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  3. Report on the Detoxification Services Planning Process and Recommendations
  4. Results of Research and Data Analytical Study of Utilization of Inpatient Detoxification Services Conducted By HFS

Results of Research and Data Analytical Study of Utilization of Inpatient Detoxification Services Conducted By HFS 

 

Results of Research and Data Analytical Study of Utilization of Inpatient Detoxification Services Conducted By HFS

The Problem

In 2011, HFS observed very high rates of readmissions for substance abuse diagnostic related groups (DRGs), specifically detoxification admissions. Upon further research, HFS found that the readmissions were primarily occurring in 10 Cook county hospitals and that clients were cycling between these hospitals. Initial research data from 2010 indicated that approximately 2,400 individuals were involved in this behavior averaging 3 days per stay at a cost of $2,100 to the state's Medicaid program.

There were approximately 600 clients with more than six 3-day detoxification admissions per year; those 600 clients had 24 admissions a year – two per month. Of the 600, there was a subset of 200 clients with more than 24 admissions a year; those 200 had 48 admissions a year – 4 per month. The top group of clients had approximately 100 admissions week to week. They were traveling from hospital to hospital with little to no time out of a hospital. It was noted that many of the clients had been utilizing these services in this manner for several years. The typical high-volume of stays client was middle-aged, African American, male, disabled and had some contact with the Division of Alcohol and Substance Abuse (DASA) of the Department of Human Services.

One of the key issues with this target population is the need for immediate medical attention and services, along with their history of chronic dual disorders of mental health and substance abuse problems. This "complex" diagnosis presentation requires a high degree of differential diagnosis and triage within the medical setting, while simultaneously working with community providers and the client towards engaging the individual with available services. It is of note that many of these clients are reluctant to engage in community-based substance abuse and mental health recovery services and require a more proactive approach on the part of the hospital and community providers. This lack of engagement in services upon discharge manifests itself in the frequent cycling of emergency room and hospital detox admissions throughout the year.

Based on these data, it was projected that the State could save $26 million in over-utilization costs for these services within the first 12 month period of full implementation of the policy changes which were subsequently included in the SMART Act. See the following three charts (Exhibits 1, 2 and 3) for details.

Exhibit 1

IL Department of Healthcare and Family Services

Medicaid Inpatient Detoxification Stays

Source: HFS EDW 3/18/2012 unless otherwise noted

Summary: The same patients are recycling repeatedly through detox stays at a handful of hospitals

This is expensive, multi-year problem (only 2010 shown)

Calendar Year 2010

General Hospital Name County Unique Patients Admissions Days Cost Admits/Patient Days/Admit Cost/Admit Cost/Patient
St. Mary of Nazareth Hospital 200 817 2,892 7,970 $5,996,453 3.5 2.8 $2,073 $7,340
Thorek Memorial Hospital 200 614 2,368 6,855 5,405,123 3.9 2.9 2,283 8,803
Sacred Heart Hospital 200 464 2,335 5,369 4,959,408 5.0 2.3 2,124 10,688
St. Bernard Hospital 200 503 1,772 5,103 3,184,661 3.5 2.9 1,797 6,331
Norwegian American Hospital 200 443 1,695 4,792 3,079,431 3.8 2.8 1,817 6,951
Jackson Park Hospital Foundation 200 637 1,503 3,818 2,890,981 2.4 2.5 1,923 4,538
Roseland Community Hospital 200 400 1,498 4,023 2,850,856 3.7 2.7 1,903 7,127
Holy Cross Hospital 200 419 1,467 4,014 2,347,857 3.5 2.7 1,600 5,603
South Shore Hospital Corp. 200 392 1,223 4,918 2,067,614 3.1 4.0 1,691 5,275
Ingalls Memorial Hospital 200 285 767 2,111 905,412 2.7 2.8 1,180 3,177
 
Any Patient with a Substance Abuse Stay in the Above Hospitals                  
  2,427 17,520 48,973 $33,687,796 7.2 2.8 $1,923 $13,880

 

Exhibit 2

Substance Abuse (Detoxification Stays

Data taken from Top 10 most impacted hospitals:

Holy Cross Hospital, Ingalls Memorial Hospital, Jackson Park Hospital, Norwegian American Hospital, Roseland Community Hospital, Sacred Heart Hospital, South Shore Hospital, St. Bernard Hospital, St. Mary of Nazareth, Thorek Memorial Hospital

Sources: HFS EDW Claims Adjudicated through September 26, 2012

 

