Psychiatric hospitals and other behavioral healthcare providers are racking up more outpatient visits, and that's translating into higher outpatient revenue, according to a survey released last week.
It's a good thing that providers are seeing those gains, because the respondents to the 2000 Annual Survey Report by the National Association of Psychiatric Health Systems reported another increase that is more troubling: The percentage of their expenses that can be attributed to charity care and bad debt climbed to 10.7% in 1999 from 7.6% in 1997.
The report's author, David Brown, president of David Brown and Associates in Reisterstown, Md., blamed "arbitrary caps or treatment limits" by health plans for the increase in uncompensated care.
Still, the overall outlook is good, said Jan Pyrce of Pyrce Healthcare Group, a psychiatric hospital consulting firm in River Forest, Ill.
"I feel that the industry has turned the corner. I think it's really driven by increasing demand," Pyrce said. "Occupancy is up, length of stay has stabilized, admissions are up and oversupply has been taken out of many markets."
The awareness generated by the U.S. Surgeon General's 1999 Report on Mental Health, which called for making behavioral health services as widely available as physical health services, and the increasing number of health plans offering parity between physical and mental healthcare is driving demand, Pyrce said.
At the same time the demand is growing, the supply is dwindling.
The number of staffed beds at psychiatric hospitals and in psychiatric units of acute-care hospitals dropped to 73 per facility last year from 84 per facility in 1997, or a decline of 13.1%. This figure has fallen 20.7% since 1993, according to the survey report.
Alpharetta, Ga.-based Charter Behavioral Health Systems has closed more than 50 hospitals in its liquidation (Jan. 31, p. 16), and that has been a major factor in reducing capacity, Pyrce said.
In some markets, she added, there may not be enough beds. Pyrce pointed to Connecticut, where in May state officials imposed a moratorium on bed reductions from the 32 public and private psychiatric hospitals in the state until Jan. 1, 2001.
The average number of annual outpatient visits for psychiatric hospitals and behavioral units within acute-care hospitals rose 6.8% to 20,332 in 1999 compared with 1997.
Average net revenue per day from outpatient services was $105 in 1999, up 19.3% from 1997 and up 59% since 1994. Outpatient was the only care classification to rise between 1994 and 1999. Net revenue per day declined 6.5% for inpatient care; 6.4% for residential treatment; and 10.9% for partial hospitalization between 1994 and 1999.
Median inpatient length of stay fell 2.1% to 9.2 days in 1999. The median length of stay has fallen 30.3% since 1994, when it was 13.2 days.
The survey included responses from 104 facilities, including psychiatric hospitals, behavioral units in acute-care hospitals, residential treatment centers and behavioral health group practices.