Using DRGs to Pay for Inpatient Substance Abuse Services: An Assessment of the CHAMPUS Reimbursement System

Zwanziger, Jack; Davis, Lois M.; Bamezai, Anil; Hosek, Susan D.

doi:10.1097/00005650-199106000-00015

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…[15][16][17][18][19][20][21]23,24,[27][28][29]31,34,35,[37][38][39][40][41][42][43][44][45][46]48,49 Most studies (n = 31; 86.1%) were set in the USA. [15][16][17][18][19][20][21][22][23][24][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]…”

Section: Resultsmentioning

confidence: 99%

“…A total of 29 studies (80.6%) were quantitative in nature. [14][15][16][17]19,[21][22][23][24][26][27][28]31,32,[34][35][36][37][38][39][40][42][43][44][45][46][47][48][49] In addition, there were three qualitative (8.3%) and four mixed-method (11.1%) studies. 18,20,25,29,30,33,41 In terms of quality assessment, qualitative, quantitative and mixedmethod studies received scores of >70%, >80% and >85%, respectively; however, quantitative studies were generally higher in quality compared to qualitative and mixed-method studies [ Table 1].…”

Section: Resultsmentioning

confidence: 99%

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Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Barouni

Ahmadian

Anari

et al. 2020

Sultan Qaboos Univ Med J

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In health insurance, a reimbursement mechanism refers to a method of third-party repayment to offset the use of medical services and equipment. This systematic review aimed to identify challenges and adverse outcomes generated by the implementation of reimbursement mechanisms based on the diagnosis-related group (DRG) classification system. All articles published between 1983 and 2017 and indexed in various databases were reviewed. Of the 1,475 articles identified, 36 were relevant and were included in the analysis. Overall, the most frequent challenges were increased costs (especially for severe diseases and specialised services), a lack of adequate supervision and technical infrastructure and the complexity of the method. Adverse outcomes included reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions and reduced services. Moreover, DRG-based reimbursement mechanisms often resulted in the referral of patients to other institutions, thus transferring costs to other sectors.Keywords: Health Insurance; Third-Party Payments; Reimbursement Mechanisms; Diagnosis-Related Groups; Quality of Health Care; Patient Outcome Assessment; Systematic Review.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Barouni

Ahmadian

Anari

et al. 2020

Sultan Qaboos Univ Med J

View full text Add to dashboard Cite

show abstract

“…Several clinical and psycho-social factors affect type and levelof-care treatment decisions for children with mental/ behavioral health challenges. For example, as reliance on diagnostic criteria to model psychiatric services has generated little success (Allen, et al, 1987;Goldman, et al, 1990;Mezzich and Coffman, 1985;Zwanziger, et al, 1991), symptoms represent key indicators for treatment decisions. Although symptoms are important for treatment planning, they do not drive level-of-care decisions.…”

Section: Resultsmentioning

confidence: 99%

Predicting Level of Mental Health Care Among Children Served in a Delivery System in a Rural State

Anderson

Estle

2001

The Journal of Rural Health

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The purpose of this study was to establish benchmark data to assist in identifying factors associated with mental health service needs and level of care for children living in a rural state. Clinical and psycho-social needs and strengths were assessed using retrospective chart review for all children and adolescents (n=150) with symptoms or a diagnosis of reactive attachment disorder who presented to a comprehensive treatment facility between January 1997 and December 1999. Logistic regression was used to predict factors associated with inpatient admission (n=15) vs. community-based care (n=135). Significant individual contributors to the prediction of inpatient care were more limited clinical/psycho-social strengths, history of inpatient use and history of sexual abuse. Although 80 percent of children admitted to inpatient care had a history of hospitalization, two-thirds had no history of receiving community-based services and presented to current treatment with a two-year or longer history of symptoms. Approximately two-thirds of children admitted to inpatient care had a history of sexual abuse; however, one-third of these children had no history of mental health service use and presented to current treatment with a two-year or longer history of symptoms. Findings raise concerns about current efforts in public health education, community awareness and health prevention and early intervention programs for children with mental/behavioral health challenges and children and families at risk for abuse and/or neglect living in rural areas.

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“…It was important to implement a tool that did not rely solely upon diagnosis, but rather on a comprehensive clinical profile, so that we could better inform the development of treatment options for youth and their families. Reliance on diagnostic criteria to model mental health services has generated little success (Allen, Coyne, Beasley, & Spohn, 1987;Goldman, Pincus, & Morton, 1990;Mezzich & Coffman, 1985;Zwanziger, Davis, Bamezai, & Hosek, 1991 of treatment need due to several factors, including parental and provider preferences, reimbursement policy, insurance issues, stigma and point of entry into the specialty sector (Anderson & Gittler, 2005).…”

Section: Methodsmentioning

confidence: 99%

Finding the Balance in Evolving Service Sectors for Youth with Co-Occurring Disorders: Measurement and Policy Implications

Anderson¹

2008

Residential Treatment For Children & Youth

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This research assessed the extent of unmet service needs for rural youth with co-occurring mental illness and substance use problems, and the factors that predicted service utilization. All youth (age 12-18 years) living in a six-county region of Iowa and discharged from outpatient mental health or substance use treatment were included (n = 150). Chart review using the Child and Adolescent Needs and Strengths-Mental Health tool (CANS-MH) was used to retrospectively assess clinical and socio-environmental characteristics at time of admission and discharge and service utilization. Findings suggest that in spite of national practice standards that recommend both mental health and substance use services for people with co-occurring disorders, fewer than 20% of all youth received both mental health and substance use treatment. Data also show that a greater degree of depression and prior mental health and substance use residential care service utilization predicted the receipt of dual treatment. Conclusions from this research discuss the roles that measurement and policy can play in evolving service sectors and systems to better address the needs of rural youth with serious emotional disturbance and their families. Further, findings suggest attention to early assessment and appropriate intervention for the treatment of co-occurring disorders may play a critical role in treating rural youth and

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Using DRGs to Pay for Inpatient Substance Abuse Services: An Assessment of the CHAMPUS Reimbursement System

Cited by 11 publications

References 8 publications

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Predicting Level of Mental Health Care Among Children Served in a Delivery System in a Rural State

Finding the Balance in Evolving Service Sectors for Youth with Co-Occurring Disorders: Measurement and Policy Implications

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