Healthcare Reform, Length of Stay and Readmissions for Child Mental Health Hospitalizations

Abstract

Background: Healthcare reform may impact inpatient mental health services by increasing access and changing insurer incentives. We examined whether the 2014 Affordable Care Act (ACA) implementation was associated with changes in length of stay (LOS) and 30-day readmissions for pediatric patients. Methods: We used 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 washout period, on patients aged 4-18 years who were discharged from the psychiatry unit of a children’s hospital. Differences by payer (Medicaid vs. non-Medicaid) were examined in moderated interrupted time series. Logistic regression examined the association between LOS and 30-day readmissions post-ACA. Results: There were 1,874 encounters in the pre-ACA period and 2,186 encounters in the post-ACA period. Compared with pre-ACA, post-ACA implementation was associated with LOS that was significantly decreasing over time (pre-ACA versus post-ACA slope difference -0.10 days per month [95% confidence interval -0.17 to -0.02]; P=0.01), especially for Medicaid-insured patients (pre-ACA versus post-ACA slope difference -0.14 days per month [95% confidence interval -0.26 to -0.01]; P=0.03). The overall proportion of 30-day readmissions increased significantly (pre-ACA 6%, post-ACA 10%; P<0.05 for the difference). We found no association between LOS and 30-day readmissions post-ACA. 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. Post-ACA, LOS was not associated with 30-day readmissions. Further investigation to understand the drivers of these patterns is warranted.