WISCONSIN HOSPITALS AGONIZE OVER SHRINKING ADDICTION PROGRAMS

Most Patients Are Receiving Different Forms Of Treatment Due To Changes In
Funding.

Squeezed by finances, Wisconsin hospitals are backing away from 24-hour care
for alcoholics and drug addicts.

Group homes and outpatient clinics are becoming the providers of choice for
the state and private insurers. It's cheaper and just as effective,
proponents say.

But others argue that some addicts, however few, need 24-hour care in a
hospital. For them, the options are shrinking.

"It's a tragedy," said Dr. Michael Miller, medical director of Meriter
Hospital's alcohol and drug-abuse program.

"People approach me, and they tell me that with all the increases in
addiction, business must be good.

"Well, the problem is there, but business is not good because the funding to
pay for health care for these people is shrinking. That means the number of
people able to enter treatment is shrinking."

Those who hold the purse strings don't see the situation as a tragedy.

"The money is there," said Michael Quirke, program evaluator for the state
Bureau of Substance Abuse Services. "But we are evolving towards using the
money more wisely, making decisions about patient care that provide the
least restrictive and less intense form of treatment. It's not a negative
thing."

St. Clare Hospital and Health Services in Baraboo last month closed its
inpatient 24-hour alcohol and drug abuse program. The hospital, facing
estimated losses from the programs of $300,000 a year, also closed three
clinics in New Lisbon, Richland Center and Baraboo.

In Madison, Meriter Hospital is agonizing over the future of its NewStart
program, the only hospital-based inpatient drug and alcohol rehab center in
Dane County. Though no final decision has been made, employees were recently
told to expect major changes.

Across the state the numbers are sobering: from 1998 to 1999, the number of
inpatient treatment programs at hospitals dropped from 42 to 28, according
to Quirke.

In Wisconsin and elsewhere, hospital-based programs are being replaced in
part by community-based residential facilities, non-medical 24-hour programs
that are cheaper to operate, Quirke said.

Such facilities are not staffed round-the-clock by doctors and nurses, as
are hospitals, and are not for people who have medical problems along with
their addiction, he said.

Though Medicaid does not yet pay for such residential treatment, many
experts see them as an improvement over hospitalization.

"The data I've seen overwhelmingly suggests that inpatient treatment is no
more effective (than outpatient treatment) for the vast majority of people
with addictive disorders," said Dr. Ron Diamond, medical director of the
Dane County Mental Health Center.

"There may be a small number of people for whom the expense of
hospital-based treatment is justified, but for the vast majority, that's not
where I would spend the money."

Quirke acknowledged a need for 24-hour medical care for some patients. "If
for some reason these types of programs kept diminishing, the state would
have to intervene and figure out some way of bolstering them."

Anne Helwig, vice president of ambulatory services at St. Clare Hospital and
Health Services, said addicts and alcoholics who need hospitalization will
fall through the cracks.

"They will have to go elsewhere, and frankly, right now, I don't know where
that is. ... It makes you sick," Helwig said. "If they have serious medical
problems, we can longer take care of them."

The demise of facilities for hospitalizing addicts is part of a national
trend driven by dollars and changing theories of care:

In Memphis, Tenn., Methodist HealthCare announced the closure of its
residential addiction treatment program about eight months ago.

Durham County Hospital in North Carolina is thinking about closing the
county's only in-patient drug detox center.

Four Indiana psychiatric hospitals that offered inpatient addiction
treatment closed this year.

Despite increasing demand, Miami and Dade County closed their detox center
two years ago.

"The problems facing the addiction treatment field are significant and
widespread," said Miller. "Addiction programs from coast to coast have been
closing or reducing their services and offerings in the last 10 years. It is
an alarming trend."

But Quirke said state and private insurers are making wiser decisions about
patient needs which means in many cases not sending them to 24-hour
medically supervised care.

Financial pressures are a factor. Health maintenance organizations (HMOs),
private insurance companies and state-funded programs have reduced benefits
for 24-hour hospital care for addicts.

In Wisconsin, Miller said, state employees' insurance coverage changed two
years ago so that detox and rehab services were restricted.

"When the change was made for that employee group, many HMOs followed suit,"
he said.

"So patients don't have insurance benefits to cover it, and they can't
afford to self pay. Any addiction service provider is faced with these sorts
of realities."

According to a study done last year for the American Society of Addiction
Medicine, harmful addictions plague about 18 percent of the American
population.

But the value of addiction insurance coverage for employees of mid-to
large-size companies declined by 75 percent from 1988 through 1998, the
study said.

"Under managed-care plans purchased by middle-to large-scale employers,
inpatient substance abuse treatment is virtually no longer available, except
in life-threatening situations," the study said.

In Baraboo, Helwig said the decision to close 24-hour programs, while
maintaining its outpatient services, was tough.

"In recent years reimbursement for treating addiction has declined," Helwig
said in a letter July 14. "This has resulted in financial losses which have
grown beyond St. Clare Hospital's ability to absorb them."

The hospital also turned down a large state grant to provide alcohol and
drug treatment for low-income women because it would have been too costly
for the hospital to support it.

Without the program cutbacks, "it would have been necessary to follow the
path of so many alcohol- and drug-abuse programs in Wisconsin that have
closed," she said.

In short, Helwig said last week, "if we continued it as it was, it was
doomed to fail."

Diamond said the problem is not that 24-hour hospital-based programs are
closing. "The real issue is, what are we replacing it with? Who else is
opening programs and how good are they ... ?

"The problem is that the money is drying up so you are not getting other
programs."

At Meriter, hospital executives and board members are struggling over
whether to kill the NewStart program totally or just abandon some portions.

Miller, for one, advocates pairing up with St. Mary's and University
Hospital to pay for a 24-hour addiction program.

Mary Starmann-Harrison, president of SSM Health Care of Madison, said last
week she didn't know if such a partnership had been discussed.

"We have partnered on certain things in the past," she said. "That may be a
thought."