Medicaid Inpatient Psychiatric and Detoxification Utilization and 1 more...less...

Clinical Services Team: Quality Improvement & Clinical Integrity Unit

Average length of stay (LOS) for DVHA inpatient mental health & detox admissions

9.9SFQ4 2021

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Notes on Methodology
  • Please note that the data up to SFY20 Q3 does not include any ACO attributed member admissions.  
  • As of SFY20 Q3, the data does include Brattleboro Retreat and Out-of-Network ACO attributed member admissions.

Partners
  • Vermont Medicaid Inpatient Providers
  • Department of Children & Families
  • Department of Mental Health
Story Behind the Curve

This measure is important because the Quality Unit impacts and tracks the average length of inpatient psychiatric and detoxification admissions to ensure that Vermont Medicaid members receive quality services at the appropriate level of care with an appropriate length of stay.  

The Utilization Review (UR) Clinicians conduct numerous utilization management and review activities to ensure that quality services, those which increase the likelihood of desired health outcomes and are consistent with prevailing professionally-recognized standards of medical practice, are provided to members and that providers are using the program appropriately, effectively and efficiently. The UR Clinicians utilize clinical criteria for making utilization review decisions that are objective and based on sound medical evidence.  The UR Team has worked closely with providers to educate on admission criteria. Consultations have been shown to improve the understanding of requirements.  Likewise, access to the Change Health Care criteria through smart sheets located in the provider manual is beneficial. The process has also strengthened our partnerships.

The data in the above trend line shows relatively consistent average lengths of stay for the non-Level 1 DVHA-managed psychiatric adult and detox populations until SFY2020 Q4. As a result of the COVID-19 pandemic which escalated in March 2020, there was an increase in length of stay for Vermont Medicaid inpatient psychiatric placements. Almost all out of state programs had a hold on admissions and the ICPC process was temporarily shut down. Residential programs in Vermont for children and adolescents experienced overall reduced capacity. The pandemic also impacted community and residential treatment program placement for adults. Due to the lack of placements, DVHAs authorization decisions were affected and additional authorization was required to keep our members safe and stable during this time.

Narrative last updated:  12/03/2020

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy