The utilization of diagnostically related groups in outpatient mental health care

John H. Coons (1998)

Changes in reimbursement schemes for inpatient therapy have resulted in the creation of Diagnostically Related Groups (DRGs) which base treatment length upon several patient characteristics. This procedure contrasts with the reimbursement scheme for outpatient therapy which is fixed and not dependent upon possibly relevant patient characteristics. This study will present a rationale for the use of a DRG reimbursement scheme for outpatient mental health care. The first study looked directly at patient characteristics such as severity and diagnosis and how those characteristics relate to length of treatment and outcome. The second study asked therapists to suggest lengths of treatment for different diagnoses and severity levels. The results of Study 1 provided support for the idea that different patient characteristics related to treatment length and outcome. Study 1 suggests that higher severity clients stayed in treatment longer than less severe clients. Depressed clients also took longer to improve than Adjustment Disorder clients. Study 2 clearly demonstrated that therapists recommended different lengths of treatment for different diagnostic subgroups. The combined results provide rudimentary support for the creation of a DRG system for outpatient mental health care, and that therapists would accept and participate in such a DRG reimbursement scheme.