Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations.
BACKGROUND Health care reform may impact inpatient mental health services by increasing access and changing insurer incentives. We examined whether implementation of the 2014 Affordable Care Act (ACA) was associated with changes in psychiatric length of stay (LOS) and 30 day readmissions for pediatric patients. METHODS We conducted an interrupted time series analysis to evaluate LOS and 30 day readmissions during the 30 months before and 24 months after ACA implementation, with a 6 month wash out period, on patients aged 4 to 17 years who were discharged from the psychiatry unit of a children's hospital. Differences by payer (Medicaid versus non Medicaid) were examined in moderated interrupted time series. Logistic regression was used to examine the association between psychiatric LOS and 30 day readmissions. RESULTS There were 1874 encounters in the pre ACA period and 2186 encounters in the post ACA period. Compared with pre ACA implementation, post ACA implementation was associated with LOS that was significantly decreasing over time (pre ACA versus post ACA slope difference: 0.10 days per encounter per month [95% confidence interval 0.17 to 0.02] P .01) especially for Medicaid insured patients (pre ACA versus post ACA slope difference: 0.14 days per encounter per month [95% confidence interval 0.26 to 0.01] P .03) The overall proportion of 30 day readmissions increased significantly (pre ACA 6% post ACA 10% P .05 for the difference) We found no association between LOS and 30 day readmissions. CONCLUSIONS ACA implementation was associated with a decline in psychiatric inpatient LOS over time, especially for those on Medicaid, and an increase in 30 day readmissions. LOS was not associated with 30 day inpatient readmissions. Further investigation to understand the drivers of these patterns is warranted.
Hospital pediatrics