Medicare Beneficiaries With Severe Mental Illness and Re-Hospitalization Rates

1. Medicare Beneficiaries With Severe Mental Illness and Re-Hospitalization Rates DataBrief Series ● February 2013 ● No. 37 In 2010, Medicare beneficiaries age 65 and older with severe mental illness (SMI) were nearly 1.7 times more likely to be readmitted after a hospital stay than those without SMI?

2. Medicare Beneficiaries With Severe Mental Illness and Hospitalization Rates • Severe mental illnesses (SMI) “disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning” and can significantly decrease life expectancy.1,2 For the purpose of this analysis, SMI is defined as major depression, other mood disorders, and psychoses. • 46% of Medicare beneficiaries age 65 and over with SMI were hospitalized in 2010, compared to only 17% of Medicare beneficiaries without SMI. • The rate of 30-day rehospitalizations is considered an indicator of quality of care, as a rehospitalization within a short timeframe may indicate poor medication management or poor clinical follow up with the beneficiary after the first hospitalization. • Among Medicare beneficiaries age 65 and older who were hospitalized in 2010, SMI was associated with a greater rate of rehospitalizations within 30 days of the initial hospital admission.3 • 22% of Medicare beneficiaries age 65 and older with SMI were rehospitalized within 30 days, compared to 13% of those without SMI. • Substance use disorders (SUD), which often co-occur with SMI, increased the incidence of 30-day rehospitalizations; 34% of seniors with both SMI and SUD were rehospitalized. • Seniors who are dually eligible for Medicare and Medicaid, or dual eligibles, with SMI had higher rates of rehospitalizaition within 30 days than Medicare-only beneficiaries with SMI. 1 National Alliance on Mental Illness. “What is Mental Illness: Mental Illness Facts.” http://www.nami.org/template.cfm?section=about_mental_illness 2 Colton, Craig and Ronald Manderschied. “Congruencies in Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States.” Preventing Chronic Disease 3(2) (2006). http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm 3 Avalere Health, LLC analysis of 2010 Medicare Standard Analytic Files. DataBrief (2013) ● No. 37

3. Medicare Beneficiaries Age 65+ With Severe Mental Illness Are More Likely to be Rehospitalized After a Hospital Stay Than Beneficiaries Without Severe Mental Illness 1 This analysis includes admissions and readmissions to short-term acute care hospitals (STACHs) only; it excludes psychiatric and rehabilitation hospitals. 2 N = 569,620 dual eligibles without SMI with a STACH stay, 165,960 with SMI with a STACH stay, and 3,580 with SMI and substance use disorder (SUD) with a STACH stay. 3 N = 3,103,040 Medicare-only beneficiaries without SMI with a STACH stay, 394,740 with SMI with a STACH stay, and 4,660 with SMI and SUD with a STACH stay. DataBrief (2013) ● No. 37

4. A Clear Policy Connection In 2010, Medicare beneficiaries age 65 and older with SMI, and especially those with co-occurring SUD, had higher rates of both hospitalization and re-hospitalization within 30 days than senior beneficiaries without. This finding suggests that the presence of SMI complicates treatment plans and post-discharge care. These same Medicare beneficiaries with SMI also had high rates of other chronic conditions. SMI and SUD can make it difficult for patients to maintain medication and other treatment regimens, which may contribute to adverse events like rehospitalizations.1 Policymakers and providers are increasingly focused on reducing hospital readmissions by providing enhanced services to patients during care transitions. The Affordable Care Act included a provision, implemented in October 2012, that now penalizes hospitals that have higher than expected rehospitalization rates. Given the higher prevalence of readmissions among those beneficiaries with SMI and SUD, the implementation of this provision encourages hospitals to better coordinate with community-based providers, including behavioral health providers, to ensure beneficiaries do not get readmitted. • This analysis used 2010 Medicare claims data to identify individuals with severe mental illnesses. • Individuals were defined as having severe mental illness if their Medicare claims had one or more International Classification of Diseases, Version 9 (ICD-9) codes associated with selected severe mental illnesses in any acute care setting. Severe mental illnesses included depression, bipolar disorder, schizophrenia, and other psychotic disorders. • This analysis is limited to individuals age 65 and older enrolled in the fee-for service, or traditional, Medicare program, and excludes beneficiaries who died in 2010. 1 Druss, Benjamin and Elizabeth Reisinger Walker. “Mental Disorders and Medical Comorbidity.” Robert Wood Johnson Foundation, 2011. http://www.rwjf.org/content/rwjf/en/research-publications/find-rwjf-research/2011/02/mental-disorders-and-medical-comorbidity.html DataBrief (2013) ● No. 37