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Unethical psychiatric hospital practices, health benefits of a universal basic income, and the value of care coordination

December 15, 2016

In order to bring you more of the news you want to read, Right Care Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, Right Care Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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When hospitals put profits over patient needs, the effects can be disastrous. In an in-depth investigation of Universal Health Services (UHS), America’s largest psychiatric hospital chain, Buzzfeed reporters found widespread use of unsafe and unethical practices, including inadequate staff training, inappropriate opioid prescriptions, and keeping patients locked in wards against their will and without cause. Buzzfeed’s interviews with current and former UHS employees reveal an emphasis on filling beds and keeping patients as long as their insurance covered the stay. “They [hospital administrators] keep track of our numbers as if we were car salesmen,” said Karen Ellis, a former UHS counselor who was interviewed. UHS staff were pressured to acquire patients by any means necessary–even misrepresenting their symptoms on evaluations to label them as dangerous and in need of confinement. In contrast, some UHS hospitals would turn away patients with a demonstrated need for mental health services because their insurance no longer covered the stay. Some hospitals made profits up to 50 percent, yet they continued to cut staff. “It was true greed,” said a former UHS hospital administrator.

Researchers have long documented the connection between income level and health. But can simply giving people money better their health? In The BMJ‘s annual Christmas issue, Anthony Painter, director of Action and Research at the RSA, argues that providing a universal basic income (UBI) could improve recipients’ health. He cites two natural experiments, one in Dauphin, Canada, and one in North Carolina, in which a specific population was given a regular, unconditional payment of $4000-$5000 a year. In both cases, researchers found improved health outcomes for recipients compared to non-recipients, including fewer mental health diagnoses, fewer hospital admissions for accident and injury, improved behavioral and emotional health, and decreased drug and alcohol intake. Unconditional cash transfers in developing countries are also associated with higher birth weights, healthy growth, reduced HIV infection rates, and reduced psychological distress, according to research by the charity GiveDirectly. The evidence suggests that further exploration of UBIs as health policy might be worthwhile: Painter concludes that “failing to test this promising intervention… would be a missed opportunity to invest in the health and wellbeing of an increasingly insecure and unequal society.”

“We should coordinate care not to save money but because coordinated care is better care.” In a NEJM Perspective article and audio interviewJ. Michael McWilliams, MD, PhD, associate professor of medicine and health care policy at Harvard Medical School, argues that programs to improve the coordination of medical care are valuable for their own sake, but they are not a magic bullet for reducing health care spending. While “hot spotting” programs like those created by the Camden Coalition and the Stanford Coordinated Care Clinic have produced impressive reductions in hospitalizations, ER visits, and other utilization of high-intensity medical services, those programs have targeted extremely sick patients, and many other programs haven’t reduced utilization enough to make up for the cost of running the program. Rather than considering care coordination a failure if it doesn’t reduce spending, though, McWilliams points out that care coordination improves outcomes for patients, and that improvement alone is worth the effort and resources spent on the programs. In the end, he argues, we’ll be better off by focusing on reducing low-value care and improving care coordination in parallel, but not relying on coordination to do both jobs at once.

Announcements

This Sunday, December 18 is the last day to submit an abstract for the Research Symposium at the Lown Conference on May 5, 2017. If you have new research on overuse, underuse, or right care, we want to hear it! Read the call for abstracts and submit your proposal here. We are also still accepting proposals for workshops for the conference; learn more here.

The Lown Institute’s Young Innovator Grant program is launching soon. Young Innovator Grants are given to support original initiatives that help challenge the culture of overuse in health care. Stay tuned for more details.

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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.

 

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