A significant problem regarding health care access involves obtaining hospital admission for those experiencing a mental health crisis.
The backlog in obtaining insurance approval for admission to a hospital bed is problematic for the patient in crisis, other emergency room patients and physicians.
A research letter to be published in the May issue of the journal Annals of Emergency Medicine argues that pre-authorization process is akin to health care “rationing by hassle factor.”
“An emergency department is just about the worst place for a psychiatric patient to wait for an inpatient bed, and yet that is exactly what the pre-authorization process forces on millions of these vulnerable people,” said senior author J. Wesley Boyd, M.D., Ph.D.
“The thousands upon thousands of hours emergency physicians spend obtaining prior authorization for admission to the hospital are hours we are not spending on direct patient care. Only Medicare does not require prior authorization for us to admit psychiatric patients to the hospital; maybe they are onto something.”
In the study, researchers recorded data on 53 patients — most were in the emergency department because they were having suicidal thoughts.
Half of the authorization requests took under 20 minutes to be approved, but 10 percent of the patients’ authorizations took an hour or more. Only one of the 53 patients’ insurance carriers denied pre-authorization. There are approximately 2.5 million psychiatric admissions to hospitals every year in the U.S.
“Psychiatric care is really the poor stepchild in the world of insurance coverage,” said lead author Amy Funkenstein, M.D., of Brown University in Providence, R.I..
“Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better.”