Drug center at hospital is struggling Pathways fails to attract patients


In Friday's Anne Arundel editions, the actress who appeared in Annapolis in October for the opening of the Pathways Chemical Dependency Program at Anne Arundel Medical Center was identified incorrectly. Cathy Lee Crosby appeared at the opening. In addition, the hospital will not move its 12-bed psychiatric unit to Pathways, but rather is considering working some psychiatric services into the program.

The Sun regrets the errors.

Ten months ago, Anne Arundel Medical Center viewed the opening of its new adolescent addictions treatment center as such an event that it dragged local-girl-made-good Kathie Lee Gifford back to Annapolis to help in the celebration.

So far, the center has failed to live up to its advance hoopla -- a victim of bad timing and a health care network that shies away from confining substance abusers to hospitals. Officials at the medical center are scrambling to find ways to fill the facility's 40 beds.

Those ways include possibly transferring to Pathways the hospital's 12-bed psychiatric unit. Hospital officials have been trying to close that unit for months, saying it is under-used, but have yet to receive permission from the state.

Because admissions at Pathways have been so low, hospital administrators abandoned their original plan last month to treat only 12- to 25-year-olds and started accepting adults of all ages.

Before then, the center had an average of only seven or eight patients. Since accepting older adults, admissions have picked up, hospital spokeswoman Nancy Hemby said.

Yesterday, the program had 15 residential patients, the highest number to date. The number of patients using the program's out-patient services has also doubled, from about 20 to 40, she said.

But even though admissions have picked up, two-thirds of the facility's beds remain empty. And more than a third of the admitted patients have been reduced-payment or "charity cases," those who cannot afford payment at all, administrators said.

"It's been really rough," said Fran D. Counihan, vice president of public relations and marketing, stressing that low admissions are mostly because Pathways is a new program. Building a reputation and gaining more referrals takes time, she said.

But others in the drug treatment field said Pathways' slow start is mostly a case of bad timing. The hospital opened the $4.5 million, 31,000-square-foot facility at the same time insurance companies were tightening up on in-patient treatment.

"The bottom just fell out of the industry," Susan Ward, vice president of operations at North Arundel hospital, said during a Local Health Planning Board meeting last week where Pathways' problems were discussed.

North Arundel, citing annual losses of more than $1 million, closed its hospital-based drug and alcohol detoxification program June 1. During its final year, almost 80 percent of the patients treated either had no insurance or had insurance that didn't cover the treatment, said hospital spokesman Kevin Murnane.

Richard J. Coughlan, an administrator with the Maryland Health Resources Planning Commission, said Pathways is not the only addictions center feeling the crunch.

Other drug treatment providers in the state that had planned to open similar facilities two or three years ago are now thankful they didn't, he said.

"Some have said, 'Thank God you delayed our approval and we didn't do it,' " he said. "Pathways was built on the assumption that there would be a continuing need and there would continue to be third-party payers. . . . Insurance companies may have been too generous in the past with who they'd cover. Now they're covering fewer people."

Focus has shifted

Emphasis has shifted from in-patient to out-patient treatment, which is less expensive at least initially, he said. But in some cases, it may be less effective.

Although some patients do well with out-patient services, said -- Phyllis Baron, clinical director of Pathways, others need the around-the-clock treatment provided by residential programs. After a number of studies are completed determining what types of treatment are most effective, insurance providers may relax -- some restrictions, she said.

"If you don't give the proper treatment up front, you'll end up treating them again and again, which will cost more in the long-run," she said. Insurance companies "want the most for their money. They may conclude that means more residential treatment."

In the meantime, Pathways is aggressively pursuing strategies to increase admissions and make the facility more profitable. The hospital recently embarked on an "awareness campaign," said Ms. Hemby, approaching businesses with employee assistance programs, schools and other organizations to sell its program.

The hospital is pursuing contracts with various health-care providers, said Ms. Baron. It recently signed an agreement to accept indigent adolescent clients, whose care would be paid for by the state's Mental Hygiene Administration, she said. Pathways is the sixth facility to have such a contract with the state and Ms. Baron speculated it could result in a substantial number of new clients.

Working with insurers

Pathways also continues to seek agreements with insurance companies and health maintenance organizations, which will refer patients only if they have a relationship with a program. Developing these relationships takes time, said Ms. Baron, but Pathways recently negotiated a number of new contracts with insurance providers.

"The hospital is backing Pathways. They are really committed to keeping it open," she said. "They're not interested in making a profit on it. They just want it to break even."

Mr. Coughlan said whether residential treatment facilities survive over the next few years may depend on how creative they are about offering needed services. "If they're poorly used, they'll have to figure out ways to make it work," he said.

Two weeks ago, Anne Arundel Medical announced it would consider moving psychiatric services, such as a unit for people diagnosed with both addiction problems and mental illnesses, into Pathways. In April, the hospital had requested permission from the state to close its 12-bed psychiatric unit in the Franklin Street facility in downtown Annapolis.

Although a staff report from the health planning commission indicated approval would be forthcoming, hospital administrators asked the state to postpone its decision while they studied other options.

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