Defense Health Care

The Defense Department (DOD) has taken several steps to better manage mental health costs under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and improve the quality of care for beneficiaries. DOD has undertaken initiatives and demonstration projects that use management techniques similar to those used by private-sector companies and health plans that intensively manage mental health care. DOD has also instituted controls over payments to psychiatric facilities and improved standards for residential treatment centers. As a result, CHAMPUS mental health costs leveled off in fiscal years 1990 and 1991. Several problems persist, however, including poor medical record documentation, potentially inappropriate admissions, excessive hospital stays, and poor-quality care. Inspections of residential treatment facilities continue to reveal significant safety and health problems, and corrective actions often took many months. Moreover, DOD has proposed further changes to its methods of reimbursing psychiatric facilities. DOD should adopt these additional changes because it pays considerably higher rates for comparable services than do other public programs.

GAO found that: (1) recent DOD management initiatives, payment controls, and demonstration projects that employ utilization management techniques have reduced mental health care costs and improved the quality of care; (2) DOD medical records reviews have identified poor record documentation, potentially inappropriate admissions, excessive hospital stays, and poor-quality care; (3) residential treatment center inspections have identified unlicensed and unqualified staff, inappropriate use of patient seclusion and medication, inadequate staff-to-patient ratios, and inadequate treatment documentation; and (4) DOD has planned to change the CHAMPUS facility reimbursement methodology because it has paid psychiatric facilities more for comparable services than other federal programs.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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