Appendixes B, C, D

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Appendix B — Treatment of Patients With Dual Disorders: Sample Cost Data

To provide readers with illustrative data on the costs of running programs for patients with dual disorders, the consensus panel Chair obtained data on actual costs during fiscal year 1991-1992 from three programs in urban areas. One program, on the West Coast, provided day and evening intensive outpatient services. The second, in the Northeast, provided intensive outpatient services during the day. In the third program, in the Northwest, daytime intensive outpatient services, partial hospitalization, and intensive case management were provided.

Included in the tables below are descriptive data for each program, including institutional status (for example, private for-profit or public), payer mix (for example, Medicaid or self-pay patients), number of clients served (at 100 percent capacity), salary ranges of various levels of staff, and other expenses (for example, facility costs). Total expenses and total revenues for each program are listed at the end.

TREATMENT OF PATIENTS WITH DUAL DISORDERS SAMPLE COST DATA

Program 1 Program 2 Program 3
___________________________________________________________
PROGRAM TYPE
Evening Intensive X
Outpatient
Day Intensive X X X
Outpatient
Partial X
Hospitalization
Other Day treatment
and intensive
case
management
___________________________________________________________
REGION West Coast Northeast Northwest
___________________________________________________________
LOCALE Urban Urban Urban
___________________________________________________________
INSTITUTIONAL STATUS
___________________________________________________________
Private for-profit X
Private nonprofit
Public X X
Other
___________________________________________________________
PAYER MIX (BY PERCENT)
___________________________________________________________
Insurance/Managed X
Care
Medicaid 66% 30%
Medicare X 25%
Self-pay X 4%
HMO contract X
State grant/purchase 30% 45%
of care
TREATMENT OF PATIENTS WITH DUAL DISORDERSSAMPLE COST DATA
Program 1 Program 2 Program 3
____________________________________________________________________________________________
NUMBER OF PATIENTS SERVED (AT 100 PERCENT CAPACITY)
____________________________________________________________________________________________
Daily 50+ 45 100
Weekly 320 225 300
____________________________________________________________________________________________
SALARY RANGES
____________________________________________________________________________________________
Administrators/managers $60,000 to 70,000 $38,000 to 50,000 $35,000 to 60,000
Physicians $70/hour to $85,000 $70,000 to 90,000
100/hour
Social workers $30,000 to 50,000 $30,000 $26,000 to 35,000
Psychologists $50,000 to 60,000 n/a $50,000 to 70,000
Support staff $18,000 to 27,000 $20,000 to 29,000 $22,000 to 28,000
Other Addiction Nurses, Addiction
counselors, counselors and mental health
$23,000 to 35,000 recreational specialists
therapists $23,000 to 33,000
$25,000 to 38,000 -----------------
Nurses
$32,000 to 48,000
TREATMENT OF PATIENTS WITH DUAL DISORDERS SAMPLE COST DATA
__________________________________________________________________________
Program 1 Program 2 Program 3
__________________________________________________________________________
OTHER EXPENSES (BY PERCENT)
__________________________________________________________________________
Administrative overhead 7.1% 24% 20%
Personnel (including 80.5% 60% 70%
fringe benefits)
Facility costs 12.4% 16% 10%
__________________________________________________________________________
TOTAL EXPENSES FY 1991-1992 TOTAL REVENUES
FY 1991-1992
__________________________________________________________________________
Program 1 $482,000 $489,000
Program 2 $811,052 $561,052
Program 3 $2,200,000 $1,980,000
__________________________________________________________________________

