Medicare Quality Contract Recipient Says Depression Screening is Underutilized in Wake of Hurricane Sandy

NEW BRUNSWICK, NJ—Healthcare Quality Strategies, Inc. (HQSI), New Jersey’s recipient of Medicare quality improvement contracts for the past three decades, issued a report regarding behavioral health issues in the wake of Hurricane Sandy.

New Brunswick was included as one of ten municipalities profiled within the report.

Nicole Skywer-Brandwene, a clinical program manager at HQSI, said the nature of the company’s work involves helping hospitals, nursing homes, and doctor’s offices to improve healthcare quality and access.

In the Hurricane Sandy project, Skywer-Brandwene said HQSI took a closer look at behavioral health conditions, such as depression, in heavily affected areas both before and after the storm.

“This particular project, the Superstorm Sandy Project as we call it, is actually a separate award from [the Medicare contract,]” she said.

“It’s the first time that [Medicare] has funded a quality improvement project focused on behavioral health needs. Because of the advent of [Hurricane Sandy] they wanted to look at trends and patterns in the incidence and prevalence of certain behavioral health conditions before and after.”

The goals of the project were two-fold, though each goal is vast in its own right. First, she said, the project is designed to help communities and healthcare organizations coordinate with one another in order to act more effectively in future disasters. Second, the project attempts to help people make better use of existing services.

One such service is a Medicare covered annual depression screening, a benefit that Skywer-Brandwene said was first implemented in January 2012.

“Medicare allows a professional depression screening for [beneficiaries] to be done in a primary care setting – so, in a doctor’s office – on a yearly basis. That service is reimbursed…separately from the usual cost of an office visit,” she said.

In order to make better use of the screening, the report builds profiles based on Medicare claims that identify the prevalence of the top-five factors that put a person at risk for depression.

These so-called ‘proxy disorders’ include Alzheimer’s disease or other forms of dementia, hip or pelvic fractures, substance and alcohol abuse, sleep disturbance, and amputation. If someone has one or more of these factors, Skywer-Brandwene said, they would be a prime candidate for the screening.

“One of the main goals of this project is to raise awareness and incorporate behavioral wellness along with clinical wellness by utilizing that depression screening. It is available and covered by insurance at no cost to the patient,” she said.

She added that the locations were chosen for quality improvement reasons and that structural damage from Hurricane Sandy was not a relevant factor – instead HQSI identified communities where there was a lapse in healthcare quality or access and compiled profiles for those towns.

“Our data analysts pulled several data points together to identify hot spots in areas where there might be need for improvement,” she said. “For example, we looked at high concentration of Medicare beneficiaries – if a community did not have a high concentration of Medicare beneficiaries it would not be considered a hotspot.” Other factors were a high at-risk population and low depression screening utilization.

Here in the Healthcare City the screening is grossly under-utilized. On average in New Brunswick, roughly 278 per 1,000 Medicare beneficiaries were diagnosed with depression or a proxy disorder before the storm, and an additional 167 per 1,000 were found to be at risk. Despite this higher-than-county average, only 1.19% of beneficiaries were screened.

The rate in Middlesex County at large was even lower, with less than 1% of Medicare beneficiaries receiving depression screening. However, the prevalence of depression and proxy disorders in the county is slightly lower than New Brunswick itself, with about 236 per 1,000 beneficiaries diagnosed.

Since the storm, the new incidences of depression diagnoses among Medicare recipients has decreased nearly 26%, and prevalence in general has dropped a bit. But, given the lack of screening utilization the undiagnosed population may well be substantial.
Skywer-Brandwene said the report represents an opportunity bridge some of the gaps in healthcare service, especially during a crisis situation like a natural disaster.

“This is an area where we can really get the word out and maybe the profiles will be really useful,” she said.

“[The profiles are meant] to help start a conversation about how we can put our heads together and take advantage of available resources and get everyone at the community level to talk to each other and raise some awareness.”

The covered depression screening can help identify depression and the proxy disorders and allow Medicare recipients to start receiving treatment, it just needs to be utilized first. The hope of Skywer-Brandwene is that HQSI’s report helps turn the tide.