Hospitals try to stem flow of mentally ill in ERs

The mentally ill and homeless often wind up receiving costly emergency room care when they encounter any sort of health issue--a trend some hospitals are trying to avoid, the New York Times reported.

A pilot program engineered in part by WakeMed Health in Raleigh, N.C., ferries such patients to psychiatric facilities instead of acute care hospitals for examinations, depending on how they answer a series of questions posed by paramedics regarding their medical condition and their preferences for care. In one instance, paramedicis took a homeless man who thought his medication wasn't working directly to a psychiatric hospital.

"He doesn't have a medical complaint, he's just a mental health patient living on the street who is looking for some help," Michael Lyons, a local paramedic who picked up and ferried the patient, told the Times. "The good news is that he's not going to an ER. That's saving the hospital money."

WakeMed's hospitals have treated about 314 patients per month on average with a primary diagnosis of psychosis, up by about a third from 2011. It has 14 full-time employees who are devoted solely to finding beds outside of the hospital for such patients.

Some hospitals in other parts of the country, such as University Medical Center of Sourthern Nevada in Las Vegas, have had to divert ambulances after patients with mental health issues took up too many of their ER beds, according to the article.

Care for such patients is expected to cost as much as $38.5 billion in 2014, nearly double the sum spent a decade ago, according to data from the Agency for Healthcare Research and Quality. Mentally ill patients in the Medicare program cost about five times as much to treat as other patients. The Centers for Medicare & Medicaid Services launched a demonstration project in several states, including North Carolina, to help address the issue.

Although other providers outside of North Carolina are looking at the protocols in place in Raleigh, many state laws prohibit ambulance services from transporting patients anywhere but an acute care hospital. And Medicare and Medicaid rarely reimburse ambulance companies for transportation to facilities other than a hospital ER, according to the Times.

To learn more:
- read the New York Times article

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