Provider
Profiling
Substance Abuse NonHospital Short Term
Rehabilitation
01/01/12 to 12/31/12
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Substance Abuse Non-Hospital Short Term Rehabilitation
CBHNP utilizes a provider profiling process that is an important provider-level quality
improvement activity, as well as an opportunity to internally track and trend data over a
set period of time to identify possible areas of improvement. It is also a tool to make
meaningful comparisons based on a varied data set including claims data, authorization
data, quality reports and demographic information. Provider profiling results have been
compiled using data from January 1, 2012 to December 31, 2012.
Substance Abuse Non-Hospital Short Term Rehabilitation Services include twenty-four
hour professionally directed, medically monitored, evaluation, care and treatment for
addicted Members in acute distress.
All SA NH Short Term Rehab providers across the Network with Members in service
were profiled during this period. The profiled providers are as follows alphabetically:
Bedford/Somerset Profiled Providers
Bowling Green Brandywine, Inc.
Fairmount Behavioral Health Systems
Gateway Rehabilitation Center
Gaudenzia, Inc.
Greenbriar Treatment Center
Outside In School of Experiential Education, Inc.
Pyramid Healthcare, Inc.
Roxbury Treatment Center
Twin Lakes Center
Valley Forge Medical Center and Hospital, Inc.
White Deer Run/Cove Forge, Inc.
Blair Profiled Providers
Bowling Green Brandywine, Inc.
BPC Management Group, Inc.
Eagleville Hospital
Greenbriar Treatment Center
Pyramid Healthcare, Inc.
Roxbury Treatment Center
Twin Lakes Center
Valley Forge Medical Center and Hospital, Inc.
White Deer Run/Cove Forge, Inc.
Franklin/Fulton Profiled Providers
Bowling Green Brandywine, Inc.
Clearbrook, Inc.
Firetree, LTD.
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Pyramid Healthcare, Inc.
Roxbury Treatment Center
White Deer Run/Cove Forge, Inc.
Lycoming/Clinton Profiled Providers
Bowling Green Brandywine, Inc.
Clearbrook, Inc.
Eagleville Hospital
Fairmount Behavioral Health Systems
Firetree, LTD.
Gateway Rehabilitation Center
Gaudenzia, Inc.
Outside In School of Experiential Education, Inc.
Pyramid Healthcare, Inc.
Roxbury Treatment Center
Twin Lakes Center
Universal Health Services Recovery – Keystone, Inc.
White Deer Run/Cove Forge, Inc.
Capital Profiled Providers
Bowling Green Brandywine, Inc.
BPC Management Group, Inc.
Clearbrook, Inc.
Colonial House, Inc.
Eagleville Hospital
Fairmount Behavioral Health Systems
Firetree, LTD.
Gaudenzia, Inc.
Nuestra Clinica of SACA, Inc.
Penn Foundation, Inc.
Pyramid Healthcare, Inc.
Roxbury Treatment Center
Twin Lakes Center
Universal Health Services Recovery – Keystone, Inc.
Valley Forge Medical Center and Hospital, Inc.
White Deer Run/Cove Forge, Inc.
Profiled indicators include demographics, utilization, quality, compliance, competency
and satisfaction.
Demographics
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Demographic information available for Members receiving SA NH Short Term Rehab
services includes age, gender, race and diagnostic data. Demographic mix is consistent
with previous years with no developing change in trend.
Overall, eight percent of the Members who received SA NH Short Term Rehab services
were between the ages of thirteen and twenty, thirty-four percent were between twentyone and thirty, thirty-four percent were between thirty-one and forty-four, twenty-three
percent were between forty-five and sixty-four and one percent of the population was
sixty-five years of age or older.
Forty percent of Members receiving this service were female and sixty percent were
male.
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Seventy-five percent of these Members were Caucasian, sixteen percent were African
American and nine percent were categorized as Other.
The most common diagnoses of Members receiving SA NH Short Term Rehab services
were Opioid Dependence – 304.00 at forty-one percent, Alcohol Dependence – 303.90 at
twenty-four percent, Polysubstance Dependence – 304.80 at eight percent, Cocaine
Dependence – 304.20 at seven percent and Cannabis Dependence – 304.30 at three
percent.
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Utilization
Utilization information available for Members receiving SA NH Short Term Rehab
services includes the total number of discharges, the average length of stay, the number
of recidivism episodes and the thirty day readmission rate.
The total number of discharges across the Network was 2,292. There were seventy-one
discharges in the zero to seventeen age group and 2,221 in the eighteen and over age
group.
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The total average length of stay across the Network was 21.05 days for both age groups
combined. The average length of stay for the zero to seventeen age group was 24.77 days
and 17.33 days for the eighteen and over age group. The Blair and Lycoming/Clinton
Contracts had an average length of stay less than the Network. Providers that had a total
average length of stay below the Network average met one of the three target criteria for
performance.
Across the Network there were 110 episodes of recidivism, which is the number of
readmissions for unduplicated Members, one from the zero to seventeen age group and
109 from the eighteen and over age group.
