Behavioral-health disorders have a significant effect on hospital readmissions. But many hospitals have yet to give them sufficient attention, even as they strive to develop better care-coordination plans for other chronic conditions.
Studies show that patients with substance-abuse and mental-health disorders are less likely to comply with treatment recommendations and three times more likely to experience repeated hospital admissions than patients without these issues. A 2011 study by the Agency for Healthcare Research and Quality reported that four of the top 10 conditions leading to higher 30-day readmission rates for Medicaid patients were mental-health or substance-abuse disorders. And among the privately insured, mood disorders were the second-leading cause for readmission.
The Hospital Readmission Reduction Program, enacted under the Affordable Care Act, financially penalizes hospitals for perceived “avoidable” readmissions for Medicare patients. The CMS estimates that financial penalties for avoidable hospital readmissions will reach $428 million this year.
Despite the poorer health outcomes and higher costs associated with patients who suffer with co-morbid behavioral-health disorders, hospitals and medical practitioners have been slow to respond to the problem. Stigma, lack of training and uncertainty about how to treat or where to refer contribute to this challenge.
Behavioral-healthcare organizations are well-positioned to play a more active role in an integrated-care environment and to partner with hospitals to help and thereby reduce readmissions. It is important that providers open a dialogue with hospitals, accountable care organizations and patient-centered medical homes.
Many systems and ACOs are understandably concerned right now with building the infrastructure necessary to deal with other chronic conditions like diabetes and cardiovascular disease. It is up to behavioral-healthcare organizations to make hospitals aware of how chronic mental and substance-abuse conditions also impact readmission rates, and the positive role we can play in helping them manage these complications.