Published by: Kiran Sreenivas on 1/6/2012 4:32:30 PM
This New Year marks another year closer to Medicaid expansion in 2014 and Medicare’s Value Based Purchasing Program for fiscal year 2013. Both are part of the Affordable Care Act (ACA) of 2010. While NAPH works with safety net hospitals to adapt to health reform through various projects, like the NAPH Safety Network, hospitals also have to continue addressing problems present before and after health reform. Domestic violence or intimate partner violence (IPV) is one of those ongoing challenges for hospitals.
The CDC separates IPV into four types: physical violence, sexual violence, threats of physical or sexual violence, and psychological/emotional violence. Any one of the four types constitutes as IPV, and there is no frequency or severity threshold for defining IPV. It can be committed by a spouse, an ex-spouse, a current or former boyfriend or girlfriend, or a dating partner.
The prevalence of IPV may surprise some. Through the Behavioral Risk Factor Surveillance System, the CDC in 2005 found that one in four women has experienced IPV in her lifetime.
For me, the real surprise is the associated health conditions of IPV and the resulting treatment costs. The CDC found that women who have experienced IPV are 80% more likely to have a stroke, 70% more likely to have heart disease, and 70% more likely to drink heavily than women who have not experienced IPV. A 2011 study in Denmark found that women of violence had about 1,800 Euros (approx. $2,300) more in health care costs per year than non-victims. Studies in the U.S. have found that the cost of IPV within the first 12 months after victimization can range from $2.3 billion to $7 billion.
While the issue of domestic violence would ideally be left to law enforcement officials, hospitals often find themselves in the middle. Victims of IPV often seek treatment through the emergency department. Hospitals are pushed to screen for domestic violence through accreditation and licensure requirements. To be accredited by the Joint Commission, a hospital must have a policy to screen and meet the needs of domestic abuse victims. In California, state law requires licensed hospitals to have written policies and procedures to not only screen but also document related injuries in the medical record and refer victims to available crisis intervention services.
Given their large proportion of low income patients, safety net hospitals have to be extra vigilant of potential IPV victims. People with an annual income of below $25,000 are at a 3-times higher risk of IPV than people with an income over $50,000.
The American Medical Association and the American Hospital Association state that if domestic violence is identified, a domestic violence diagnostic code should be used as a primary diagnosis. This, however, is not often the case, because the reimbursement level for this code is very low or non-existent. The Affordable Care Act may potentially help fix this problem. Domestic violence screening and counseling is included in the list of preventive services women will receive at no additional cost beginning in August 2012.
It is unfortunate more is not being done to prevent IPV. It looks like the problem may only be getting worse as it begins to start at earlier ages. In a 2008 survey of 11-14 year olds, one in four said dating violence (e.g. physically hurting relationship partners) is a serious problem among peers.
The Supreme Court case on the ACA this year may significantly impact the burden of health reform for hospitals. Unfortunately there is nothing the Supreme Court can say that will solve or ease the burden of domestic violence or intimate partner violence.