Services Research Outcomes Study (SROS)

1. CHARACTERISTICS OF TREATMENT FACILITIES
   • Table 3-1. Organizational characteristics of the four types of SROS facilities
   • Table 3-2. Median costs in four types of SROS facilities

CHARACTERISTICS OF TREATMENT FACILITIES

As discussed previously and in Appendix A, DSRS drew samples to represent an appropriate number of clients from each of four standard types of facilities: hospital inpatient, residential, outpatient methadone, and outpatient nonmethadone treatment. [ In facilities housing more than one type of treatment modality, the facility was classified as the type that had the highest number of reported admissions during 1989 –1990. ] When the SROS staff attempted to re-engage the 120 facilities from DSRS Phase II for the SROS data collection plan three years after the last DSRS contact, 12 facilities were no longer in operation, and many of the remainder were under new ownership or administration (the latter refers to publicly owned facilities reporting to a different agency). As a result of refusals, inaccessibility of records, and logistical obstacles, 21 of the 120 DSRS Phase II facilities (17 percent) did not participate in SROS. Among the 99 facilities that did participate, a substantial degree of organizational change had taken place, as reported in facility director interviews completed in 1994 (see Table 3-1). About one-third of the participating facilities changed ownership or administration between 1990 and 1994, with a handful of facilities changing more than once. Annual staff turnover averaged about 23 percent, and key personnel had been with each facility an average of about seven years.

Facility director reports of staffing and service cost patterns make clear some of the differences among the four treatment types. The hospital inpatient facilities had the highest reported ratio of staff hours to clients, with much higher ratios of medical staff (primarily nursing personnel) than other facilities: Medical staff in hospital inpatient facilities spent an average of 4.2 staff hours per week per actively enrolled client (hours/week/client), which was an order of magnitude greater than the staff hours spent in methadone and residential facilities and 100 times greater than in the outpatient nonmethadone facilities. The hospital inpatient facilities also reported a higher ratio of nonmedical clinician hours at 2.5 staff hours/week/client, compared with 0.6 to 1.0 clinician hours/week/client in the other facilities. Hospital inpatient facilities reported surprisingly low ratios of administrative and support personnel, comparable to staffing ratios at the two types of outpatient facilities; however, these low reported ratios probably reflect the high degree of centralization of such functions in hospitals, which takes these staff out of the purview of the facility director. Residential facilities reported much higher ratios of administrative and support personnel than the two outpatient types, which one would expect in view of the 24-hour, generally freestanding nature of these facilities.

Because staffing is the major cost element in every facility type, the differences in staffing patterns, along with other facility differences, led to substantial differentials among facility types in charges per unit of service (see Table 3-2). One day of treatment cost an average (median) of $400 at the hospital inpatient facilities that reported such cost rates, but the median cost per day was only $55 at residential facilities, a rate quite similar to the per-visit cost in the two outpatient types of treatment. Despite variations in treatment duration (length of stay) and in the frequency of staff visits during treatment that tended to make the median revenue per patient somewhat less divergent, a substantial spread still existed: The median facility reported revenues per admitted patient of about $3,200 in the hospital inpatient facilities, $1,800 in the residential units, $1,700 in the outpatient methadone units, and $700 in the outpatient nonmethadone units. Between two-thirds and seven-eighths of these revenues were from public sources in the residential and the two outpatient facilities, while only about one-half the revenues in the hospital inpatient units were from public sources; however, this last comparison is vitiated by missing data on the revenues variable for nearly one-half of the participating hospital inpatient facilities.

Despite these variations in staffing and costs, facility directors reported that the four types of facilities were similar in several other attributes. About two-thirds of each type of facility allowed participants to define their own treatment goals, about one-fifth collected followup data, and about one-fourth of each facility type made followup reports available. About one-half of hospital and residential facilities and one-third of methadone units sponsored voluntary alumni groups, but almost none of the outpatient nonmethadone facilities did so.

Table 3-1. Organizational characteristics of the four types of SROS facilities

Characteristics	Type of Treatment
	Hospital Inpatient	Residential	Outpatient Methadone	Outpatient Nonmethadone
Staff Stability, 1990-1994	n=22	n=27	n=26	n=24
Change in owner/administration	45%	26%	19%	33%
Number of owner/administration changes	1.2	1.14	1.2	1.25
Average annual staff turnover rate	0.25	0.23	0.19	0.23
Average tenure of key personnel, in months	88	82	94	91
1990 Staffing Patterns—Average Staff Hours/Week per Client
Medical: Physicians, psychiatrists, nurses	4.2	0.19	0.40	0.04
Clinical (nonmedical) personnel	2.5	1.04	0.75	0.59
Administrative and support	0.53	1.68	0.52	0.32
Volunteers	0.06	0.11	0.08	0.03
TOTAL	7.29	3.02	1.75	0.98
Orientation Toward Outcome Goals
Participants set own goals to a great extent	67%	78%	54%	74%
Sponsor voluntary alumni groups	52%	48%	32%	4%
Collect followup data	24%	22%	19%	21%
Generally make reports on followup data available	29%	22%	26%	20%
Source: Survey of 99 Services Research Outcomes Study facility directors, 1994.

Table 3-2. Median costs in four types of SROS facilities

Characteristics	Type of Treatment
	Hospital Inpatient	Residential	Outpatient Methadone	Outpatient Nonmethadone
Sample n	22	27	26	24
Charge/24-hour day (Number of facilities)	$400 (17)	$55 (16)	N/A	N/A
Charge/outpatient visit (Number of facilities)	N/A	N/A	$41 (19)	$50 (23)
Revenue/client (Number of facilities)	$3,196 (15)	$1,835 (21)	$1,671 (24)	$662 (24)
Public revenue as percentage of revenue (Number of facilities)	49% (12)	86% (23)	75% (20)	68% (18)
Source: Survey of 99 Services Research Outcomes Study facility directors, 1994. N/A = not applicable.

This page was last updated on June 03, 2008.

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