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Nevada Behavioral Health Utilization. FY2010 Update. Presenter Title/Department Date. Agenda. Children’s Services Utilization Snapshot Inpatient Services Residential Treatment Outpatient Services Psychotropic Drugs Adult Services Recommendations. Children’s Services. FY2006– FY2010.
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Nevada Behavioral Health Utilization FY2010 Update Presenter Title/Department Date
Agenda • Children’s Services • Utilization Snapshot • Inpatient Services • Residential Treatment • Outpatient Services • Psychotropic Drugs • Adult Services • Recommendations
Children’s Services FY2006– FY2010
Residential Treatment– Cost • * Admissions that are still in progress (no record of discharge has been received by fiscal agent as of report run date) are not included. Therefore, admission-based metrics for most recent time period might be underreported for RTC facilities. Those facilities had very long LOS and thus it takes substantially longer for admissions to be included in the data.
Outpatient Services – Rehab vs. Therapy • * Daily rate billing for Treatment Homes was discontinued in FY2009.
Hour-Based Services: Regional Differences Children from Washoe County have $9,000 higher cost per year compared to Clark County!
Pediatric Pharmacy Concerns Update
Pharmaceutical Utilization • In the last year there was little change in the overall percentage of children using psychotropic drugs. The exceptions are younger Welfare children. The metric went down from 8% to 6% for 0-5 year olds and for down from 33% to 30% for 6-12 year olds. • Utilization of psychotropic drugs is still 3 times higher for children in state custody than in the rest of the Medicaid pediatric population. *Psychotropic drugs are defined as anti-psychotics, anti-depressants, stimulants (for ADHD), or barbiturates/anticonvulsants *Each ‘fill’ represents a purchased prescription of the drug *The ‘Welfare’ aid group are children in state custody
Pharmaceuticals and Lack of BH Services • *BH services included in the analysis are any visit during the year to: • PT 14 Outpatient-Rehab, • PT 26 Psychologist, • PT 20 Physician w specialty 146 Psychiatry and 147 Child Psychiatry, • PT 24 Nurse Practitioner with following procedure codes ('90801', '90802', '90804', '90805', '90806', '90807', '90817', '90819', '90845', '90846', '90847', '90853', '90862' ).
Adult Services FY2006– FY2010
Recommendations for Children’s Services Continue to focus on reducing utilization of inpatient, particularly length of stay in Clark County Continue to focus on reducing utilization of residential treatment; although LOS has decrease significantly over the last few years, there is still room for improvement While Washoe County has done a good job of reducing use of inpatient care and increasing use of community-based services, the increase is beyond what would be expected and requests for these services should be reviewed for appropriateness and length of service The penetration rate for use of outpatient services (15%) is typical for the Medicaid population, however, the number of children receiving psychosocial rehabilitation and skills training is higher than expected; requests for service should be reviewed for progress in treatment and possible duplication of services
Recommendations for Adult Services As with children, the penetration rate for use of outpatient services (14.4%) is typical for the Medicaid population, however, the number of adults receiving psychosocial rehabilitation and skills training is higher than expected; requests for service should be reviewed for progress in treatment and possible duplication of services The majority of adults utilizing outpatient services are receiving therapy; the PUPM is low ($50) which begs the question of the type of service being received. If the majority of adults are receiving medication management, the PUPM would indicate approximately one visit every three months which would be typical. However, if the majority of adults are receiving individual therapy, the PUPM would indicate one visit every month which is low.
