More threads by David Baxter PhD

David Baxter PhD

Late Founder
Detox Without Followup Does Nothing to Stop Addiction
Wednesday, April 18, 2007

A story from yesterday's New York Times looked at excessive Medicaid spending on drug and alcohol related treatment in New York state. As you can see in the graphic below, the laws that govern Medicaid in New York state incentivize hospitals to use costly detox treatments for persons who arrive at the emergency room drunk or intoxicated. Essentially, what has been created is a situation wherein it is not in hospital's best interest to treat indigent addicts, who are often homeless, in a manner that is both cost effective and effective for the situation. As the NYT writes, the nature and even the root of the problem are understood by virtually everyone involved:

Among state officials, doctors who treat addiction, service groups dedicated to helping the homeless and mentally ill, even the addicts themselves, there is remarkable agreement on why the treatment system in New York is overpriced and inefficient.

In other states, most addicts who go through detox programs do so on an outpatient basis, while in New York the vast majority are inpatients. Medicaid rules in New York also encourage hospitals to provide the most expensive kind of inpatient detoxification, though it is often not medically necessary, while many other states favor a less expensive form of inpatient treatment.

And in New York, when patients are discharged ? typically after about five days ? the needed transition to an outpatient treatment program often never occurs. That is one reason many patients do not fully recover from their addictions and return to detox wards, experts say.​
According to numbers dug up by the NYT, New York spends $50 million alone on its 500 most expensive clients. In 2005 one patient spent 279 days out of the year in a detox ward, which cost the state $300,000 for that person alone.

This is a system that cleans these individuals up and sends them back into the world where they may have no place to go, may not have the skills or support to survive, and then goes through all the motions again when someone shows up at the ER a couple of days or weeks later. The problem is that in our current system, it's difficult to make it worth hospitals time to do the hard work of rehabilitating addicts, and setting them on a path toward recovery.

As folks in the article discuss, a change as small as following up with patients after discharge to make sure that each person has found an outpatient program to continue their movement toward a healthier life could have an enormous impact not only from a financial standpoint, but from the standpoint of the lives that would be effected. Say for example that Medicaid allowed each hospital to create an administrative position to follow up on difficult cases. A simple cost-benefit analysis would tell us how much that person should be paid, and it's not unreasonable to figure that a $60,000 employee could save hundreds of thousands if not millions of dollars.

The incredibly talented writer Malcolm Gladwell covered this same territory over a year ago with an article that he wrote about dealing with homelessness. The measures that he talks about in that piece could shine a bright light on this current situation in New York, and potentially serve as a starting point for great discussion about treating addicts nationwide.
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