH Visits

ALOS Med patients

ALOS BH patients

Med/Surg admission rate

ED patients LWBS

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65,350

5,500

4.5 hours

6.5 hours

17.0 %

1,200

What could a reduction in the BH patient ALOS in ED mean to a hospital….Assume a ½ hr. reduction in BH ALOS

Potential additional ED patients

Med/Surg Admission Rate

Additional Med/Surg admission

Net Revenue Opportunity

Net ED Revenue Opportunity

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550

17%

96

$900,000

$350,000

Issues facing Hospital BH programs: Focused on Inpatient bed based services only Patient needs have moved from custodial to active

treatment Many hospital programs not prepared for influx of chronic

and forensic patients Safety issues (patient and staff) increasing ED the major source of patients Medicare beds being used as general adult Reimbursement for many patients reduced or non-existent High number of short-term stays with increasing re-

admission rates

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Does every patient presenting in ED require an Inpatient stay?

How many things are you doing in Med/Surg on the Outpatient side that were done on the Inpatient basis 10 years ago?

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Service Intensity

More Less

Crisis Unit

Psych ICUUnit

Med-Psych Unit

Gero-Psych Unit

Specialty Units

General Adult Unit

RTF Services

23-HourObservation

PHP ½ Day PHP & SOP

IOP Individual & Family Therapy

Aftercare & Home Care

TransitionServices

Triage and Intake

ECT

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Options?

Continue as is…

Outsource Behavioral Health Evaluations and Assessments to 3rd party…

Close beds…

Fix and expand current programming…

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Continue as is…

Can the hospital afford losses and additional costs

- Throughput issues

- Sitter/Security costs

- Program diminished performance

Liability and safety issues for patients and staff issues

Continued increase in re-admission rates

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Outsource Behavioral Health Assessments and Evaluations to 3rd party…..

May address Doctor to Doctor evaluation faster Improves throughput for patients discharged to home May improve throughput to existing programs

Does not improve disposition options. What do you do with the patient?

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Close beds

Stop the immediate fiscal bleeding for an existing Inpatient unit Potentially replace with med/surg service with better return Reduce staff and patient safety issues on unit

What do you now do with those patients showing up in the ED?

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Fix and expand current programming…

Are the beds utilized under the best designation? Medicare Exempt Units (Distinct Part Unit) is reimbursed on a per

diem vs. DRG Medicaid days in a Medicare Exempt Unit do not count towards

DSH

On average an increase of 1 Medicare ADC for a year should generate an additional $250,000 in net revenue for a Medicare Exempt Unit.

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Fix and expand current programming (continued)

Are you meeting the needs within the community? Do you have an adequate and working continuum? Is your programming contemporary? Is the staff training and credentials contemporary? Do you have denial issues? Are your psychiatrists aligned with the hospital? Is your consultation coverage for the ED and Med/Surg units

working?

A detailed assessment of your programs is a way to get a handle on these issues!

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As with many throughput issues it could be a combination of these various options!

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In closing:

Need for comprehensive behavioral health services increasing

State and local resources reduction not likely to be reversed in near term

Behavioral Health ED visits and ALOS increasing Hospitals are being left to address the issue and need a

comprehensive strategy

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Contact Information:

James J. Free

Senior Vice President, Business Development

Diamond Healthcare Corporation

(800) 443-9346

[email protected]

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Documents

August 2012 If you have an Emergency Department, you are in the Behavioral Health Business…