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Most of the nation’s psychiatric hospitals are maintaining stable, and brief, length of stay (LOS), according to survey data released recently by The National Association of Psychiatric Health Systems (NAPHS) in Washington, DC.
However, the association’s 2000 annual survey report, Trends in Behavioral Healthcare Systems: A Benchmarking Report, shows that based on responses to the spring 2000 questionnaire, it’s hard to predict if short LOS will remain the status quo.
Limited monetary resources, limited access to aftercare services, and lack of funding and support for the most severely mentally ill patients are concerns that Mark Covall, executive director of NAPHS, expressed with the release of the report. "Resources remain exceedingly tight for behavioral health care," he says, "and behavioral health caregivers are working harder with limited resources. Community access to aftercare services [such as outpatient care and partial hospitalization] is becoming an increasing concern," he explained.
The report was compiled from survey responses of NAPHS members, including 300 specialty hospitals, general hospital psychiatric and addiction treatment units, residential treatment centers, youth services organizations, partial hospital services, behavioral group practices, and other providers of behavioral health care.
Within the hospital setting, LOS remain short, according to the results of the survey. Average hospital LOS for all age groups was 10.2 days in 1999, the same as in 1997. Over the same period, median LOS continued to decline, from 9.4 days in 1997 to 9.2 days in 1999.
The continuing downward pressure on LOS is part of a dramatic shift in the role of hospitals toward a stabilization model. Over the past decade (from 1990-1999), hospital LOS plummeted 60.1%, going from 25.6 days in 1990 to the current 10.2 days.
At the same time, respondents to the survey report that they’re treating significant numbers of patients. A typical hospital in 1999 saw an average of 1,831 inpatients, an increase of 4.9% since 1997. And hospital occupancy rates have grown, as well, from 54.5% in 1997 to 62.3% in 1999. (Editor’s note: no survey was conducted in 1998; therefore, comparisons track trends from 1995, 1996, 1997, and 1999.)
NAPHS members are providing significant care for the Medicare and Medicaid populations. Together, those government programs accounted for 40.9% of all inpatient admissions in 1999, according to the survey data.
"With continued reductions in [LOS], hospitals now focus on stabilizing patients and discharging them to outpatient care as soon as possible," Covall stated.
"However, outpatient care has not grown to the degree necessary to adequately provide the care required for the most severely ill patients. The challenge for the future will be to ensure that all levels of care receive adequate support and funding so that individuals with the most severe mental illnesses will receive effective care," he added.
Hospital Case Management welcomes guest columns about clinical path development and use. Articles should include any results (length of stay, cost, or process improvements) that use of your pathway has helped achieve and should be from 800 to 1,200 words long. Send article submissions to: Lee Reinauer, editor, Hospital Case Management, P.O. Box 740056, Atlanta, GA 30374. Telephone: (404) 262-5460. Fax: (404)262-5447.