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Partial hospitalization, also known as PHP (from Partial Hospitalization Program), is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. Since partial hospitalization focuses on overall treatment of the individual, rather than purely safety, the program is not used for acutely suicidal people.

The pioneer of partial hospital programs, Dr. Albert E. Moll,[1] believed that some patients would be unable to be away from their families or from work and that these programs would reduce the cost of long-term care.

Partial hospitalization is provided in various milieus. They can be found on or in affiliation with a hospital or stand alone facilities. These stand alone facilities are known as Community Mental Health Centers (CMHC)[2].

Treatment during a typical day may include group therapy, individual therapy,and psychopharmacological assessments and check-ins.

Programs are available for the treatment of alcoholism and substance abuse problems, Alzheimer's disease, anorexia and bulimia, depression, bipolar disorder, anxiety disorders, schizophrenia, and other mental illnesses. Programs geared specifically toward geriatric patients, adult patients, adolescents, or young children also exist. Programs for adolescents and children usually include an academic program, to either take the place of or to work with the child's local school.

Funding – the majority of service providers are funded by fees collected from Medicare[3].

Currently, many providers are moving away from the partial hospitalization model of day treatment and are adopting a psychosocial rehabilitation (PSR) model instead. The focus of PSR is on patient (or "member," as they are often referred to) empowerment, while seeking to "rehabilitate" patients with chronic mental illness so they can function more independently in the local community (see Clubhouse Model of Psychosocial Rehabilitation for a description of these types of services).

Additionally, some people have objected to the term partial hospitalization itself, since hospitalization for mental illness generally seeks to prevent injury to the patient or to those the patient encounters. In the United States, for a person to be hospitalized involuntarily, it is necessary to demonstrate they pose an immediate danger to themselves or others. This is generally done via a report from a witness, such as a neighbor, friend or family member, that the person is dangerous. The person is transported by ambulance to the nearest hospital, where they wait for a psychiatrist to diagnose them, which may take hours, especially if the transport is late at night. The psychiatrist speaks to the person for a few minutes to determine whether they pose a threat. Many patients in partial hospitalization programs do not, have not, and likely will never be psychiatrically hospitalized. As such, they object to the implication that a partial hospitalization program is "one step away" from actual hospitalization.

PPACA Effects

The Patient Protection and Affordable Care Act (PPACA) plays a huge role in PHPs or Community Mental Health Centers (CMHC). PPACA creates new obligations under the False Claims Act whereby a Medicare provider (such as a CMHC) who fails to timely report and refund an overpayment may be subject to substantial damages and penalties.

This law creates a minefield for CMHCs. First, CMHCs and other Medicare providers have only 60 days to comply with the reporting and refund requirement from the date on which the overpayment was identified or, if applicable, the date any corresponding cost report is due, whichever is later. Of course, the PPACA does not actually explain what it means to “identify” an overpayment.

Nonetheless, the PPACA makes this reporting and repayment requirement an “obligation” under the FCA. Pursuant to the Fraud Enforcement and Recovery Act of 2009 (FERA) amendments to the FCA, an individual or entity may be liable if he or it “knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government.” Thus, CMHCs who fail to meet their 60 day “obligation” may be subject to monetary penalities of up to $11,000 per claim, and treble damages[4].

References

  1. The News and Courier Center Gives Day Mental Care, page 1. Charleston, SC, May 13, 1952.
  2. http://www.cmhcinc.org/Home.aspx.
  3. http://www.medicare.gov.
  4. http://www.partialhospitalization.com.

See also

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