Psychological care can reduce cardiac costs
Mayo Clinic model offers best practice
Do patients recovering from coronary artery disease benefit from psychological care? It would seem so, intuitively, but investigators are attempting to substantiate the assumption.
The practice directorate of the American Psychological Association (APA) and the Mayo Clinic in Rochester, MN, are joining forces to produce an actuarial model to show the positive impact of integrating psychological services into the care of coronary patients. They hope to show the cost-effectiveness and improved health outcomes that result from relieving psychological distress of patients with cardiac disease.
Cynthia Marquardt, RN, MS, director of provider relations for Kaiser-Permanente in Rockville, MD, agrees that providing psychological care to cardiac patients makes sense.
"When I worked in a cardiac step-down unit," she says, "the hospital employed a psychiatric liaison nurse who saw many of our patients who we thought could benefit from psychological counseling after a cardiac event.
"The nurse would screen those patients for emotional and psychological problems and would either counsel them herself or refer them for more intensive therapy."
Health care systems have been "carving out" mental health benefits in an effort to control costs, resulting in a barrier to the integration of psychological services into medical-surgical treatment. The APA-Mayo model should help force the reintegration of the split areas at a time when the federal government is moving toward requiring parity for mental health benefits in health care coverage.
In some patients, a threshold of distress results in a second heart attack. "We’re assuming that if we can treat that distress, we should be able to reduce the likelihood of a second event," says Henry Engleka, administrative director for professional practice at the APA.
The APA will take results of research Mayo has done, along with data from national health care databases, and build an actuarial model to quantify in language that purchasers and health system administrators can understand the benefits of combined treatment. The investigators will determine which interventions affect specific CPT codes.
"Once the model is completed," Engleka says, "we’ll pursue a full-scale demonstration project in a large statewide delivery system to test the model’s predictions." That probably will happen early next year.
An idea whose time has come
Studies conducted over the past 30 years have shown that medical cost offsets occur when psychological interventions are integrated with health care. A 1995 Mayo study, for example, examined patients with some level of distress in the areas of depression and anxiety and demonstrated that ongoing psychological distress is an independ- ent risk factor for poor medical outcomes and increased cost.1 Specifically, psychologically distressed patients were nearly 2.4 times more likely to be rehospitalized than nondistressed patients. After hospitalization, the cost for distressed patients was $7,358 more than for those who were rehospitalized but not distressed.
Payers aren’t convinced
Policy-makers and third-party payers haven’t been persuaded by the data generated so far, however, largely because most studies used small samples 75, 200, and 500 cardiac patients. "Those studies have sat on the shelf," Engleka explains, "and we haven’t seen their results utilized by health care plans." The APA-Mayo study takes the science already achieved and translates it into language more easily understood by decision makers and purchasers of health care. By using actuarial analysis, investigators are building on earlier data and expanding the sample sizes.
"We’re taking the results of original research done at Mayo and adjusting for population and regional differences," Engleka says. "We’re projecting utilization and cost to a national model using aggregated data that actuaries have access to."
Projections will be in the areas of improved cardiovascular health, cost offsets, utilization of services and resources, medical and mental health benefits, and total savings to the system.
"We expect to see decreases in hospital readmissions, decreases in significant cardiovascular events that would trigger care, and improved psychological health as a result of the interventions," he says. "All those result in lower costs to the system."
Reference
1. Allison TG, Williams DE, Miller TD, et al. Medical and economic costs of psychological distress in patients with coronary artery disease. Mayo Clinic Proc 1995; 70: 734-742. t
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