State systems to track availability of psychiatric hospital beds vary

Recognizing the critical need for inpatient hospital and residential mental health and substance use disorder treatment settings, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) has released a report that examines how states make information on open beds available to consumers, the impact of effect that inpatient bed tracking has on patient access, and the challenges that remain with inpatient bed tracking systems. The researchers concluded that among the 17 states that track availability of psychiatric hospital beds, only five states allow for public access. In some states, systems to track the availability of psychiatric hospital beds have been challenged by the reluctance of hospitals to update information on open beds frequently enough to be useful given rapid patient turnover (ASPE Report, August 2019).

Need for inpatient bed tracking

ASPE conducted a study to examine how states make information on open beds available to consumers, the impact of effect that inpatient bed tracking had on patient access, and the challenges that remain with inpatient bed tracking systems. Inpatient hospital and residential mental health and substance use disorder (SUD) treatment settings are a critical component of behavioral health services care. Patients may require an inpatient hospital stay when they experience a psychiatric or SUD emergency, pose a threat to themselves or others, and need 24-hour medical monitoring and treatment. In the absence of a bed registry, emergency room staff, patients, or other providers must call multiple hospitals or residential settings to determine if there is a slot available that would be appropriate given the patient’s needs. This results in long waits in emergency departments.

Systems to track openings

The researchers conducted an environmental scan by identifying states that have systems to track openings in behavioral health treatment settings, such as hospital psychiatric beds and residential treatment beds. The study found among the 17 states that tracked this information, only five states allowed public access. The other 12 states kept the information about bed availability behind a firewall and only available to providers. The researchers found significant variation among states in how the registries were operating, the types of behavioral health providers they included, and perceptions of their usefulness. In some states, systems to track the availability of psychiatric hospital beds have been challenged by the reluctance of hospitals to update information on open beds frequently enough to be useful given rapid patient turnover.

Emergency department staff noted that the system does not negate the need for them to call hospitals to confirm that there is still an open bed that is appropriate for the patient’s needs and that relationships among hospitals and emergency departments and other crisis system staff may be more efficient than using the bed registries. However, some states reported that the registries were very helpful in locating open beds as well as in documenting the need for additional psychiatric beds.

Registries that post available openings in SUD residential, detoxification, and other non-hospital-based systems are less common than hospital bed registries. Connecticut has a publicly-facing registry that indicates openings in SUD treatment settings. Interviewees reported that patients with SUDs and providers like the system and find it useful. However, more effort is needed to make patients and family members aware of the system.

Future research

There have been no formal evaluations of the effect of bed registries on access to care. The report concluded that future research could help improve understanding of the characteristics and processes that make the bed registries most useful. Some avenues to explore include: (1) how financial, regulatory, contractual, and policy levers can be used to encourage participation in bed registry systems; (2) how many consumers are using the public registries and how to increase their usage; (3) whether technology can substitute for human data entry to track available treatment beds; and (4) whether registries reduce the time and effort required to locate an appropriate inpatient or residential bed.

Are retail clinics an opportunity for expanded access to care or unnecessarily running up costs?

New forms of delivery of health care are generally viewed as a positive move towards a future where access to health care, through the use of different delivery models, is greatly increased. Yet a new study has suggested that one new form, the retail clinic, is actually unnecessarily running up costs of health care and contributing to the rising costs of health care nationally.

JAMA/RAND study

According to a new study conducted by the RAND Corporation and published in Health Affairs, “retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits.” However, according to the study, visits to retail clinics may actually be increasing costs because they drive up utilization of health care services.

In order to make this assertion that retail clinics are increasing utilization altogether rather than acting as a substitution for other, more costly types of care, RAND compared insurance claims data from one insurance provider, Aetna, between 2010 and 2012. The researchers focused on 11 different types of “low acuity” conditions, including urinary tract infections, sinusitis, flu, upper respiratory infections, bronchitis, and other unspecified viral infections. These types of conditions represent more than 60 percent of the visits to retail clinics by patients.

Ultimately, the study revealed that 58 percent of visits to retail clinics represented new utilization. Further, those visits were associated with a rise of spending in the form of $14 per person per year. According to the study’s authors the report’s findings “do not support the idea that retail clinics decrease health spending.” The study noted that over 2,000 retail clinics are currently open and that these clinics see more than six million patients overall.

Other issues

Experiences in certain areas show that health care costs are not the only issues associated with the existence of retail clinics. Recently, in New York state, according to the proposed state Senate’s budget, publicly traded companies can operate retail clinics but the state health commissioner will have the power to regulate these clinics. Conversely, the state’s Assembly’s budget does not allow these companies to operate such clinics. Both the budgets would “limit any clinic’s role to acute care, or preventive care, essentially depriving the clinic of any long-term customers, or patients who want help managing a chronic disease,” according to local sources.

These sources note that the state legislature is attempting to limit the role of retail clinics for several reasons. First, “the fear is that patients, whose care is being managed by a large health care, will seek the convenience of a retail clinic for diseases that the health system’s care manager should know about.” This notion, according to the local source, threatens the functioning of the value-based payment models. Further, the legislature is concerned that the clinics could undermine pediatrician offices and could overprescribe medications. Both legislative house budgets in the state attempt to limit the role of the retail clinic for these reasons.