‘Proactive C-L Psychiatry on hospital medicine units can add more value to health systems than traditional, on-demand psychiatry consults’
An economic evaluation of a one-year Proactive C-L Psychiatry program at a hospital medical unit has resulted in financial outcomes showing heightened value compared with traditional Psychiatry consultation on-demand services.
Few studies to date have provided such specific financial data that can be used to negotiate the setting up of proactive C-L Psychiatry programs.
Results of the research at Stony Brook University Hospital, New York—a suburban, academic 600+ bed tertiary care regional referral and safety-net hospital—are to be published in the Academy’s journal. The lead author is Brian Bronson, MD, who chairs the Academy’s C-L Psychiatry Division Directors’ forum.
Dr. Bronson et al. evaluated the pilot’s return on investment and concluded: “Proactive C-L Psychiatry programs on hospital medicine units can add more value to health systems than traditional psychiatry consultation on-demand services by reducing the duration of hospitalization for persons with active psychiatric and substance use comorbid conditions, thereby allowing for additional bed-backfills and associated revenue which substantially offsets program costs.”
During the pilot the percent of discharges that received psychiatric consultation increased from 7.34% to 13.79%, and length of stay (LOS) for patients consulted on declined by a mean of 1.82 days, compared to an increase of 0.15 days on the traditional care units.
The one-year pilot LOS reduction saved 451.71 days in total, allowing for 73.81 bed-backfills, with a value of $419,343.
“Value in health care, often evaluated as the health outcomes per cost, should underlie all health care performance improvement activities,” say the authors. “The importance of demonstrating cost-effectiveness in C-L Psychiatry is increasingly appreciated; yet, despite growth in the field’s recognition, research regarding C-L Psychiatry’s value has resulted in inconsistent findings.”
By comparison, there is growing evidence that the Proactive C-L Psychiatry model provides value, mainly by reducing LOS. “The potential for enhanced value occurs by reducing the length of stay for patients receiving psychiatric consultation and producing a positive direct contribution margin by allowing for more backfills.”