Behavioral health patients and the programs that serve them deserve appropriate lengths of stays for their treatment episodes. Much of the focused effort goes into documenting why our patient demographic is need of the current loc, which is necessary. But our advocacy shouldn’t stop there. Identifying a patient’s barriers to discharge (or step down to a lower level of care) is vital if we expect insurance companies to deem a program’s requested length of stay medically necessary.
Barriers to discharge speak to what would happen if the patient were to be therapeutically stepped down to a lower level of care than they’re currently being serviced at. These barriers often identify that the patient’s current coping skills aren’t sufficient in allowing them to succeed in the lower, less-restrictive, level of care. As a result, many of these patients go on to repeat the admissions process to a higher level of care, prolonging their suffering and furthering the financial strain on the behavioral healthcare field.
Identifying, documenting, and relaying a patient’s barriers to discharge is not only useful for providers to ensure their patients aren’t discharging before they’re ready, but also for insurance companies to see where a premature discharge would land the patient, which is a level of care that lacks the structure they need, and them, needing to fund another admission to a higher level of care.
Examples of barriers to discharge can be: passive SI, self-harm urges, post-acute withdrawal symptoms, paranoia, hallucinations, ongoing psychiatric medication changes, bio-medical conditions, high cravings for substances or other maladaptive coping mechanisms, past failed attempts at lower levels of care, psychosocial stressors impacting the patient’s daily functioning, poor family dynamics.
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