Anorexia, Bulimia Therapy Hampered by Managed Care
Originally published by Reuters Health, June 8, 2001
NEW YORK (Reuters Health) — Changes in healthcare delivery have led to shorter hospital stays and higher readmission rates for patients with eating disorders, results of a study suggest.
Researchers reviewed the records of more than 1,100 patients treated for anorexia and bulimia in a New York hospital between 1984 and 1998. The average length of stay declined to just under 24 days from nearly 150 days, and the percentage of patients who were readmitted rose to 27% from 0% over the same period. The rate of readmissions could actually be higher, the authors note, since some patients were readmitted to other hospitals.
Although there was no difference in the average body mass index (BMI) of patients who were admitted to the hospital over the years, the average BMI of patients at discharge dropped to 17.7 in 1998 from 19.3 in 1984. A healthy BMI, a measure of weight in relation to height, is about 20-24.
"Over the past 15 years, eating disorder hospital treatment has metamorphosed from long-term treatment of a disorder to stabilization of acute episodes," according to Dr. Katherine A. Halmi of the Weill College of Medicine at Cornell University in White Plains, New York, and colleagues. "For some patients, this change has been deleterious and not cost effective."
Upon discharge from the hospital, many patients are treated in outpatient settings where they do not receive the same intense care as they do in the hospital, making it easier to stop eating, binge, purge and over-exercise. Ultimately, the patient may be rehospitalized.
"Although we are certainly not suggesting a return to the 1980s when the norm was 6 months of inpatient treatment, the current 'frequent flier' model of eating disorder treatment is helping neither our economy nor our patients," Halmi's team writes in the June issue of the International Journal of Eating Disorders.
The report cites changes in healthcare economics that have helped to fuel the shift. In the 1980s, for instance, private insurance was mostly responsible for eating disorder hospitalizations. In today's managed care environment, reimbursement for hospitalization, the most expensive part of psychiatric care, is often limited.
Meanwhile, the cost for an inpatient day at the hospital in the study was $415 in 1984—equal to $651 in 1998, the report indicates. By the end of the 1990s, the cost of one day's stay in the same hospital rose to $1,400.
"Due to the higher costs for inpatient hospitalization, intense pressure has been applied to reduce the length of inpatient stays," Halmi and colleagues explain.
