Healthcare News of Note: How to prevent pediatric mental health revisits

• A new study provides a better understanding of the trends and factors associated with an increase in pediatric mental health ED revisits.
• Black and brown skin tones are underrepresented in medical training and textbooks, which can lead to missed diagnoses and inequities in care. Dermatologists are doing what they can to address the issue.
• A Wallethub report, “2022’s Neediest Cities,” ranks 182 of the nation’s cities based on key indicators of economic disadvantage, such as child poverty, food insecurity and uninsured rates.

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.    

1. Pediatric mental health visits and revisits increased during a five-year pre-pandemic period

Hospital and community interventions need to focus on identifying high-risk patients to curb the increase in pediatric mental health ED revisits, according to results of a study published Dec. 27 in JAMA Pediatrics.

“These findings suggest that pediatric mental health ED visits are increasing, and identifying patients at high risk of revisit provides an opportunity for tailored interventions to improve mental health care delivery,” wrote the authors.

The study found an 8% annual increase in pediatric mental health ED visits between Oct. 1, 2015, and Feb. 29, 2020, with 13.2% of nearly 218,000 patients during that time period having “a mental health ED revisit within 6 months of the index visit.”

Other study findings include:

• Patients with psychotic disorders, disruptive or impulse control disorders, or neurodevelopmental disorders were more likely to revisit the ED.
• Patients with substance use disorders were less likely to revisit.

“Markers of disease severity and health care access were associated with mental health revisits,” wrote the authors. “Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.”

2. Dermatologists address ‘skin of color’ gaps in medical training and textbooks

“Skin of color is underrepresented in medical training and textbooks, which can lead to missed diagnoses and inequities in care,” wrote Nada Hassanein, a reporter with USA Today, in a Dec. 5 article.

“Between 2006 to 2020, only 1 of 6 dermatology textbooks saw an increase in images of dark brown or Black skin, and half of textbooks lacked images of dark-skinned patients with common conditions like acne and psoriasis,” wrote Hassanein.

Tackling the issue

Given the slow progress in this area, it’s no surprise that Hassanein found some dermatologists “taking matters into their own hands”:

• Jenna Lester, MD, a dermatologist with the University of California, San Francisco, said she rarely saw Black and brown skin in textbooks when she was a medical student and that she and other students relied on professors describing “how a medical condition would look different on dark skin.” Lester started the Skin of Color Program at UCSF “to bring focused care to people of color and train dermatology residents in treating skin of color,” wrote Hassanein.
• Nada Elbuluk, MD, a board-certified dermatologist and assistant professor at the USC Keck School of Medicine, Department of Dermatology, “created  Project IMPACT at VisualDx, a database of clinical images that helps medical professionals form diagnoses,” wrote Hassanein. Elbuluk is quoted as saying: “Across the board, medical schools and training programs are all re-examining their curriculums and the resources they use and how they’re teaching students, because there are gaps.”

3. Detroit is ranked as the neediest city in the U.S., according to a Wallethub report

The report “2022’s Neediest Cities” ranks 182 U.S. cities “based on 28 key indicators of economic disadvantage, such as child poverty, food insecurity and uninsured rates.”

“In 2021, 11.6% of the U.S. population lived in poverty,” wrote the report author.

A May 27, 2022, article by HFMA’s Eric Reese, senior editor, described how people living in disadvantaged areas struggle with issues stemming from the social determinants of health: “For many Americans, social determinants of health (SDoH) reflect unyielding circumstances that keep them from living healthy lives and accessing the essential preventive healthcare services that could help them avoid developing chronic conditions, requiring costly hospitalizations or facing premature nursing home placements.”

10 neediest U.S. cities in 2022

According to the Wallethub report, published Dec. 19, the following were ranked as the 10 most-needy cities (See the report for the entire list of needy cities):*

1. Detroit
2. Brownsville, Texas
3. Cleveland
4. Gulfport, Mississippi
5. Fresno, California
6. Laredo, Texas
7. Philadelphia
8. New Orleans
9. Los Angeles
10. Shreveport, Louisiana

HFMA SDoH resources

For more insights on SDoH, members can download the report “Beyond Boundaries: Why finding ways to address social determinants is vital to healthcare’s future.”

*In order to determine the cities with the neediest populations, WalletHub compared 182 cities — including the 150 most populated U.S. cities, plus at least two of the most populated cities in each state — across two key dimensions, “Economic Well-Being” and “Health & Safety.”

HFMA bonus content

• Check out a video about HFMA’s completely revamped website.  
• Read the article “Medicare contractors should more closely examine providers’ bad debt claims, HHS watchdog says,” by Nick Hut, senior editor.
• Watch a video with HFMA’s Mary Mirabelli, senior vice president of corporate strategy, discussing cost effectiveness of health with Mike Giardina at the 2022 NOBULL CrossFit Games. Mirabelli is a CrossFit practitioner and trainer.

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