Health policy has often been in the news headlines this month.
To cite three examples, CDC released a new report about causes of death. CMS published data showing wide variations in hospital charges for common procedures. And, in the context of a newly-reported Oregon Medicaid expansion study, states have been making decisions about Medicaid
expansion.
Let's look at the mental health policy stories behind the headlines.
Suicide on the Rise
The CDC
reported this month that as of 2009, there were more deaths from suicide in
the United States than there were from motor vehicle accidents.
Suicide rates increased by over 28 percent among men and
women aged 35-64 from 1999 to 2010. While
men were three times more likely to commit suicide, the rate increased more for
women (32 percent) than for men (27 percent).
Suicide rates are highest in the west, but they are
increasing in 39 states.
Men are most likely to commit suicide with firearms, women with
poison. The most rapidly growing cause
is suffocation.
During the same period, results were down slightly among
elders, and up slightly among youth. CDC
speculated that the bad economy could be affecting rates. It also noted that baby boomers have had
elevated suicide rates throughout their lives.
So what are we doing about this? The recent Medicaid and Medicare debates
suggest a whole lot less than we should be.
Oregon Study Links Medicaid
Expansion to Reductions in Mental Illness
By now, everyone knows that the Florida legislature decided
not to expand Medicaid to over 1 million residents.
Florida
isn’t alone – it looks like elected officials in approximately half the states
will turn down Medicaid expansion for at least this year, and forfeit
billions of dollars that could be used for patient care.
Many expansion opponents latched onto a study published this
month in the New England Journal of Medicine to support the case against
expansion. The study analyzed the results
of an Oregon Medicaid expansion program over a two-year period. It concluded that the Oregon expansion had no
effect “on the prevalence or diagnosis of hypertension or high cholesterol
levels or on the use of medication for these conditions.”
Expansion proponents looked for a silver lining, arguing
that the study also showed that Oregon’s expansion improved access to care and increased
the use of preventive services.
But both seemed to overlook the study’s most definitive
conclusion – diagnoses of depression went down by 30 percent among those covered
by the Medicaid expansion.
Mental
Health America notes that depression has been estimated to cost $77 billion
annually. So how many billions could
we save by cutting depression rates by 30 percent?
And why isn’t this garnering all the headlines?
New CMS Data Show Wide
Variations in Payments for Psychosis Care
This past week, the Centers
for Medicare and Medicaid Services (CMS) released data on charges for hospitals
throughout the country. The release attracted plenty of attention,
because there were wide variations in what different hospitals charged for the “same
level of care.”
CMS wants high-charging hospitals to lower their charges.
Those charges, however, may not be the most important
numbers in the data. The real headline
is in what Medicare actually pays for the “same level care” throughout the
country.
If you suffer from psychosis, you’re better off being
hospitalized in Maryland – where Medicare pays an average of $11,277 per
discharge, twice as much as it does in a half dozen other states – than in any
other place in the country.
The variation in payments in states – even within geographic
regions – was astonishing. I put a
table with the numbers for all the states on my State Rankings
page, but here are just a few examples. Alabama
hospitals were paid only $5,256 per discharge, while those in Florida were paid
$7,006 and those in Georgia $6,605.
Connecticut hospitals were paid $8,239 (note: the overall number of
discharges was very small for Connecticut), while those in Massachusetts were
paid $7,494. North Carolina hospitals
were paid $6,188; those in Virginia were paid $5,851 and those in the District
of Columbia were paid $9,444. California
and Oregon hospitals were paid $8,916 and $8,816, respectively, but Washington
hospitals were paid only $6,504.
You can see information for all the states here.
When we look at the three reports together, they certainly beg
at least this question. Is this really
the best we can do?
Paul Gionfriddo will be speaking at the breakfast meeting of the Middlesex (CT) County Coalition on Housing and Homelessness on Friday, May 17, at 8 a.m. It is open to the public; RSVP to ann@anendinten.org.
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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