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Hospital stay duration and cost for the elderly with non-dementia psychiatric illnesses varies by care settings

While dementia is the psychiatric illness most often associated with elderly hospitalizations, other conditions, such as depression, bipolar disorder, and substance abuse, also often require inpatient treatment. General hospitals, psychiatric units, long-stay hospitals, and skilled nursing facilities (SNFs) are the inpatient settings where these conditions, called non-dementia psychiatric illnesses (NDPI), are treated. Medicare's cost-cutting reimbursement strategies and caps on stay lengths in addition to treatment advances have affected how the elderly receive their care, a new study finds.

Researchers used Centers for Medicare and Medicaid Services data from 1992 to 2002 to study if the decline in Medicare hospital admissions and expenditures that occurred in the 1990s continued into the following decade for this group of patients. Mean inpatient length of stay for NDPI illnesses fell from nearly 14.9 days in 1992 to just 12.1 days in 2002. Similarly, mean Medicare expenditures per stay declined from $8,461 to $6,207.

The authors point out that these declines occurred during a period of increased use of outpatient service and drug therapy. Each of the four types of facilities treating these patients was impacted differently during the 10-year period. The portion of NDPI stays that were in general hospitals fell from 34.5 percent to 27.4 percent, and the portion in long-stay hospitals fell from 19.5 percent to 11.3 percent.

Except for SNFs, all facility types saw mean Medicare expenditures, covered days, and beneficiary expenditures per NDPI stay fall from 1992 to 2002. However, SNFs witnessed mean Medicare-covered days per NDPI stay remain stable, while mean Medicare-covered costs rose from $4,153 to $6,375. These increases may result from more SNFs becoming certified by Medicare (the number of certified SNFs rose from nearly 4,000 in 1992 to more than 6,800 in 2002). Thus, these SNFs could be reimbursed by Medicare for services at a higher rate than they would be for services provided under Medicaid.

This study was funded in part by the Agency for Healthcare Research and Quality (HS16097).

See "Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992-2002; length of stay and expenditures by facility type," by Donald R. Hoover, Ph.D., M.P.H., Ayse Akincigil, Ph.D., Jonathan D. Prince, Ph.D., and others in the July 2008 Administration and Policy in Mental Health 35(4), pp. 231-240.

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