Appendix C — Federal Resource Panel

John J. Ambre, M.D., Ph.D.
American Medical Association
Robert Anderson
Director
Criminal Justice Service
National Association of State Alcohol and Drug Abuse Directors
Richard J. Bast
Public Health Advisor
Quality Assurance and Evaluation Branch
Division of State Programs
Center for Substance Abuse Treatment
Sandra M. Clunies, M.S., N.C.A.D.C.
President, Maryland Addiction Counselor Certification Board
Dorynne Czechowicz, M.D.
Associate Director
Medical and Professional Affairs
Division of Clinical Research
National Institute on Drug Abuse
Walter L. Faggett, M.D.
National Medical Association
Rita Goodman, M.S., R.N.C.
Nurse Consultant
Division of Primary Care Services
Health Resources and Services Administration
John Gregrich
Policy Analyst
Office for National Drug Control Policy
Executive Office for the President
Claudia Hart
American Psychiatric Association
Ruth H. Carlsen Kahn, D.N.Sc.
Special Projects Section
Division of Medicine
Bureau of Health Professions
Health Resources and Services Administration
Saul M. Levin, M.D.
Director
Office of Health Care Linkage
Center for Substance Abuse Treatment
Cherry Lowman, Ph.D.
Health Scientist Administrator
Treatment Research Branch
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
Anna Marsh, Ph.D.
Associate Director for Evaluation
Office of Applied Studies
Center for Substance Abuse Treatment
Fred C. Osher, M.D.
Deputy Director
Office of Programs for the Homeless Mentally Ill
National Institute of Mental Health
Deborah Parham, Ph.D., R.N.
Chief
Special Initiatives
Policy and Evaluation Branch
Bureau of Primary Health Care
Health Resources and Services Administration
Kay Pearson, R.Ph., M.P.H.
Senior Health Policy Analyst
Agency for Health Care Policy and Research
Public Health Service
Bert Pepper, M.D.
The Information Exchange
New City, New York
Richard K. Ries, M.D. (Chair)
Director of Inpatient Psychiatry and Dual Disorder Programs
Harborview Medical Center
Seattle, Washington
Harry Schnibbe
Executive Director
National Association of State Mental Health Program Directors
Sarah Stanley, M.S., R.N., C.N.A, C.S.
American Nurses Association
Patricia M. Weisser
National Association of Psychiatric Survivors

