DataBrief:
Medicare Beneficiaries With
Severe Mental Illness and ReHospitalization Rates
Did you know…
In 2010, Medicare beneficiaries age 65
and older with severe mental illness
(SMI) were nearly 1.7 times more
likely to be readmitted after a hospital
stay than those without SMI?
DataBrief Series ● February 2013 ● No. 37
Medicare Beneficiaries With Severe Mental
Illness and Hospitalization Rates
• Severe mental illnesses (SMI) “disrupt a person’s thinking, feeling, mood, ability to relate to others and
daily functioning” and can significantly decrease life expectancy.1,2 For the purpose of this analysis, SMI
is defined as major depression, other mood disorders, and psychoses.
• 46% of Medicare beneficiaries age 65 and over with SMI were hospitalized in 2010, compared to only
17% of Medicare beneficiaries without SMI.
• The rate of 30-day rehospitalizations is considered an indicator of quality of care, as a rehospitalization
within a short timeframe may indicate poor medication management or poor clinical follow up with the
beneficiary after the first hospitalization.
• Among Medicare beneficiaries age 65 and older who were hospitalized in 2010, SMI was associated with
a greater rate of rehospitalizations within 30 days of the initial hospital admission.3
• 22% of Medicare beneficiaries age 65 and older with SMI were rehospitalized within 30 days,
compared to 13% of those without SMI.
• Substance use disorders (SUD), which often co-occur with SMI, increased the incidence of 30-day
rehospitalizations; 34% of seniors with both SMI and SUD were rehospitalized.
• Seniors who are dually eligible for Medicare and Medicaid, or dual eligibles, with SMI had higher
rates of rehospitalizaition within 30 days than Medicare-only beneficiaries with SMI.
1 National
Alliance on Mental Illness. “What is Mental Illness: Mental Illness Facts.” http://www.nami.org/template.cfm?section=about_mental_illness
Craig and Ronald Manderschied. “Congruencies in Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in
Eight States.” Preventing Chronic Disease 3(2) (2006). http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm
3 Avalere Health, LLC analysis of 2010 Medicare Standard Analytic Files.
2 Colton,
DataBrief (2013) ● No. 37
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Medicare Beneficiaries Age 65+ With Severe Mental Illness Are More Likely
to be Rehospitalized After a Hospital Stay Than Beneficiaries Without Severe
Mental Illness
1
This analysis includes admissions and readmissions to short-term acute care hospitals (STACHs) only; it excludes psychiatric and rehabilitation hospitals.
= 569,620 dual eligibles without SMI with a STACH stay, 165,960 with SMI with a STACH stay, and 3,580 with SMI and substance use disorder (SUD) with a STACH stay.
3 N = 3,103,040 Medicare-only beneficiaries without SMI with a STACH stay, 394,740 with SMI with a STACH stay, and 4,660 with SMI and SUD with a STACH stay.
2N
DataBrief (2013) ● No. 37
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About the data:
This analysis used 2010 Medicare
claims data to identify individuals with
severe mental illnesses.
Individuals were defined as having
severe mental illness if their Medicare
claims had one or more International
Classification of Diseases, Version 9
(ICD-9) codes associated with selected
severe mental illnesses in any acute
care setting. Severe mental illnesses
included depression, bipolar disorder,
schizophrenia, and other psychotic
disorders.
This analysis is limited to individuals
age 65 and older enrolled in the feefor service, or traditional, Medicare
program, and excludes beneficiaries
who died in 2010.
A Clear Policy Connection
In 2010, Medicare beneficiaries age 65 and older with SMI, and
especially those with co-occurring SUD, had higher rates of both
hospitalization and re-hospitalization within 30 days than senior
beneficiaries without. This finding suggests that the presence of SMI
complicates treatment plans and post-discharge care.
These same Medicare beneficiaries with SMI also had high rates of
other chronic conditions. SMI and SUD can make it difficult for patients
to maintain medication and other treatment regimens, which may
contribute to adverse events like rehospitalizations.1
Policymakers and providers are increasingly focused on reducing
hospital readmissions by providing enhanced services to patients
during care transitions. The Affordable Care Act included a provision,
implemented in October 2012, that now penalizes hospitals that have
higher than expected rehospitalization rates. Given the higher
prevalence of readmissions among those beneficiaries with SMI and
SUD, the implementation of this provision encourages hospitals to
better coordinate with community-based providers, including
behavioral health providers, to ensure beneficiaries do not get
readmitted.
1 Druss,
Analytics powered by Avalere Health LLC
Benjamin and Elizabeth Reisinger Walker. “Mental Disorders and Medical Comorbidity.” Robert Wood
Johnson Foundation, 2011. http://www.rwjf.org/content/rwjf/en/research-publications/find-rwjfresearch/2011/02/mental-disorders-and-medical-comorbidity.html
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