Transfers of hospitalized psychiatric patients under Medicare's prospective payment system

Article Abstract:

Medicare provides payment for psychiatric patients hospitalized in certain covered facilities but not in other exempt facilities. An exempt facility may be a different hospital or simply another unit in the patient's own hospital. If a patient is transferred between two covered hospitals, the transferring hospital is paid for each day of the stay there. The destination hospital receives a full payment of the calculated diagnosis-related group (DRG) rate. For a transfer to an exempt facility, however, the transferring covered hospital receives a full DRG payment, while the receiving unit is paid based on costs. Thus, the possibility exists that transfers are financially, rather than therapeutically, motivated. Hospitals may even move patients to their own exempt units. Transfer activity during 1985 for Medicare patients with drug abuse, alcoholism, or mental illness was analyzed by examining hospital discharge records. It appeared that only 3.4 per cent of all discharges for this patient group involved a transfer, with the most common type of transfer a move from a nonspecialized general hospital bed to a Medicare-exempt bed in the same hospital. Although this small number of transfers implies that the prospective payment system is not being abused, it is suggested that transfer of psychiatric patients be reimbursed on a per diem basis for the first part of the transfer, regardless of whether it is to an exempt or a covered facility. Any incentive other than a therapeutic one for transferring a patient would thereby be eliminated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Insurance, Medicare

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Transdermal nicotine and smoking behavior in psychiatric patients

Article Abstract:

Problems linked to creating successful smoking cessation programs for psychiatric patients are numerous. The patients may have no desire to stop smoking in addition to having poor impulse control. Impaired cognition can make it difficult to follow instructions. In order to assess whether nicotine skin patches (transdermal nicotine administration) could reduce cigarette smoking among psychiatric patients who were long-term smokers, 14 psychiatric patients of various ethnic backgrounds were studied. The patients did not have to indicate any motivation to stop smoking in order to participate in the study. They were randomly assigned to receive either a nicotine or placebo patch which was taped to their nondominant forearm. Patches were applied in the morning, and for the next seven hours, while being observed, patients were provided with unlimited access to their favorite cigarettes. One week later, during a second seven-hour session, the opposite patch was applied. Patients were told to ignore the patch and smoke as they normally would. Results showed that patients smoked significantly less while wearing the nicotine patch. However, infrequent smokers were not affected by treatment. Among the heavy smokers (those who smoked at least 1.8 cigarettes an hour) cigarette smoking was reduced by 24 percent. This finding suggests that nicotine skin patches may be useful in reducing smoking among severely nicotine addicted psychiatric patients, whether or not they are motivated to stop smoking. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Smoking cessation programs, Smoking cessation, Substance abuse, Substance abuse treatment, Tobacco habit

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Managed health care and the Massachusetts experience

Article Abstract:

In the last decade, cost and efficiency have received a great deal of attention in the health care industry. Managed health care is a recently developed concept which replaces conventional health care with some combination of alternate health insurance, benefit management, and service delivery. Through prepaid health delivery systems and utilization review, managed health care is the greatest trend in modern health care. Examples of how the profession of psychiatry has been involved in managed care through the efforts of the Massachusetts Psychiatric Society are reviewed. The authors conclude that the future of psychiatric practice and the availability of psychiatric care depend heavily on the organized activities of psychiatrists.

Social aspects, Economic aspects, Psychiatric services, Mental health services, Massachusetts, Managed care plans (Medical care), Massachusetts Psychiatric Society

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