“PUT IT ON MY TAB:” ASSESSING THE COST OF GERIATRIC “REGULARS” IN THE PSYCH ED.

Abstract

Introduction Emergency Departments (ED) have seen an increasing number of mental health visits over the past decade, resulting in increasing strain on health care resources. With an aging population the general consensus is that this demand is expected to rise dramatically. Appropriate resource allocation by the national health care system will be a key part of preparing for this upcoming crisis. This study seeks to assess the financial strain that geriatric high utilizers place on the system, and whether their needs are met in the psychiatric ED. Methods This study took place at a single metropolitan hospital with a separate psychiatric emergency department called the Comprehensive Psychiatric Emergency Program (CPEP). This study looked at visits by patients age 60 and above who came to the CPEP more than 5 times in 2017 (117 visits), compared to a random sample of CPEP visits (146) throughout the year. Results Results show that only 15.5% of geriatric high utilizers visits in 2017 resulted in admission, with the rest being outpatient referrals. In comparison, 43.8% of a random sampling of (non-high utilizer) CPEP visits resulted in admission. This percentage of admission increased to 58% when focused on geriatric, non-high utilizers. Interestingly, geriatric high utilizers were domiciled during 83.2% of visits, in supportive housing 14.0% of visits, and undomiciled only 0.9% of visits. Geriatric high utilizers had an outpatient psychiatrist for 40.2% of visits. Substance abuse history was noted for 14% of visits. Conclusions This data suggests that the geriatric high utilizer population has basic needs met (i.e housing), only has limited substance use issues, and so has other needs that either are not or cannot be met by psychiatric emergency services. At a conservative estimated cost of $1350 per visit, geriatric high utilizer visits in 2017 that did not result in admission had a yearly cost of $125,550. This money came directly from tax payers as no high utilizer had commercial insurance. This cost becomes alarming given the fact that it was incurred by only 11 individuals visiting one hospital. Our study does not account for visits by these same individuals to other CPEP's at nearby hospitals. The cost is expected to increase significantly if the definition of high utilizer is expanded to those who come at least 3 times per year. All of this serves as evidence for the need to develop a program to evaluate and address the needs of geriatric patients that cannot be met by a psychiatric emergency department, if only to help alleviate the financial burden over-utilization causes. This research was funded by NA