Admission Substance Abuse Admissions All Other Admissions
Quarter Admissions Days MedicaidPaid Admissions Days MedicaidPaid
Q1 2009 3,072 8,667 5,650,649 12,410 59,389 35,276,942
Q2 2009 3,323 9,200 5,992,261 12,423 61,060 36,160,327
Q3 2009 3,927 10,894 7,187,190 12,608 61,144 36,748,816
Q4 2009 3,703 10,474 6,960,348 12,138 59,439 35,270,126
Q1 2010 4,191 11,844 8,210,830 12,792 64,412 37,945,330
Q2 2010 4,277 11,867 8,236,926 12,617 62,240 37,537,732
Q3 2010 4,699 13,135 8,858,411 12,487 61,746 36,251,356
Q4 2010 4,363 12,149 8,395,093 12,158 60,527 37,526,799
Q1 2011 4,210 11,818 8,182,913 12,227 62,172 37,414,296
Q2 2011 4,432 12,356 8,552,013 11,422 57,032 34,570,499
Q3 2011* 4,487 12,366 8,714,182 11,593 56,843 34,515,407
Q4 2011* 4,237 11,879 8,302,013 10,584 51,674 31,660,664
Q1 2012* 4,126 11,573 8,020,067 9,905 50,251 30,131,017
Q2 2012* 3,756 10,284 7,168,874 8,256 41,082 24,926,802

*Incomplete data

Exhibit 3

HFS Medical Programs Demographics for Inpatient Detoxification Stay Recipients

Service Year 2010

Source: CCPI Data Mart

Note: This Exhibit concentrates on geography rather than specific hospitals.

  1. This is a Cook County problem
  2. About 600 recipients are affected by the 60 day restriction
  3. 200 utilize these services at a significantly higher rate
  4. Most recipients are in Chicago
  5. Most detox stays are associated with 10 hospitals
  6. Most of the hospitals are in Chicago
  Number of Recipients Percent of Recipients Average
Recipient Status Total DASA Claim* AABD Status Black Male DASA Claim* AABD Status Black Male Stays Age
All Recipients with 2010 Detoxification Stay 5,047 1,585 3,383 2,503 2,824 31% 67% 50% 56% 4.4 44.9
Non-Cook County Recipients 1,854 575 843 254 933 31% 45% 14% 50% 1.5 39.6
Cook County Recipients 3,193 1,010 2,540 2,249 1,891 32% 80% 70% 59% 6.0 48.0
Cook County Recipients with More than 6 Detox Stays 593 365 524 502 387 62% 88% 85% 65% 24.3 48.9
Cook County Recipients with More than 24 Detox Stays 200 161 189 178 134 81% 95% 89% 67% 48.4 48.3

* One or more DASA Claims during 2010, indicating DASA relationship.

Recipient Status Number of Recipients Detox Stays
  Total Chicago % Chicago Total Top 10 Hospitals* % Top 10 Hospitals
Cook County Recipients with More than 6 Detox Stays 593 536 90% 14,416 13,467 93%
Cook County Recipients with More than 24 Detox Stays 200 179 90% 9,687 9,060 94%

* 9 hospitals are in Chicago: Thorek, Sacred Heart, St. Bernard, Norwegian, Roseland, Holy Cross, Jackson Park, South Shore

1 Hospital is Suburban Cook: Ingalls

The Impact of the SMART Act In-Patient Detoxification Services Utilization Policy Change on Client/Patient Behavior and Hospital Admissions

HFS included new detoxification admission rules into the SMART Act. The new rules limited clients to one detoxification admission every 60 days totaling a maximum of 6 admissions per year. The policy change also stipulated concurrent approval of each hospitalization for reimbursement by the Medicaid program. The impact was immediate and dramatic. Detoxification admissions in the ten (10) hospitals with the most readmissions dropped by 60% and have to date remained at that level.

Furthermore, being concerned about the possibility of hospital stays shifting to other diagnoses for members of this group, HFS has been tracking and monitoring the clients who had the most detoxification admissions in 2011. It was found that there had been only a nominal increase in psychiatric and medical admissions post-SMART Act new admissions policy implementation. There also had been a decrease in emergency room admissions (these clients frequently use the emergency room) and a modest increase in the use of DASA residential day services. See Exhibit 4 for admissions data by month for 2010, 2011 and 2012 for the 10 most impacted hospitals.