Appendix D — Field Reviewers

Arthur I. Alterman, Ph.D.
Scientific Director
Center for Studies of Addiction
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania
Robert Anderson
Director, Criminal Justice
National Association of State Alcohol and Drug Abuse Directors
Gloria J. Baciewicz, M.D.
Director
Alcoholism and Drug Dependency Program
University of Rochester Medical Center
Rochester, New York
Stephen J. Bartels, M.D.
Medical Director
West Central Services, Inc.
Research Associate
N.H. Dartmouth Psychiatric Research Center
Lebanon, New Hampshire
Richard J. Bast
Public Health Advisor
Center for Substance Abuse Treatment
Joseph J. Bevilaqua, Ph.D.
Director
South Carolina Department of Mental Health
Dolores M. Burant, M.D.
Program Director and Medical Director
University Outpatient Recovery Services
Madison, Wisconsin
Ricardo Castaneda, M.D.
Director
Inpatient Psychiatry at Bellevue Hospital
New York Medical Center
Nancy C. Carter
Director
Special Division for Alcohol and Drug Abuse Services
South Carolina Department of Mental Health
Maureen Connelly, Ph.D.
Professor
Department of Sociology and Social Work
Frostburg State University
Frostburg, Maryland
Marcelino Cruces, L.I.C.S.W.
Administrative Coordinator
Andromeda Transcultural Mental Health Center
Substance Abuse Treatment Division
Washington, D.C.
Dorynne Czechowicz, M.D.
Associate Director for Medical and Professional Affairs
Division of Clinical Research
National Institute on Drug Abuse
Robert E. Drake, M.D., Ph.D.
Professor/Director
N.H.-Dartmouth Psychiatric Research Center
Dartmouth Medical School
Lebanon, New Hampshire
Mary Katherine Evans, C.A.D.C., N.C.A.C. II
Treatment Coordinator
Evans and Sullivan
Beaverton, Oregon
Walter L. Faggett, M.D.
Pediatrics/Health Care Consultant
Capitol Area Health Services
National Medical Association
Denis Ferguson, M.A., C.S.A.D.C.
Program Manager
Substance Abuse Services
DuPage County Health Department
Wheaton, Illinois
James Fine, M.D.
Director
Addictive Disease Hospital at Kings County Hospital Center
Clinical Associate Professor
Department of Psychiatry
State University of New York
Health Service Center at Brooklyn
Brooklyn, New York
Agnes Furey, L.P.N., C.A.P.
Primary Care Coordinator
Florida Drug and Alcohol Abuse Program
Department of Health and Rehabilitation Services
Tallahassee, Florida
Harry W. Haverkos, M.D.
Acting Director
Division of Clinical Research
National Institute on Drug Abuse
Elizabeth A. Irvin, M.S.W.
Director of Service Integration
Department of Mental Health
Commonwealth of Massachusetts
Edward K. Katz, M.D., M.P.H.
Mind Science
Consultation for Problems in Thinking and Feeling
Stow, Ohio
Ruth H. Carlsen Kahn, D.N.Sc., R.N.
Special Projects Section
Division of Medicine
Bureau of Health Professions
Health Resources and Services Administration
George Kolodner, M.D.
Kolmac Clinic
Silver Spring, Maryland
Susan Krupnick, R.N., M.S.N., C.A.R.N., C.S.
Psychiatric Consultation Liaison Nurse
Department of Psychiatric Nursing
Hospital of the University of Pennsylvania
Fox Chase Manor, Pennsylvania
Robert M. Lichtman, Ph.D., C.A.C.
Associate Psychologist/Program Coordinator
Richmond Hill Outpatient Division
Creedmoor Psychiatric Center
Richmond Hill, New York
Herbert J. McBride
President and Medical Director
Re-Enter, Inc.
Philadelphia, Pennsylvania
Catherine Devaney McKay, M.D.
Chief Executive Officer
Connections Community Support Programs, Inc.
Wilmington, Delaware
Norman S. Miller, M.D.
Associate Professor of Psychiatry
Department of Psychiatry
University of Illinois at Chicago
Thomas Neslund
Executive Director
International Commission for the Prevention of Alcoholism and Drug Dependency
Silver Spring, Maryland
John Nielsen, L.P.C., C.C.D.C., M.S.S.
Alcohol and Other Drugs Counselor
Threshold Youth Services
Sioux Falls, South Dakota
Robert E. Nikkel, M.S.W.
Coordinator
Adult Program Services Team
Mental Health and Development Services Division
Office of Mental Health Services
State of Oregon
Fred C. Osher, M.D.
Acting Director for Demonstration Programs
Center for Mental Health Services
William C. Panepinto, A.C. S.W.
Assistant Director
Homelessness/Housing Unit
New York State Office of Alcoholism and Substance Abuse Services
T. Allan Pearson, M.S.W.
Mental Health, Alcohol, and Other Drug Abuse Counselor
Ozaukae County Department of Community Programs
Port Washington, Wisconsin
Walter E. Penk, Ph.D.
Chief
Psychology Services
Edit Nourse Rogers Memorial Veterans Hospital Bedford, Massachusetts
Harold I. Perl, Ph.D.
Public Health Analyst
Homeless Demonstration and Evaluation Branch
National Institute on Alcohol Abuse and Alcoholism
Ernest Quimby, Ph.D.
Assistant Graduate Professor
Department of Sociology and Anthropology
Howard University
Washington, D.C.
Kathleen Reynolds, M.S.W., A.C.S.W.
Associate Coordinator
Livingston/Washtenaw Substance Abuse Coordinating Agency
Washtenaw Community Mental Health
Ypsilanti, Michigan
Henry Jay Richards, Ph.D.
Associate Director for Behavioral Sciences
Patuxent Institution
Jessup, Maryland
Richard K. Ries, M.D.
Director of Inpatient Psychiatry and Dual Disorder Programs
Harborview Medical Center
Seattle, Washington
Bruce J. Rounsaville, M.D.
Associate Professor of Psychiatry
Division of Substance Abuse
Yale School of Medicine
New Haven, Connecticut
Harry Schnibbe
Executive Director
National Association of State Mental Health Program Directors
Bonnie Schorske, M.A.
Coordinator
Special Populations
New Jersey Division of Mental Health and Hospitals
Candace Shelton, M.S., C.A.C.
Clinical Director
Pascua Yaqui Adult Treatment Home
Tucson, Arizona
Elizabeth C. Shifflette, Ed.D.
Staff Development and Training Coordinator
South Carolina Commission on Alcohol and Drug Abuse
Virginia Stiepock, R.N., A.C.S.W., C.S.
Assistant Center Director/Clinical Director
Northern Rhode Island Community Mental Health Center, Inc.
Woonsocket, Rhode Island
Mathias E. Stricherz, Ed.D., C.D.C. III
Director
Student Counseling Center
University of South Dakota
Vermillion, South Dakota
J. Michael Sullivan, Ph.D.
Clinical Director
Evans and Sullivan
Beaverton, Oregon
Johnie L. Underwood, B.S., C.S.W.
Assistant Deputy Director
Division of Mental Health and Addictions
Indiana Family Social Services Administration
Mark C. Wallen, M.D.
Medical/Clinical Director
Livengrin Foundation, Inc.
Bensalem, Pennsylvania
Linda M. Washington, M.S.N., R.N., C.S.-P.
Psychiatric Nurse Clinical Specialist
Outpatient Addictions Services
Montgomery County Department of Addictions, Victims, and Mental Health Services
Rockville, Maryland
Patricia M. Weisser
National Association of Psychiatric Survivors
Sioux Falls, South Dakota
Sonya Cornell Yarmat, M.A.
Consultant
Division of Alcohol and Drug Abuse Services
Department of Social Rehabilitation
Topeka, Kansas
Doug Ziedonis, M.D.
Assistant Professor
Department of Psychiatry
Medical Director, Substance Abuse Treatment Unit
Outpatient Services
Yale University
New Haven, Connecticut
Joan Ellen Zweben, Ph.D.
Executive Director
East Bay Community Recovery Project
14th Street Clinic and Medical Group
Berkeley, California

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