20, 21 If the ICD-10-CM codes for an ED discharge corresponded to multiple CAMHD-CS groups, we assigned the ED discharge to the most prevalent matching MH diagnosis group in the overall sample. For the remaining ED discharges, we used the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS) to assign a MH diagnosis group. We first considered ED discharges with any claims matching the HEDIS “intentional self-harm” code set as their own MH diagnosis group. We used a systematic method to assign each ED discharge, which may have multiple claims and ICD-10-CM diagnosis codes, to a single MH diagnosis group. We defined outpatient MH visits based on POS codes for outpatient settings (eg, school, home, office, health clinic) or outpatient visit procedure codes (eg, CPT 99211 “Office or other outpatient visit for E/M of an established patient”), which included care provided by MH specialists and nonspecialists. We identified MH ED visits using POS code 23 and CPT evaluation and management codes 98281 through 98285, and MH hospitalizations based on POS codes for inpatient hospitals and inpatient psychiatric facilities (codes 21 and 51, respectively). 6 Primary MH diagnoses were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) HEDIS diagnosis code sets for “mental health illness” or “intentional self-harm.” The MH encounter location (outpatient visit, ED visit, or hospitalization) was determined by procedure and place of service (POS) codes. We defined MH encounters following specifications in the Healthcare Effectiveness Data and Information Set (HEDIS) quality measure definition for MH follow-up after ED visits. These findings do not come as a surprise but do show further need to compare these two treatment modes to determine when and where telehealth is appropriate.Įditor’s note : To read HealthLeader’s coverage of this story, click here. The researchers noted that studies have seen positive results with telehealth for the treatment of people living with chronic conditions, but mixed results in acute care settings. But considering ED visits requiring follow-up care tend to involve acute concerns like chest pain, abdominal pain, and shortness of breath, it makes sense that an in-person exam ends up being necessary. “A potential mechanism to explain increased healthcare utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms,” the study explained. Meanwhile, 18% of those using telehealth for a follow-up visit returned to the ED and 5% were re-hospitalized, HealthLeaders reported. Data showed that of those who had in-person post-discharge visits, 16% returned to the ED in 30 days and 4% re-hospitalized. The data was pulled from almost 17,000 emergency department (ED) encounters from about 13,000 patients at two hospitals in California. The study compared follow-up care for patients who visited the emergency department and found those using telehealth were more likely to seek in-person care and be re-hospitalized than those who had in-person follow-up visits. Telehealth isn’t always an equal or better option than in-person care and in some cases can lead to more issues, according to a UCLA study published in the Journal of American Medical Association (JAMA).
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