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The average thirty day readmission rate, which is readmissions for duplicated Members,
for the Network for the combined age groups was 4.80%. The average thirty day
readmission rate for the zero to seventeen age group was 1.41% and 4.91% for the
eighteen and over age group. Providers that had a total readmission rate below the
Network average met the second target criteria for performance.
Multi-Year Utilization Comparison
The total number of discharges from SA NH 3B Rehab services has been increasing since
2009. The 30 day readmission rate has shown in increase since 2011, but has not
exceeded 6% in previous years. The average length of stay for the combined age groups
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has shown a slight increase since 2011, but the average length of stay for the 0-17 age
group has shown an overall decrease. The number of IP admissions during treatment has
trended downward since 2010.
Quality
The quality indicators for SA NH Short Term Rehab services were measured by the total
number of Mental Health Inpatient admissions during treatment, the number of
complaints, the number of quality of care issues and the number of critical incident
reports submitted by the provider.
There were a total of nine Mental Health Inpatient admissions during SA NH Short Term
Rehab services during the profiled period, which was an average of 0.0034 admissions
per 1000 Members. There were zero admissions in the Blair, Franklin/Fulton and
Lycoming/Clinton Contracts.
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Across the Network there was one complaint and two quality of care issues during the
profiled period. The Network number of complaints and quality of care issues per 1000
Members was 0.0011. Both the complaint and quality of care issues came from the
Capital Contract, which had an average of 0.0012 per 1000 Members.
There were forty-seven Critical Incident Reports (CIR’s) filed for SA NH Short Term
Rehab services during the profiled period. Three of the CIR’s resulted in a quality of
care or safety issue. The Network number of CIR’s resulting in quality of care or safety
issues per 1000 Members was 0.0011.
Compliance
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Compliance indicators were measured using the number of denied administrative appeals
and the number of provider performance issues reported for each provider.
There were forty-four denied administrative appeals across the Network, with an average
of 0.0164 denied appeals per 1000 Members. The Bedford/Somerset, Blair and
Franklin/Fulton Contracts scored below the Network average.
Across the Network there were ninety-one documented provider performance issues, with
an average of 0.0340 provider performance issues per 1000 Members.
The
Bedford/Somerset Contract had zero provider performance issues.
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Competency
Competency was measured using the percentage of provider trainings that were attended.
Providers have the opportunity to attend provider trainings offered by CBHNP
throughout the year. Although these meetings are not mandatory, they include valuable
information for providers, and all providers are encouraged to attend. However, during
2012 there were zero trainings offered to SA NH Short Term Rehab providers.
Satisfaction
Member satisfaction was measured by the percentage of Members satisfied with the
outcomes of complaints that were filed. The overall Members satisfaction related to
complaints for the Network was 100%.
Target Criteria
Although all aspects of performance are important, the specific targets of an average
length of stay less than the Network average, a thirty day readmission rate less than the
Network average, and zero Credentialing Corrective Actions since 01/01/12 are goals that
all providers should strive to achieve. The following providers in each Contract met all
three target criteria.
Bedford/Somerset Profiled Providers
• Bowling Green Brandywine, Inc.
• Fairmount Behavioral Health Systems
• Gateway Rehabilitation Center
• Gaudenzia, Inc.
• Greenbriar Treatment Center
• Roxbury Treatment Center
• Valley Forge Medical Center and Hospital, Inc.
Blair Profiled Providers
• Bowling Green Brandywine, Inc.
• Eagleville Hospital
• Pyramid Healthcare, Inc.
• Roxbury Treatment Center
• Valley Forge Medical Center and Hospital, Inc.
• White Deer Run/Cove Forge, Inc.
Franklin/Fulton Profiled Providers
• Clearbrook, Inc.
• Firetree, LTD.
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Roxbury Treatment Center
White Deer Run/Cove Forge, Inc.
Lycoming/Clinton Profiled Providers
• Eagleville Hospital
• Gateway Rehabilitation Center
• Gaudenzia, Inc.
• Pyramid Healthcare, Inc.
• Twin Lakes Center
Capital Profiled Providers
• BPC Management Group, Inc.
• Colonial House, Inc.
• Fairmount Behavioral Health Systems
• Firetree, LTD.
• Nuestra Clinica of SACA, Inc.
• Penn Foundation, Inc.
• Roxbury Treatment Center
• Twin Lakes Center
• White Deer Run/Cove Forge, Inc.
Network Recommendations
When summarizing the information contained above, several strategies for impacting SA
NH Rehab provider performance can be identified.
 Establish an active treatment culture that incorporates evidence based treatment
packages.
 Continue with developing co-occurring competency.
 Encourage all SA NH Rehab staff to actively focus on appropriate and meaningful
discharge planning with full family involvement.
 Distribute CBHNP resource guide to all internal staff in order to fully develop
natural and community supports.
 Develop a consortium of SA NH Rehab providers in order to share information
and collectively address difficulties.
 Develop procedures that will assist SA NH Rehab staff with meeting CBHNP
expectations.
 Develop internal policies and procedures to facilitate more effective collaboration
with other mental health providers and community agencies (e.g., Probation;
CYS).
 Utilize Best Practice Guidelines to inform all treatment efforts.
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