Exhibit 4

200 Recipients with Most Substance Abuse Detox Stays
(48 stays on average)

Source: HFS EDW Adjudicated + Pending Through 8/16/2013

  42 Substance Abuse Admissions Acute Psych Admissions All Other Admissions Emergency Room** DASA*
        159Medicaid     Medicaid     Medicaid   Medicaid Medicaid
  Month Admits Days Cost Admits Days Cost Admits Days Cost Visits Cost Costs
1 2010_01 663 1,823 $1,355,994 20 108 $61,761 9 28 $41,051 164 $47,364 $18,030
2 2010_02 575 1,592 1,188,366 19 119 73,211 12 40 49,506 147 36,590 16,035
3 2010_03 683 1,882 1,405,087 15 96 51,892 6 13 31,002 150 33,372 11,277
4 2010_04 652 1,796 1,333,857 12 76 47,274 8 24 30,947 176 43,045 6,315
5 2010_05 664 1,817 1,348,081 18 124 77,292 13 45 58,031 155 49,146 10,037
6 2010_06 674 1,819 1,356,043 12 97 53,315 11 63 72,805 157 31,998 8,735
7 2010_07 716 1,987 1,409,239 9 66 39,987 13 33 36,790 146 38,323 10,894
8 2010_08 709 1,950 1,408,836 16 123 73,982 14 31 42,572 160 53,906 10,909
9 2010_09 714 1,983 1,422,641 12 90 51,085 12 30 72,918 160 50,569 10,343
10 2010_10 752 2,064 1,528,322 16 106 64,851 16 52 128,942 167 46,321 15,434
11 2010_11 698 1,918 1,427,726 19 136 85,392 14 44 58,173 167 43,034 14,910
12 2010_12 747 2,063 1,527,851 14 115 70,825 5 16 16,365 188 46,149 6,689
13 2011_01 780 2,175 1,595,546 15 111 67,780 10 31 41,744 167 53,013 10,034
14 2011_02 692 1,917 1,425,854 17 99 81,035 7 25 28,385 134 37,805 4,462
15 2011_03 833 2,296 1,701,417 15 106 65,931 8 34 53,693 161 43,964 12,154
16 2011_04 819 2,243 1,671,412 17 158 86,692 11 52 77,740 180 62,282 9,806
17 2011_05 874 2,380 1,783,749 24 150 88,178 14 33 59,212 231 61,030 4,389
18 2011_06 838 2,287 1,711,943 19 123 73,806 14 46 43,033 204 49,522 12,015
19 2011_07 895 2,466 1,802,707 27 175 100,452 10 32 79,773 189 58,289 5,488
20 2011_08 850 2,327 1,731,098 20 151 88,862 10 39 53,413 156 55,831 3,556
21 2011_09 819 2,247 1,682,961 19 134 84,424 8 22 35,632 162 42,878 10,214
22 2011_10 821 2,262 1,696,136 34 205 126,238 9 36 52,099 201 51,159 13,606
23 2011_11 767 2,156 1,600,251 25 189 117,719 9 44 30,849 161 55,195 8,117
24 2011_12 720 1,977 1,498,387 24 139 89,701 15 72 80,472 123 33,237 13,125
25 2012_01 753 2,072 1,545,292 27 167 106,126 7 52 64,784 127 29,987 6,624
26 2012_02 661 1,835 1,361,110 15 73 47,234 11 48 59,479 115 41,234 6,989
27 2012_03 718 2,013 1,471,413 8 44 28,221 6 20 18,097 110 29,877 12,097
28 2012_04 655 1,808 1,348,737 16 104 67,052 11 34 33,804 143 38,692 12,095
29 2012_05 622 1,811 1,347,014 12 95 61,909 18 67 58,318 120 49,355 7,702
30 2012_06 571 1,577 1,172,952 16 83 55,156 13 45 48,950 135 42,558 8,746
31 2012_07 104 278 208,209 50 401 261,395 16 48 65,867 138 105,240 10,805
32 2012_08 48 138 91,598 50 307 189,902 20 65 76,255 127 36,660 9,251
33 2012_09 104 296 210,180 40 289 176,478 7 36 34,401 113 44,905 16,058
34 2012_10 53 162 82,873 35 255 164,256 15 75 124,264 125 47,124 13,587
35 2012_11 107 311 218,052 37 235 149,512 12 48 97,918 112 36,432 25,741
36 2012_12 46 135 72,407 42 315 199,424 16 64 71,860 131 33,626 19,594
37 2013_01 97 286 18,671 42 284 175,417 16 53 68,799 126 36,767 20,188
38 2013_02 52 147 82,574 36 244 153,557 16 68 103,059 117 38,932 21,009
39 2013_03 82 225 153,759 38 268 168,621 13 76 89,576 102 43,879 18,057
40 2013_04 60 169 97,891 45 316 190,985 13 44 68,349 117 39,050 17,893
41 2013_05 64 187 111,979 49 325 201,400 18 54 82,270 145 37,423 10,154
42 2013_06 54 159 111,317 29 215 135,773 17 48 61,402 98 34,142 14,850

*Some DASA costs may be missing as interagency claims are historically slow to report.

**Pending Emergency Room claims are not easily identifiable and therefore not included; ER is therefore less complete with respect to recent months than inpatient admissions.