Characteristics of high staff intensive Medicare psychiatric inpatients.
Previous analyses of the costs of Medicare psychiatric inpatients have been limited by the use of claims and provider cost reports that fail to quantify differences in patient characteristics and routine costs. This article uses new primary data from 66 psychiatric inpatient units in 40 facilities nationwide to measure the times staff spend in therapeutic and other activities caring for Medicare patients. Patient days are divided into two groups of very high and low staff intensity and patient characteristics compared in each group. Results identify key patient characteristics associated with high staffing days, including old age, dementia and cognitive impairment, severe psychiatric diagnosis, deficits in activities of daily living (ADLs), and assaultive or agitated behaviors. Policy implications and suggested enhancements are made with regard to the proposed CMS case-mix classification system based on claims data alone.
Cromwell
Jerry
J
RTI International, Waltham, MA 02452-8414, USA. jcromwell@rti.org
Maier
Jan
J
Gage
Barbara
B
Drozd
Edward
E
Osber
Deborah
D
Richter
Erin
E
Greenwald
Leslie
L
Goldman
Howard
H
D000203:Activities of Daily Living; D000368:Aged; D017050:Episode of Care; D017721:Hospital Costs; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000145:classification*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000145:classification / Q000191:economics / Q000628:therapy*; D011445:Prospective Payment System; D012720:Severity of Illness Index; D013996:Time and Motion Studies; D014481:United States