Mountainview Lodge Hospital in Glendale died last week, like a dinosaur at the close of a short-lived era.
It was created four years ago by a group of business investors who saw a demand for a costly product and identified a means to get paid for supplying it.
The product was acute psychiatric care for young people who lose their way in alcohol, drugs, truancy, hostility, depression and thoughts of suicide. The means of payment, by and large, was private medical insurance, called bennies in the trade.
From the outset, the formula was challenging. The 31-bed hospital charged about $600 a day. The psychiatrists and counselors who admitted their patients there charged their fees on top of that. The treatment could easily last 90 to 180 days.
The hospital was prepared to write off some of its charges. Most insurance companies require their beneficiaries to pay at least 20%.
“If you have to have the child here 90 days. . . ,” Managing Director Saul Goldfarb said Friday, doing the arithmetic in his head. “There’s no working family that can afford $11,000.”
The obvious corollary is that there is no insurance company eager to pay four times that for a virtually open-ended service whose duration is established by a clinician’s opinion on whether the child is doing well or not.
“Mental health has never been a very actuarially easy one to get a hold on,” Goldfarb said, adopting as philosophical a posture as he could while presiding over the last details of the hospital’s extinction.
Adolescent mental health, surely, is toughest of all. Adolescents are typically committed by their elders--without any say-so--and may not even want to get their lives back together.
“Sometimes, they just look at us like we’re weird,” he said.
To counteract that alienation, Mountainview Lodge assembled a legion of professionals. In it were nurses, social workers, psychiatric technicians, counselors, occupational therapists, speech and language therapists, and teachers. There were 75 full-time positions, about 90 employees in all to cover a 24-hour day.
“It got off to a raucous start,” Goldfarb said. “It took it awhile to stabilize.”
Stability turned out to be rhythmic, with a spurt of business each fall, just about the time that the first report cards went home, exploding little bombs of angst all over suburbia. A downturn would come in the summer, as pleasures such as the beach and freedom soothed juvenile emotions.
Then, last fall, the slump didn’t end. It got worse.
“New Year’s Day, 1989, we had one patient in the hospital,” Goldfarb said. “The anxiety level was pretty high.”
By then, the company was down about $500,000, Goldfarb estimated, and was trimmed to 35 employees. The owners decided to close. Last Thursday, Goldfarb sent the last patient home.
All day Friday, he and a skeleton crew cleaned the grounds, cleared out files and fielded telephone calls.
“No, it has not been sold,” Goldfarb politely, but wearily, told a reporter who was suspicious that the owners had decided to make a killing by selling the former Raleigh Hills smoking clinic on Glenoaks Boulevard.
Perhaps the moral of this story is that the Mountainview Lodge owners are making a killing in real estate, or simply that the problem of troubled adolescents went away. But probably not.
Goldfarb contended that the closing of Mountainview is a symptom, not a story in itself. The real story, he said, is the shifting sands of insurance coverage.
Even when Mountainview opened in 1984, the field was becoming confused. To hold down payments, insurance companies increasingly required the hospital to sign contracts providing payment at below its standard charge.
“Some were nice, some unacceptable,” Goldfarb said. He defined unacceptable as anything less than $400 a day.
Then came managed care. The idea was to have an insurance claims representative talk to the doctor before admission and then every week or so.
The notion of a medical doctor begging a claims agent for a few more days of treatment ruffled the administrator’s practiced demeanor.
“ ‘OK, you can admit, but you only have five days, seven days. Keep us posted,’ ” Goldfarb said, mimicking the conversation.
About then, Marvin Fickle, Mountainview’s medical director, stepped into Goldfarb’s office back from the search for new work. He let his bitterness show.
“Short-term treatment of adolescents is really a waste of time,” he said. “All you are doing is wiping the blood away and sending them back into the same situation. It’s a service that’s not worth buying.”
Goldfarb remained more sanguine.
“It may be that this kind of program is one of the anachronisms of our time,” he said. “What will be the consequence? A part of me says, ‘I hope to hell they’re right.’ If society can take care of all its emotionally disturbed kids, then the price-cutting efforts will reap a great benefit.”
He wasn’t betting on it.