North Arundel Hospital to close drug detox unit New regulations make it harder to get payment

February 05, 1993|By Deidre Nerreau McCabe | Deidre Nerreau McCabe,Staff Writer

North Arundel Hospital announced yesterday it will close its 12-bed chemical dependency unit this June, leaving Anne Arundel County without a facility where people can kick their drug habits in a hospital setting.

Hospital spokesman Kevin Murnane said officials at the Glen Burnie hospital could no longer justify the financial drain caused by the unit -- particularly in light of new state regulations making it harder to get Medicaid reimbursement for patients going through detoxification.

It costs about $800 a day to treat a patient in the unit, he said, and this year the hospital will not receive payment for almost 80 percent of those patients. Officials expect the unit to loose $1.5 million in the fiscal year ending June 30. The unit lost more than $1 million the previous year, Mr. Murnane said.

North Arundel, which opened its chemical dependency unit in 1981, treats about 100 to 120 patients a month. It has treated 12,000 people since it opened, Mr. Murnane said.

County drug treatment workers lamented North Arundel's decision, saying it would leave a gap in needed services.

"I can't even say how extensive the impact will be, I'm just not sure at this point," said Bill Rufenacht, director of Hope House, a residential treatment facility in Crownsville.

"It's just really a mess," he said. "It's a real shame another level of care is disappearing."

Last October, Anne Arundel Medical Center opened its first drug and alcohol treatment program, called Pathways, which is certified to do nonhospital detoxification. That means it can treat patients who need "mild to moderate" detoxification services, said spokeswoman Carolyn Tonty. But those in need of "acute" detoxification and round-the-clock medical care cannot be served there, she said.

Most county patients in need of such treatment probably will have to seek it in Baltimore, which also has had its share of closings. Only three city hospitals still have units -- Harbor Hospital Center and Francis Scott Key Medical and Mercy Medical centers.

Administrators at Harbor -- the closest hospital that also has a detoxification unit -- said they will work within the new regulations to keep its 10-bed unit open.

The new state regulations no longer allow Medicaid patients to check themselves into a hospital for detoxification. Instead, a doctor must determine that there is a medical need for a hospital stay and that detoxification could not be handled through

outpatient services.

Harbor, which serves northern Anne Arundel County and South Baltimore and treats a large number of low-income patients, has changed the way Medicaid patients are admitted to the unit.

"All patients must now be admitted through the emergency room," said Vicki Shockey, clinical leader for chemical dependency. "If they have medical problems, they can be

admitted for treatment, and it will be covered."

Ms. Shockey said she does not think the new Medicaid rules will put patients at risk.

But other hospital administrators were not so sure.

Dr. Donald Jasinski, chief of the Center for Chemical Dependency at Francis Scott Key Medical Center, said that under the new regulations, which went into effect Dec. 1, reimbursement was being denied even for some of the sickest patients.

"That's the experience we've had," he said. "They've basically decided they don't want to pay for inpatient detoxification."

Despite that, he said, Francis Scott Key is committed to keeping its 26-bed unit open.

"It's going to be an ethical, moral, medical and legal disaster," he said, referring to the closing of units. "We're going back to how it was 20 years ago."

Dr. Jasinski said Key Medical Center normally is not reimbursed for 30 percent to 40 percent of its detoxification patients.

When the North Arundel program opened, patients -- about 95 percent of whom were county residents -- received seven days of treatment.

Over the years, as insurance companies reduced payments for hospital-based drug and alcohol treatment, the length of stay has dwindled to 2.2 days, he said. And as more hospitals have closed their units, patients have come from farther away. Now, 65 percent of the clients are from Anne Arundel.

Many patients do not have insurance coverage, and even those who do may not have benefits for inpatient alcohol and drug treatment, Mr. Murnane said.

"A lot of people come in, they may not have a job or insurance," he said. "Even if they have insurance, it may not cover treatment."

To accommodate patients who normally would be admitted to the unit, counselors will be assigned to the emergency room to help them find outpatient treatment, he said. Patients with serious medical problems in addition to chemical dependency, such as bleeding ulcers or severe gastrointestinal problems, will be admitted to one of the hospital's other departments for treatment.

Pushing more clients to outpatient treatment may decrease the chances of success for some people, Mr Murnane said. But, he said, the hospital has no other option.

"More of the responsibility will have to go back to the client," he said.

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