Would you send your mother to a pediatrician for her
arthritis, or your child to a geriatrician for his well-baby exam?
Probably not – unless there were no other provider in town.
But some new reports from the Agency for Healthcare Research
and Quality (AHRQ) suggest that something akin to that is happening every day to people with
mental illnesses.
Two reports – Costs for
Hospital Stays in the United States, 2010 and Most Frequent
Conditions in U.S. Hospitals, 2010 – were released in January 2013. The third, Most Frequent
Procedures Performed in U.S. Hospitals, 2010, was released in February.
They make for fascinating reading, with an unexpected twist at
the end.
Spoiler alert – mood
disorders are among the most common reasons for hospitalizations for people
under 65. But mood disorders aren’t
driving the increase in hospital costs, because the procedures hospitals most
often perform have nothing to do with treating people with mood disorders.
Mood disorders accounted for 877,000 hospital inpatient
stays during 2010. Apart from being
born, they were the #1 reason that children under the age of 18 were admitted
to hospitals, ahead of pneumonia, asthma, and appendicitis.
Mood disorders were also the 3rd most common primary
diagnosis among all people between the ages of 18 and 44. The other four in the top five all related to
childbirth and delivery.
And among adults between the ages of 45 and 64, mood disorders
ranked 5th as a reason for inpatient hospitalization, behind four
conditions closely related to aging – osteoarthritis, back pain, chest pain,
and coronary artery disease.
Mood disorders may be
common reasons for hospitalization, but they have nothing to do with the recent
increase in health care costs.
The mean cost of a hospital stay was $9,700 in 2010, up from
$6,700 (in 2010 dollars) in 1997. That
represents a 45% increase over a thirteen year period.
But the mean cost for mood disorders was less than half of
that – just $4,800. And what’s even more
interesting is this. That represented a 6%
decrease from the $5,100 cost per stay in 1997.
On the other end of the scale, the most expensive hospital
stay was for adult respiratory arrest, at $22,300. In other words, we pay almost five times more
for people to die in a hospital than to be treated for mental illness in a
hospital.
We also pay $18,000 to diagnose and treat an acute brain
injury – four times than what we pay to diagnose and treat a chronic brain
disease.
And in every age group,
the most common procedures hospitals perform have nothing to do with mood
disorders.
Among children, hospitals most frequently offer vaccinations,
circumcisions, respiratory intubations, and appendectomies. Among younger adults, the most frequent
procedures include those related to child birth and delivery – such as
Caesarian sections and repairs of obstetric lacerations, and blood transfusions. And among older adults, blood transfusions,
cardiac catheterization, respiratory intubation, and upper GI endoscopy are most
common, along with knee and hip procedures for the very old.
So what do we need to do to respond to the needs of people
with mood disorders who are entering our hospitals?
The answer isn’t to
deny or restrict care to patients with mental illnesses who show up at
hospitals because they have no other place to go, or to force hospitals to discharge
patients with mood disorders before they are ready to go, or to wait for jails
to pick up the slack – as we do in so many places today.
We have choices.
One is to fund more community treatment programs – to
replace those we lost to massive budget cuts – so that thousands of people can
avoid hospitalizations in the first place.
And another is to insist that when patients are admitted to hospitals,
our new mental health parity rules and regulations mandate payment for
hospitals to use new procedures like functional MRIs (fMRIs) to diagnose more
accurately – and therefore to treat more effectively – mental illness in their
patients. FMRIs are brain scans that can show differences in brain activity
that are correlated with specific mood and anxiety disorders.
FMRIs aren’t exotic – they have already been used in
consumer studies to measure consumer preferences for brand names. If we
can use fMRIs to help sell cola or political candidates, why can’t we use
them in hospitals to help treat mental illness?
We always have choices.
To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com. Twitter: @pgionfriddo. Facebook: www.facebook.com/paul.gionfriddo. LinkedIn: www.linkedin.com/in/paulgionfriddo/
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