The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.
Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area.
Department of Psychiatry & Human Behavior, Brown University, Providence, Rhode Island 02903.
R J
RJ
Goldberg
J
J
Daly
R C
RC
Golinger
D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000523:psychology / Q000628:therapy; D010348:Patient Care Team / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011445:Prospective Payment System / Q000191:economics*