Psychiatric Annals, April 23, 2013
Approximately 1.6 million psychiatric patients with private insurance are admitted to the ED every year in the United States, which means that about 1 million hours are spent seeking authorization on their behalf.
During a 3-month period, Amy Funkenstein, MD, of Brown University, and colleagues collected data on 53 patients seeking inpatient psychiatric care at the Cambridge Health Alliance psychiatric ED in Cambridge, Mass. The researchers calculated how long the patients stayed in the ED before hospitalization and the length of time ED psychiatrists spent obtaining their insurance approvals. Patients’ diagnoses spanned the entire psychiatric spectrum, and the most common complaint was suicidal ideation.
In all but one case, authorization was granted to the patients. The average time between first contact with the insurance company until authorization for admission was granted or denied was 38 minutes. According to the researchers, half of the requests were resolved in less than 20 minutes, but for about 10% of patients, the approval process took 1 hour or more to complete. The longest wait for admission was 5 hours. The median time that patients spent in the ED was 8.5 hours; the shortest stay was 3 hours and the longest 20 hours.
According to study researcher J. Wesley Boyd, MD, PhD, of Harvard University, insurers use the authorization process as a deterrent to avoid paying for inpatient care.
“Insurers hope that clinicians will be so hassled by authorization procedures that they won’t seek admission for their patients, saving insurance companies money,” Boyd said in a press release. “Placing profits ahead of the health of patients when mental illness makes them vulnerable is immoral. A single-payer Medicare-for-all health care system would represent a great leap forward for patients and providers alike.”
The researchers noted that reimbursements for psychiatric care are lower compared with that of other health care services, and health care organizations frequently limit the number of psychiatric beds a hospital can have, which in turn increases the demand for mental health care.
“[T]he result is that our nation’s EDs are de facto psychiatric wards, with 79% of emergency physicians reporting that their hospitals board psychiatric patients for whom appropriate treatment resources could not be found, sometimes for days,” the researchers wrote. “The situation is so dire that EDs (are) now being designed and configured to house psychiatric patients awaiting placement.”
Disclosure:The researchers report no relevant financial disclosures.
Funkenstein A. Ann Emerg Med. 2013;doi: 10.1016/j.annemergmed.2012.10.033.
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