In 2022, Door County was billed $447 per day for inpatients, but in 2023 it was billed about $975 per day.
The figures for inpatient costs and days of inpatient treatment are in a table on https://www.co.door.wi.gov/AgendaCenter/ViewFile/Agenda/_02122024-1611#page=42. The total cost for 2023 is yet to be determined, since it says that for the “Separated Inpatient/Residential cost for 2023” there have been “Seven clients bills not accounted for in totals”.
The jump in costs also shows up when looking at the per day cost averages for the four quarters. The Q1 per day average is $557, Q2 is $$857, Q3 is $1254, and Q4 is $987. The Q1 figure is relatively close to the 2022 average per day cost and the subsequent quarters are all closer to the 2023 average per day cost.
The budgeted amount for 2023 was similar to the actual cost for 2022, indicating that the jump in costs was unexpected; there was a large budget overrun for inpatient costs.
There are more figures on the next page which state that 83.95% of the inpatient treatment costs for 2013 came from just 12 people.
It doesn’t seem right that the per-day cost of medical or psychological treatment would jump so much in just one year.
The table makes it look as if the 2023 cost over-run was because of the 12 people. That could possibly be the case, but there isn’t enough information in the table to be sure.
Were the costs in 2022 also largely from the dozen people with the most expenses? Do other counties in Wisconsin also incur most of their inpatient treatment expenses from bills charged over a relatively small number of people?
There were actually more total days of inpatient treatment in 2022 than there were in 2023. Were the 12 people in an inpatient facility for an unusually long time, or are they somehow being billed more than usual for some other reason?
Going back to https://www.co.door.wi.gov/AgendaCenter/ViewFile/Agenda/_02122024-1611#page=43, page 43 also has figures for out of home placement of children. The figures can be compared to the figures for child placement from 2017 to 2020: https://www.co.door.wi.gov/AgendaCenter/ViewFile/Agenda/_02082021-838#page=15
These are among the things mentioned:
RCC — Residential Care Center
TX Foster Care — Treatment Foster Care
CBRF — Community-Based Residential Facilities
AFH — Adult Family Home
YA corrections — refers to Juvenile Corrections
It is interesting that “Treatment Foster Care” is not listed in the 2023 figures. Possibly it is not separated from “Foster Care”, or Treatment Foster Care was not used in 2023.
Neither the recent nor older figures describe how many children were taken for 72-hour holds. The number of 72-hour holds was last reported over a decade ago:
There is also another sort of arrangement, which was mentioned in 2019, https://web.archive.org/web/20190410014257/http://map.co.door.wi.us/Agendas-Minutes/Human%20Services/2019/2019-01-03%20Human%20Services%20Agenda%20Packet.pdf#page=10, but is not reported in the tables:
A couple of key things occurred over the last few years. One was that many juvenile detentions centers in surrounding counties closed their juvenile detention areas, and the other was the increase in complexity of cases and need for more intensive services and supervision. There were times when juveniles would need supervision during the day due to expulsion or suspensions and caregivers were not available to supervise. Often times the social worker would have the juveniles stay at the agency in an office or conference room as a means to intervene during unstructured time the juvenile would have. Without some type of supervision or intervention, juveniles would be vulnerable to poor decision-making and maladaptive behaviors.
Questions and thoughts about the inpatient care costs:
What can Door County do to get the per-day costs back around 2022 levels?
Did other counties also see a massive jump in per-day costs?
Are county supervisors legally able to get to the bottom of exactly why the costs jumped so much, or are they restricted from looking at things due to privacy laws?
Are county staff able to get to the bottom of this, and to share their findings with the supervisors, or are they also restricted by privacy laws?
Sometimes the pharmaceutical industry gives doctors kickbacks. This doesn’t mean that any local doctors were getting the money; payments to doctors in other places still cost money and along with other marketing expenses, the companies have to get it somehow.
When doctors are paid by pharmaceutical companies it is typically not illegal. Legal payments are reported to the federal government, which maintains a database at https://openpaymentsdata.cms.gov/. Both the doctors and companies which sell medication can be searched.
A 2021 study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260092/, found that “Over half of active psychiatrists (55.7%) received some form of payments from pharmaceutical manufacturers.” However, the largest total payments listed at https://www.propublica.org/article/we-found-over-700-doctors-who-were-paid-more-than-a-million-dollars-by-drug-and-medical-device-companies are for diabetes and blood thinning drugs rather than psychiatric medication.
Sometimes, the payments to doctors are illegal. In 2016, a psychiatrist in Chicago was sent to prison for accepting kickbacks: https://www.justice.gov/usao-ndil/pr/chicago-psychiatrist-who-took-kickbacks-prescribe-mental-health-medication-sentenced
But even legal payments are able to, on the whole, “manipulate prescribing behavior”: https://journals.lww.com/rca/fulltext/2018/12000/how_drug_companies_manipulate_prescribing_behavior.8.aspx
Some other posts, listed at https://doorcounty.substack.com/t/honor-or-shame, have related to questions of honor and shame, as compared to guilt and innocence. Questions about corruption also relate to guilt, since a recent study found that “Guilt-prone People in Power are Less Likely to Be Corrupt”:
https://www.futurity.org/guilt-prone-people-power-corruption-2937232/
Other posts about services:
https://doorcounty.substack.com/t/services