title: Psychiatric complications and comorbidities in medical inpatients: the inadequacy of attestation at discharge.
abstract: The determination of an appropriate level of prospective payment for inpatient medical services requires consideration and documentation of psychiatric problems which impact on resource utilization. A major source of information for reimbursement planning is the list of secondary diagnoses referred to as "complications and comorbidities" (CCs) taken from the medical record. If psychiatry problems are omitted on the attestation sheet, they are unlikely to be included in any reimbursement formulae. This study was designed to look at actual hospital experience in terms of how often psychiatric diagnoses were attested to on the medical record. Of the 100 patients evaluated, 25 were found to have 33 psychiatric complications and CCs. Of the 33 psychiatric CCs, only 9 (24%) were recorded on the attestation sheet. Reasons for and implications of this low rate of attestation are discussed. The complete and accurate attestation of psychiatric problems may be the single most important priority for psychiatrists in general hospitals. Even when the DRG system is replaced by capitation payment, the importance of accurate diagnostic recording and recognition will remain paramount to making rate analyses and adjustments.
authors.affiliation: Department of Psychiatry, Rhode Island Hospital, Providence 02903, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: J
authors.initials: J
authors.lastname: Daly
authors.forename: D
authors.initials: D
authors.lastname: Backstrom
mesh_terms: D015982:Bias; D015897:Comorbidity; D006302:Health Services Research; D006788:Hospitals, Voluntary; D006801:Humans; D007297:Inpatients; D008499:Medical Records / Q000592:standards*; D006278:Medicare; D001523:Mental Disorders / Q000150:complications*; D010351:Patient Discharge; D012051:Reimbursement Mechanisms; D012237:Rhode Island; D014481:United States