Beyond gamesmanship: strategies for coping with prospective payment.

Area of Science:

• Healthcare Economics
• Psychiatric Services Management

Background:

• Prospective payment models present significant economic challenges for inpatient psychiatric units.
• Maintaining financial viability requires more than just increased treatment efficiency.

Purpose of the Study:

• To identify strategies for inpatient psychiatric units to navigate economic challenges posed by prospective payment systems.
• To explore necessary adjustments in treatment goals and patient case mix for unit survival.

Main Methods:

• Analysis of economic pressures on psychiatric units.
• Evaluation of treatment efficiency improvements.
• Consideration of ethical and political factors in case mix alteration.
• Assessment of patient benefit from high-cost treatments.

Main Results:

• Increased treatment efficiency alone is insufficient for unit survival.
• Altering patient case mix (high-cost vs. low-cost) and modifying treatment goals are necessary.
• Ethical and political concerns must precede case mix adjustments.

Conclusions:

• Units should decrease disposition times, utilize electroconvulsive therapy (ECT) when appropriate, and enhance aftercare services.
• Negotiation with hospital administration is recommended to reallocate conserved resources within psychiatry.