Insurer: PrairieCare readmission rates too high
The PrairieCare chain of child and adolescent psychiatry clinics is disputing figures from health insurer Medica/Optum suggesting children treated at PrairieCare's inpatient facilities are re-hospitalized at nearly three times the rate of children treated at other providers, and after longer stays than needed.
According to data provided upon request to the Post-Bulletin by Medica/Optum, over a recent 12-month period, children treated inpatient at PrairieCare clinics were readmitted to the hospital within 90 days of discharge 42 percent of the time, versus a 15.5 percent readmission rate for children treated elsewhere.
The adolescent readmission rate was also higher at PrairieCare, according to Medica/Optum, but by a smaller margin — 18.6 percent versus 15.5 percent. Readmission rates are a generally accepted metric for the effectiveness of psychiatric treatment. The lower the readmission rate, the better the outcome.
PrairieCare strongly disputes the readmission rate figures, which it says it had never heard of prior to being notified of them by the Post-Bulletin. It also says it requested them of Medica/Optum during negotiations with no response.
"In these situations there are statistics and there are lies," said PrairieCare President Dr. Stephen Setterberg, "and sometimes it's tough to know the difference."
PrairieCare has an outpatient pediatric psychiatric facility in Rochester that recently announced plans to double in size and begin treating adults. The 5-year-old, for-profit company is the fastest-growing provider of child and adolescent psychiatric services in Minnesota, with four centers in outer ring suburbs of the Twin Cities, the year-old center in Rochester and a brand new 50-bed facility in Brooklyn Park expecting to treat 1,500 patients a year.
The figures arrive in the wake of a recent PrairieCare-issued press release announcing it would leave the Medica/Optum network due to an 18-month-long dispute over length-of-stay allowances for Prairie Care. The move meant that the 20 percent of Prairie Care patients covered by the insurer will begin paying higher, out-of-network rates.
"They're approving fewer days and they're giving a lot of pressure to our psychiatrists to discharge patients and get them out of our programs much sooner than we feel is medically reasonable," said Todd Archbold, chief development officer for PrairieCare. In the Sept. 9 press release, PrairieCare CEO Dr. Joel Oberstar stated that Medica/Optum's approach is "well outside the community standard and creates a real barrier to care."
According to Larry Bussey, communications director for Medica/Optum, it is PrairieCare that is operating outside the standard. The insurer says PrairieCare's inpatient facilities are treating adolescents and children for an average of three days longer than at other clinics in the region — roughly nine days on average compared to six elsewhere. (Medica says PrairieCare's partial hospitalization length of stays are in line with other providers.)
"The average length of stay in our program has been 9.4 days for adolescents which is exactly the national average," countered Archbold. "Our length of stay in all our programs have been spot on with the national average."
The question of how long a child or teenager should be confined to a locked ward is one of best practices, not money, according to both the insurer and the clinic. "We basically believe in a recovery based care model that our members be served in the best and least restrictive environment," Bussey said. "As a model and philosophy of care, its about getting people back to their normal lives ... movement along a continuum of more intensive to less intensive care is important."
"We have no motivation to treat kids longer than they need care," Archbold said. "In fact, the demand is such that we try to stabilize kids as effectively as possible so that we can offer care to more kids waiting at the door."
"The usual precipitant of an inpatient admission is a suicide attempt or suicidal intent," said Minnesota Psychiatric Society president Dr. Lloyd Wells in an email. Wells had no comment on the PrairieCare-Medica/Optum dispute, but said "the difference between one week or three can be lifesaving, and the disruption in a child's life is already there."
Because the Rochester facility is outpatient only, the effect locally of PrairieCare's decision to leave the Medica/Optum network is limited to future growth. "What this does," Archbold said, "is prevent us from ever being able to offer partial hospitalization to the kids down there."