In 2002, roughly 60% of patients at the Austin Riggs Center paid for treatment out of pocket, with the remaining 40% having relied partially or entirely on insurance. Finances are candidly discussed with patients and/or their families at admission and beyond to help figure out how to make the most of their resources. Said Shapiro, ŎThis is the place where Riggs has met the realities of the outside world.Ŏ The most intensive level of care at Riggs--in-hospital care--costs $870 per day, while the least intensive--aftercare--costs $105 per day. Patients see their individual therapist four times per week regardless of treatment level and are followed by the same clinical team through the entire stay at the program. When Maryland's Chestnut Lodge (an intensive, long-term, psychodynamically oriented treatment institution) closed its doors in April 2000, it left a vacuum. In Montgomery County, Md., administrators at Sheppard Pratt Health System began receiving inquiries from patients and family members who had been treated at Chestnut Lodge. ŎWe realized the only way we could do that was to make it a private-pay situation,Ŏ said Bonnie Katz, vice president of corporate business development for Sheppard Pratt, in an interview with PT. ŎThe milieu on any of the units is geared toward the majority of the patients, which is one of crisis stabilization--that's all insurance will really pay for. å We had heard from folks that if they were paying, they would be looking for something that offered more privacy and more amenities. We decided to blend those two needs--longer-term psychodynamic milieu and an environment [where] people would feel they were getting the physical setting their payment provided.Ŏ
Ironically, not a single former Chestnut Lodge patient has been treated at The Retreat since it opened, said Katz.
Inpatients on the six-bed unit are expected to stay a minimum of 20 days, compared to the average three- to five-day stay for patients being treated on other Sheppard Pratt units. The cost is $1,500 per day. The hospital hopes to generate profits of $350,000 to $400,000, which Katz said will go to subsidize less profitable hospital programs.
The $750,000 spent on renovating and furnishing the 19th-century building has resulted in a tasteful, comfortable environment that Katz said, Ŏlooks more like a bed and breakfast than an inpatient unit.Ŏ She added, ŎI don't think we've gone to extremes in terms of the decor. å The focus, regardless of the decor, was to create a safe environment. We still had to pay attention to issues that might interfere with a patient's safety.Ŏ Consequently, draperies, as well as plumbing and electrical fixtures, have been modified, and patients staying in the tastefully decorated rooms will see themselves reflected in mirrors made of safety glass.
The benefits of a self-pay unit may be more than skin deep, according to Michael C. Miller, M.D., editor in chief of The Harvard Mental Health Letter. The longer lengths of stay on such units afford the clinical team extra time to put together a better aftercare plan, not an insignificant consideration given the ever-increasing limits on both inpatient and outpatient treatment imposed by third-party payers. ŎIf the clinicians have a free hand to do everything in their power to figure out what the person's problem is and how to be most helpful, that seems to be money [well] spent,Ŏ he told PT.
In addition, the personalized care offered by high-end units enables clinicians to spend more time talking to patients and their families about clinical issues, time that isn't reimbursable on ordinary units. ŎClinicians, whether doctors, nurses or other mental health professionals, are all very busy, and there is very little time for the kind of supportive interactions that any family or individual might like as part of their treatment,Ŏ said Miller. ŎThe shame is that it's not just rich people who deserve that attention, but the way the system is set up, money and time need to be rationed out.Ŏ
Personalized attention is the raison d'etre at Butler Hospital's Duncan Lodge, where patients stay for about 14 days at an average cost of $2,100 per day. The Lodge includes five suites, all of which have the amenities of a luxury hotel room. According to Anne Powers, vice president of marketing and public affairs at Butler Hospital, no modifications related to safety concerns were made in the design or decor of Duncan Lodge, as patients are expected to be able to safely manage in an unlocked setting.
There are no dog-eared issues of magazines lying around common areas. The Wall Street Journal is delivered daily and patients can leaf through current issues of Architectural Digest, National Geographic and The New Yorker, the last of which happens to be a popular and fertile source of inquiries for all three programs.