Hospitalization OK for Psych Patients Can Take Hours
WEDNESDAY April 24, 2013 -- U.S. psychiatrists spend a total of 1 million hours on the phone each year getting insurance companies to approve hospitalization for patients with severe mental illnesses, a new study reports.
For the study, which was published April 23 in the journal Annals of Emergency Medicine, researchers looked at psychiatrists in the Boston area and found that they spent an average of 38 minutes per patient on the phone getting insurance authorization.
About one in 10 cases took more than an hour to get approval, and one case took up five hours of the psychiatrist's time, the investigators found.
Each year in the United States, there are about 1.6 million psychiatric admissions for patients with private insurance. An average of 38 minutes of phone time per patient to get insurance authorization works out to about 1 million hours of "wasted" time for psychiatrists nationwide, according to the news release from the Physicians for a National Health Program.
The three-month study did not include uninsured patients or those covered by Medicare, which does not require prior authorization.
Most of the patients that required hospitalization had been deemed suicidal or, in some cases, posed a danger to others. The time spent obtaining insurance authorization delayed care for the patient in need and prevented psychiatrists from seeing other patients, the study authors noted. Only one of the 53 requests for authorization was denied, they pointed out.
The average time that patients spent in an emergency department (ED) awaiting hospital admission was 8.5 hours. The shortest wait was three hours and the longest was 20 hours, according to the study findings.
Mental health disorders affect nearly one-quarter of American adults a year, but less than one-third of them receive psychiatric care, according to background information in the news release.
"Society pays for inadequate psychiatric care; more than half of all prison inmates and a third of all homeless people are mentally ill. Massachusetts is considered a model for health reform, yet we found that seriously ill patients routinely spent hours stranded in the ED due to insurance bureaucracy. The hours psychiatrists spend obtaining those authorizations could be far better spent treating our patients," study lead author Dr. Amy Funkenstein, a child psychiatry fellow at Brown University, said in the news release.
She led the study while she was a psychiatric resident at Cambridge Health Alliance (CHA) and Harvard Medical School.
Study senior author Dr. J. Wesley Boyd, attending psychiatrist at CHA, said that "private insurers are obstructing care by requiring authorizations before a qualified psychiatrist can hospitalize a dangerously ill patient. With doctors, nurses and emergency departments already overburdened, adding a time-consuming bureaucratic task that doesn't help patients is unconscionable," he said in the news release.
"Insurers hope that clinicians will be so hassled by authorization procedures that they won't seek admission for their patients, saving insurance companies money," Boyd, who is also an assistant clinical professor of psychiatry at Harvard Medical School, suggested in the news release. "Placing profits ahead of the health of patients when mental illness makes them vulnerable is immoral. A single-payer Medicare-for-all health care system would represent a great leap forward for patients and providers alike."
The National Alliance on Mental Illness has more about treatments and services for mental illness.
Posted: April 2013
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