Medicare mental health parity: a high potential change that is long overdue

Mental illness, access to hospitals with invasive cardiac services, and receipt of cardiac procedures by Medicare acute myocardial infarction patients

OBJECTIVE

Older persons with coronary heart disease have reduced access to appropriate medical and surgical services if they are also mentally ill. This study determined whether difference exists in access to hospitals that provide on-site invasive cardiac procedures among a national cohort of Medicare acute myocardial infarction (AMI) patients with and without comorbid mental illness, and its implications for subsequent procedure use.

METHODS

Retrospective analyses of Medicare claims for initial AMI admissions between January and September 2007. Hospital service availability was obtained from annual survey data. Logistic regression estimated the associations of mental illness with admission to hospitals with any invasive cardiac services (diagnostic catheterization, coronary angioplasty, or bypass surgery) and post-admission care patterns and outcomes.

RESULTS

Eighty-two percent of mentally ill AMI patients (n = 28,888) versus 87 percent of other AMI patients (n = 73,895) were initially admitted to hospitals with invasive cardiac facilities [adjusted odds ratio (OR) = 0.81, p < .001]. Admission to such hospitals was associated with overall higher rate of procedure use within 90 days of admission and improved 30-days readmission and mortality rates. However, irrespective of on-site service availability of the admitting hospital, mentally ill patients were one half as likely to receive invasive procedures (adjusted OR approximately 0.5, p < .001).

CONCLUSIONS

Among Medicare patients with AMI, those with comorbid mental illness were less likely to be admitted to hospitals with on-site invasive cardiac services. Mental illness was associated with reduced cardiac procedure use within each type of admitting hospitals (with on-site invasive cardiac services or not).

Medicare parity: we're not done yet!

While Medicare's discriminatory copayments for mental and physical health care are being eliminated, much remains to be done to achieve true parity within Medicare. Medicare needs to recognize and pay for such critical mental health services as case management, psychiatric rehabilitation, and assertive community treatment. Medicare must cover payments for all behavioral health professionals. Also the 190-day lifetime limit on inpatient psychiatric hospital days under Medicare must be removed. We envision a time-in the not too distant future-when Medicare provides a mental health benefit that includes vital community services.