Outpatient revenues are increasingly important to the fiscal health of psychiatric health systems, as managed-care penetration and other pressures push patients into lower-cost treatment options. Still, most patients seen by behavioral health systems continue to be treated on an inpatient basis, according to the results of a survey released today by the National Association of Psychiatric Health Systems.
The Washington-based trade group polled its 302 members in the fall of 1998. Some 188 facilities, or 62%, responded. About 90% of the respondents were specialty psychiatric hospitals, with the balance being psychiatric units within acute-care hospitals, residential treatment centers and other types of facilities.
The survey showed that among facilities providing outpatient services, outpatient revenues as a proportion of overall revenues grew to 10% in 1997 from 6% in 1996.
The increase in outpatient-care revenues comes in the context of greater emphasis on outpatient treatment and a growing split in the kinds of patients receiving such treatment: Those who in the past would have received outpatient care and those who would have had inpatient care or partial hospitalization.
In 1997, the average facility saw 1,897 patients for regular outpatient services, a 75% increase over the previous year. The number of regular outpatient visits per patient declined to 8 visits in 1997 from 8.7 in 1996. At the same time, the average facility admitted 183 patients for intensive treatment, 24.4% more than in the previous year. Average length of stay for those patients, seen three or more times per week, grew to 21 days from 17.1 in 1996.
More than 29% of inpatient admissions were paid for by a managed-care plan (See chart).
The dramatic increase in length of stay for intensive outpatient treatment may reflect a move away from partial hospitalization for patients with intense treatment needs, according to Mark Covall, president of the NAPHS. But trends picked up by the survey should be interpreted cautiously, Covall said, because a slightly different group of hospitals responds each year.
Revenues from partial hospitalization, a day program of treatment in which patients are seen for more than three hours each day, accounted for 10% of overall revenues for hospitals that provided those services.
Facilities that provided overnight care and a regular treatment regimen drew 26% of their revenues from those residential treatment services. The average length of stay for these types of programs was 76.6 days, the survey showed.