Conceptual Framework

ATTACHMENT F
CONCEPTUAL FRAMEWORK

CONCEPTUAL FRAMEWORK FOR UNDERSTANDING THE GOALS AND OBJECTIVES OF THE
MEDICAID EMERGENCY PSYCHIATRIC SERVICES DEMONSTRATION (MEPD)

Key to developing an effective evaluation design is a clear understanding of the goals and
objectives of the demonstration. As depicted in our conceptual framework, the demonstration is
aimed at reducing a number of undesirable aspects of the current system of care for psychiatric
emergencies by increasing the use of private IMDs. The typical path for Medicaid beneficiaries
with psychiatric EMCs in the current system begins in a medical emergency room (ER). Once
the ER determines that the beneficiary is in need of inpatient services, the search for an available
inpatient bed begins. The lack of available beds often leads to long periods of boarding in the ER
(depicted by the wide red bar) or inappropriate placement in available beds scattered throughout
general hospital medical units. Stabilization in such units may take longer than it would if more
appropriate care was provided, leading to higher costs. Discharge planning by non-specialized
staff may result in lower quality placements. Inadequate care following a discharge that occurs
before the beneficiary is fully stabilized can result in readmission to the ER and a recurrence of
the cycle. The MEPD seeks to break this cycle by increasing the use of private IMDs. Increased
availability of beds in these specialized facilities would be expected to decrease both the time
spent in ERs awaiting inpatient services and inappropriate placements in general medical units.
Receipt of specialized care may be expected to decrease the time needed for stabilization and
increase time spent on and quality of discharge planning which, in turn, would be expected to
result in better quality post-discharge care and a reduction in the need for readmission.
Decreased use of ERs and stabilization times, along with reduced use of inpatient care due to
readmissions, could result in net savings to overall Medicaid costs.

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