Readmission Penalties Should Account for Mental Illness

Readmission rates among patients with heart failure, acute myocardial infarction, and pneumonia increase when psychiatric illness is also present.

Readmission rates among patients with heart failure (HF), acute myocardial infarction (AMI), and pneumonia increase when psychiatric illness is also present, according to research findings published in Psychiatric Services.

Nevertheless, the US Centers for Medicare and Medicaid Services (CMS) do not take co-existing mental health disorders into account when assessing and penalizing re-hospitalizations across those 3 conditions.

In an attempt to reduce readmission rates, CMS began tying readmissions to reimbursements in October 2012 under the Affordable Care Act.

"The policy was adopted as a way to curb rising health care costs and improve quality of care, and CMS chose those 3 conditions [HF, AMI, and pneumonia] because they're common, expensive to treat, and often result in readmission," said lead study author Brian K. Ahmedani, PhD, of the Henry Ford Health System, in a press release. "So, to avoid reimbursement penalties, it is very important for healthcare providers across the US to develop effective interventions to reduce 30-day readmissions. The question is, where to start to provide the most reductions in readmissions at the lowest cost?”

Choosing to center on psychiatric conditions, Dr. Ahmedani and his co-authors identified more than 160,000 patients admitted to 11 Mental Health Research Network-affiliated health care centers between January 2009 and December 2011 for any of the 3 conditions targeted by CMS. Relying on that data, the researchers investigated how psychiatric comorbidities can influence 30-day, all-cause readmissions following hospitalization for HF, AMI, and pneumonia.

Nearly 1 in 5 patients (18%) hospitalized for HF, AMI, and/or pneumonia were readmitted within 30 days, the authors found. Compared with patients without co-existing mental illness, the readmission rate was 5% higher among those with psychiatric comorbidity, and depression, anxiety, and dementia were most associated with re-hospitalization for each of the targeted conditions, as well as for all 3 combined.

“Most readmissions reduction programs do not currently include mental health components, like screening, assessment, and treatment,” Dr. Ahmedani told Pharmacy Times in an e-mail. “…We believe that mental health conditions may be a strong contributor for an increased likelihood of hospital readmission. Thus, if individuals are treated for mental health conditions more appropriately, including medication treatment, we would anticipate a corresponding reduction in readmissions.”

The study also revealed that substance abuse and bipolar disorder were linked to higher readmission rates for HF and pneumonia.

“If readmissions reduction programs begin including more mental health components, it is likely that more individuals will be treated for those conditions,” Dr. Ahmedani told Pharmacy Times. “Pharmacists will play a major role in that treatment and interact with patients facing these comorbid conditions every day.”