Massachusetts Care of mentally ill faulted in report

US survey reviews patient follow-up; state well below national average

By Liz Kowalczyk | The Boston Globe | May 14, 2014

More than half of mentally ill patients hospitalized in Massachusetts were sent home without a complete plan for follow-up care, newly released data show. And for patients who had plans, hospitals often did not communicate the information to the right person.

The information is posted on a federal website, Hospital Compare, that provides consumers with insight into the quality of psychiatric care at 1,753 individual hospitals across the country. Until now, the Centers for Medicare and Medicaid Services rated hospitals only on how they treat patients’ physical illnesses.

Despite the state’s top-notch teaching hospitals and broad health insurance coverage, Massachusetts scored well below the national average on discharge planning for mentally ill patients.

“Continuing care plans’’ should include a complete list of a patient’s medications, diagnosis, reasons for being hospitalized, and recommendations for follow-up care, according to Medicare.

The idea is to give outpatient providers adequate information about patients to help them keep improving and to prevent relapses.

Nationally, 74 percent of patients had a continuing-care plan, compared with 41 percent in Massachusetts. Plans were communicated to the appropriate outpatient provider for 63 percent of patients nationally, compared with 31 percent here. The data is for Oct. 1, 2012 through March 31, 2013.

Massachusetts hospital leaders said follow-up care plans are better than the data indicate.

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said hospitals “do discharge planning on virtually 100 percent of the patients.” Some plans, however, may not include every element that Medicare wants to see, he said, particularly since hospitals have just started reporting the data.

If a patient’s follow-up care plan is missing just one component, Medicare does not count it, he said.

“We have to improve on it,’’ he said.

Stephen Rosenfeld, board president for the Massachusetts chapter of the National Alliance on Mental Illness, said gaps in continuing care plans are the tip of the iceberg. Being discharged can be “disastrous’’ for patients, he said, but hospitals are not at fault for some problems, such as insufficient insurance coverage for residential placement and other intensive outpatient care.

“This is a very, very high priority issue for us,’’ said Rosenfeld, who has three adult sons with bipolar disorder. “The problem is that it’s so hard to figure out solutions.’’

The new Medicare data also describes how often hospitals put psychiatric patients in restraints or seclusion to control their behavior. Massachusetts has an initiative to dramatically reduce these practices, which can cause injury or even death to patients.

Heywood Hospital in Gardner, which owns a geriatric psychiatry unit, showed a higher-than-average rate of restraining patients ages 65 and older.

Heywood spokeswoman Amanda MacFadgen said Friday that she could not provide a hospital official to answer questions about the issue.

“There are many reasons it may become necessary to use restraints for the health and well being of both patients and caretakers,’’ she said in a written statement. “We carefully review every case where restraints are used for appropriateness and alternate care options. Ultimately, our goal is to minimize the use of restraints whenever possible, while providing quality care that protects the safety of our patients and our staff.”

The Medicare website showed that Mercy Medical Center in Springfield had very high rates of restraining children and teenagers in its psychiatric units, which the hospital said was because it reported the data incorrectly.

In one case, employees mistakenly told Medicare that restraints had been used for 1,346 hours instead of the 13.6 hours, said Mark Fulco, senior vice president for strategy and marketing for Sisters of Providence Health System, which owns the hospital.

He said Mercy had lower-than-average restraint use for most of the Medicare reporting period, according to data the hospital reported to the Massachusetts Department of Mental Health.

Several hospitals that scored below average on discharge planning said they are working to improve their approach to follow-up care.

At Good Samaritan Medical Center, complete continuing-care plans had not been created for any patients, and at Norwood Hospital, about 4 percent had comprehensive plans, the Medicare data show. Steward Health Care, the owner of both facilities, saw the scores last year “and took immediate action,’’ said Dr. Justine Carr, chief medical officer. “We did have plans but not at the level of detail needed,’’ she said.

One element caregivers frequently left out of plans, for example, were patients’ medications for high blood pressure and other physical illnesses. But it is important to list those drugs because they can react negatively with psychiatric medications, Carr said.

Rosenfeld said hospitals need to address more serious problems, too, such as letting psychiatric patients leave the hospital alone, rather than waiting for a relative to arrive.

“There have been occasions when someone suicidal has left the hospital in a taxi, even when family members were ready to pick them up, and killed themselves 24 hours later,’’ he said. “If someone has been an inpatient, that means they are in very bad shape. They have had some psychotic episode. Recovery from a psychotic break is very slow.’’

Medicare also planned to post information on how often hospitals discharge patients on multiple antipsychotic medications, and on when these are inappropriate. Technical issues compromised the data and Medicare now expects to release that information in April 2015.

http://www.bostonglobe.com/metro/2014/05/18/mass-mental-hospitals-faulted-continuing-care-plans/oqJBr2ryhdIE3qV8lChRVN/story.html