THE IMPACT OF PSYCHIATRIC COMORBIDITY ON MEDICARE REIMBURSEMENT FOR INPATIENT MEDICAL-CARE

Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of p sychiatric co-morbidities in Medicare patients on medical services cou ld generate incremental hospital revenue by moving patients from a low er to a higher paying Diagnostic Related Group (DRG). This increased r evenue could be used as a means of supporting the psychiatric C-L serv ice. This study documents the financial impact of screening for and do cumenting psychiatric co-morbidities on a general acute medical servic e. We clinically assessed 100 consecutive Medicare admissions and foun d 25 psychiatric co-morbidities in 20 patients. In only one case did t he psychiatric diagnosis result in moving the case to a higher DRG. Ho wever, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatr ic diagnoses by the medical team. The authors discuss both the financi al and clinical implications of screening medical inpatients for psych iatric co-morbidities and propose directions for further studies in th is area.