Effectiveness of the PASRR Program Compared With Claims Data in Identifying Nursing Home Admissions With Mental Illness.
Nursing homes (NHs) are an important setting of care for individuals with complex mental health conditions, including schizophrenia, bipolar disorder, and other (nonschizophrenia) psychoses [ie, serious mental illness (SMI)]. The federally mandated Preadmission Screening and Resident Review (PASRR) program is in place to help ensure that individuals identified as having SMI, among other conditions, are appropriately admitted to an NH rather than a less restrictive community setting. However, it is unclear the extent to which the PASRR SMI flag aligns with diagnoses recorded by clinicians in claims/encounter data.
Cross-sectional study design.
One hundred percent of 2022 Minimum Data Set admission assessments linked to Medicare (including traditional Medicare and Medicare Advantage) and Medicaid inpatient and outpatient administrative claims to examine the overlap between PASRR priority categories and SMI as derived from complementary resident claims/encounter diagnoses.
Descriptive (χ2, analysis of variance).
Of roughly 1.9 million new admissions in 2022, 2.4% had a PASRR SMI flag, whereas 12.3% had an administratively data-derived SMI diagnosis. Among the 234,519 admissions with a claims/encounter-derived SMI diagnosis, 11.3% had a PASRR:SMI flag.
Federally mandated PASRR screening assessments appropriately identify roughly 1 in every 10 admissions with a claims/encounter-derived SMI diagnosis, raising substantial concerns over whether the program can effectively facilitate appropriate NH placement, as originally intended. Forty years after the Omnibus Budget Reconciliation Act of 1987, our findings raise questions about the continued utility of this federal screening program and suggest that more substantive revisions may be necessary to meet the needs of the increasingly complex and multifaceted population of patients who enter NHs.
Cross-sectional study design.
One hundred percent of 2022 Minimum Data Set admission assessments linked to Medicare (including traditional Medicare and Medicare Advantage) and Medicaid inpatient and outpatient administrative claims to examine the overlap between PASRR priority categories and SMI as derived from complementary resident claims/encounter diagnoses.
Descriptive (χ2, analysis of variance).
Of roughly 1.9 million new admissions in 2022, 2.4% had a PASRR SMI flag, whereas 12.3% had an administratively data-derived SMI diagnosis. Among the 234,519 admissions with a claims/encounter-derived SMI diagnosis, 11.3% had a PASRR:SMI flag.
Federally mandated PASRR screening assessments appropriately identify roughly 1 in every 10 admissions with a claims/encounter-derived SMI diagnosis, raising substantial concerns over whether the program can effectively facilitate appropriate NH placement, as originally intended. Forty years after the Omnibus Budget Reconciliation Act of 1987, our findings raise questions about the continued utility of this federal screening program and suggest that more substantive revisions may be necessary to meet the needs of the increasingly complex and multifaceted population of patients who enter NHs.