Identifying clinical appropriateness in the catastrophic psychiatric case

Abstract

Catastrophic psychiatric illness has been commonly identified by demographic factors such as cost (greater than $10,000) and length of treatment (greater than 30 days). In order to determine which cases could have been better managed in order to prevent the high cost and long length of treatment, clinical identifiers were formulated by the authors. The authors examined reviews of cases identified by third-party payors and reviewed by psychiatrist reviewers. They found that the majority of the catastrophic cases were not truly clinically catastrophic but were catastrophic in terms of resource utilization. This was due to patient non-compliance, poor treatment management and poor benefit management. The authors conclude that catastrophic costs and extended treatment could be prevented, in some cases, through the use of better practice patterns and case management.