Inpatient Care and Insurance Coverage

Reprinted from Eating Disorders Review
July/August 2005 Volume 16, Number 4
©2005 Gürze Books

Inadequate reimbursement by insurance companies threatens the ability to provide optimal inpatient medical treatment for medically unstable patients with eating disorders, according to the results of a recent study at Baylor College of Medicine, Houston (J Adolesc Health 2005;36:221).

Jennifer L. Kalisvaart, MD and Albert C. Hergenroeder, MD recently studied the outcomes at discharge for 39 adolescent patients with medical complications of anorexia nervosa (AN) or eating disorders not otherwise specified (EDNOS) following treatment on an adolescent medical unit. The patients were admitted over three years, and were studied with a descriptive, retrospective cohort study design.

Patient characteristics

Admission criteria included a combination of estimated ideal body weight (% IBW) <85%, bradycardia (resting heart rate 50 beats per minute or less), hypothermia (35° C or lower), and orthostatic tachycardia, marked by an increase of at least 35 beats per minute after standing for 5 minutes. A final criterion was failure of outpatient treatment. At admission, 29 patients (74%) were diagnosed with anorexia nervosa, and 10 (26%) were diagnosed with EDNOS.

What the study showed

The mean age of the patients was 16.1 years, and IBW was 74.8%. The patients were hospitalized for a mean of 51 days and average daily weight gain was 0.100 kg. On discharge, 17% of the patients still had bradycardia and none had hypothermia. Discharge criteria included achieving 85% IBW.

The average hospital and professional charges added up to $105,853 per patient, and insurance companies reimbursed an average of 62% of the total charges out of the patients’ medical benefits policies. No patient was discharged based solely on insurance criteria. The insurance companies uniformly denied coverage for the number of requested days. The authors reported that although the majority of expenses for inpatient care on this adolescent medical unit were reimbursed by insurance companies, reimbursement did not cover achievement of a discharge rate of 85% IBW, a weight universally associated with improved outcome. Even discharging patients once they have achieved 85% IBW may be insufficient. Many authorities believe that 85% IBW may be inadequate to assure that patients will consolidate their gains after hospitalization, gain to their truly healthy weights in the range of 100% IBW, and decrease their risks of frank relapse.

The authors also added that contrary to other reports, normalization of orthostatic pulse may not be a criterion on which to base medical stabilization. Instead, this parameter may stabilize later than body temperature and heart rate in teens recovering from malnutrition due to an eating disorder.

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