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AHRQ, GAO Report on Use—and Underuse—of Behavioral Health Services

April 05, 2019

The Agency for Healthcare Research and Quality (AHRQ) last week released a Statistical Brief1 analyzing inpatient stays involving mental and substance use disorders (MSUD) in community hospitals. AHRQ examined MSUD-related inpatient stay characteristics, including costs, length of stay, discharge status, patient demographics, primary expected payor, and hospital location. 

Pennsylvania has a higher rate of MSUD inpatient stays generally, and opioid-related inpatient stays in particular.

Although the report does not provide state-by-state data, it includes a regional breakdown showing that the three states in the Middle Atlantic region (Pennsylvania, New York, and New Jersey) have a significantly higher rate of inpatient stays with principal MSUD diagnoses than the national average. Specifically, the 2016 rate of stays per 100,000 population for the region was 943, compared with 717 nationally.2 

Other 2016 data published by AHRQ specifically notes that opioid-related inpatient stays were significantly higher in Pennsylvania than compared to the rest of the nation, 362 versus 297 per 100,000 population respectively. 

Even with higher rates of inpatient stays, data suggests underutilization of MSUD treatment—with detrimental outcomes and, likely, health care spending implications. 

This higher prevalence is concerning in light of a February 28, 2019 report by the U.S. General Accountability Office (GAO) to Congress on health care costs associated with untreated behavioral health conditions among adults.3

That report documents significant underutilization of treatment among those with MSUD—suggesting that even with the higher rate of inpatient stays in the Middle Atlantic states, many still go without treatment. Specifically, the GAO estimated that 92 percent of those with substance use conditions did not receive treatment for their condition.

Such lack of treatment, the GAO asserts, may result in higher health care costs. Twenty of the 29 studies it reviewed concluded that health care costs were higher for untreated adults than for adults who were treated, perhaps because insufficient treatment can lead to other health care costs, such as the costs of emergency care for an overdose. For example, one study found reduced hospitalizations associated with an early intervention for psychotic disorders.

Given this new research from AHRQ and the GAO, Pennsylvania hospitals should be aware that, despite higher-than-average MSUD inpatient hospital stays in our region, MSUDs generally and opioid use disorder in particular may be undertreated, which ultimately may have a negative impact on overall health care costs.

For more information about these reports, contact Sari Siegel, PhD, HAP's vice president, health care research.

1Inpatient Stays Involving Mental and Substance Use Disorders, 2016. Statistical Brief #249. Healthcare Cost and Utilization Project (HCUP). 03/2019. Agency for Healthcare Research and Quality, Rockville, MD. Last accessed: 04/04/2019.
2HCUP Fast Stats – Pennsylvania and National Opioid-Related Hospital Use: Rate of Inpatient Stays. Source: Agency for Healthcare Research and Quality, Healthcare cost and Utilization Project, State Inpatient Databases, 2008-2016. Inpatient stays include those admitted through the emergency Department. Last accessed: 04/04/2019.
3Behavioral Health: Research on Health Care Costs of Untreated Conditions is Limited. GAO-19-274: Published: Feb 28, 2019. Publicly Released: 04/01/2019. Last accessed: 04/04/2019.

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