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Psychiatric Hospital Occupancy Rates Peak, Threatening Access to Care

Access to behavioral health services may be a growing challenge in many communities as psychiatric hospital occupancy rates reach the highest levels in more than five years, according to annual survey data released by the National Association of Psychiatric Health Systems. The trend is true for all types of programs (including child, adolescent, adult, older adult, and drug/alcohol programs), according to The NAPHS 2001 Annual Survey Report-Trends in Behavioral Healthcare Systems.

"Behavioral health caregivers are working harder with limited resources," said NAPHS Executive Director Mark Covall in releasing the report. "Higher occupancy is occurring at a time when closings and consolidations have reduced the number of hospitals available nationwide. With fewer beds available, the need for services growing, and lengths of stay short but relatively constant, it is important to ensure that there are adequate resources to meet the growing demand and the increasing costs of delivering care," he said.

Hospital occupancy increased significantly between 1999 and 2000, growing 11% (from 62.3% in 1999 to 69.2% in 2000). Over the last five years, occupancy rates have increased 24.4% (from an average 55.6% in 1996). Occupancy rates are calculated by taking the average daily census for the year and dividing by the number of set-up and staffed beds.

Within the hospital setting, lengths of stay remain very brief. Average hospital length of stay for all age groups was 10 days in 2000, nearly the same as 1999 when length of stay was 10.2 days. Median lengths of stay remained stable at 9.2 days in 2000 (the same as 1999). Over the past decade (from 1991 to 2000), hospital lengths of stay plummeted 57%, going from 23.1 days in 1991 to the current 10 days. The downward pressure on lengths of stay is part of a dramatic shift in the role of hospitals toward a stabilization model.

NAPHS members continue to treat significant numbers of patients. A typical hospital in 2000 saw an average of 2,113 inpatients.

Ambulatory services are an important part of the continuum of care provided. Partial hospital programs admitted an average of 487 individuals in 2000, down slightly from average admissions of 507 in 1999. At the same time, average partial hospital visits per year increased from 7,088 in 1999 to 7,715 visits in 2000 -- a reflection of the severity of illness being treated in this level of care. "However, fewer partial hospital programs now exist as facilities have struggled with administrative costs due to Medicare regulations, fewer payors for partial hospital services, and managed care organizations' pressure to look to lower-cost alternatives," said Mr. Covall.

The growing reliance on outpatient services can be seen in the increase in both outpatient admissions (up from 1,390 admissions in 1999 to 2,425 in 2000) and outpatient visits (up from 20,332 visits in 1999 to 22,755 in 2000).

NAPHS members are providing significant care for the Medicaid and Medicare populations. Together, these government programs accounted for 45.4% of inpatient admissions in 2000.

NAPHS advocates for behavioral health and represents provider systems that are committed to the delivery of responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, and adults with mental and substance use disorders.

The $400 report is available from NAPHS, 325 Seventh Street, NW, Suite 625, Washington, DC 20004-2802. Call 202/393-6700, Ext. 15, for ordering information.

---National Association of Psychiatric Health Systems

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