title: Hospitalization of patients with eating disorders on adolescent medical units is threatened by current reimbursement systems.
abstract: Eating disorders are chronic, life-threatening medical conditions that are the third most common chronic illness in adolescent females in the US. Although successful treatment of eating disorders on medical units has occurred for at least thirty years, some insurance companies refuse payment for such care.
  
  
  OBJECTIVE
  To describe outcomes of and reimbursement for treatment of patients with eating disorders (ED) on an adolescent medical unit.
  
  
  METHODS
  39 participants, mean age 16.1 +/- 1.9 years, with anorexia nervosa (AN) or eating disorder not-otherwise-specified, subtype AN (EDNOS) admitted to an inpatient adolescent medical unit at a large, urban teaching hospital.
  
  
  METHODS
  Using a retrospective, cohort study design, medical records were reviewed for outcomes at hospital discharge for patients admitted between 2001-2003. Data on hospital and professional charges and payments from medical insurers were collected. Results showed that admission percent estimated ideal body weight was lower in AN vs. EDNOS participants. Controlling for admission weight, length of stay and daily weight gain were independent of the diagnosis of AN vs. EDNOS. Mean length of stay was 51 days. 37/39 patients completed their stay. Insurance companies reimbursed 62% of charges.
  
  
  CONCLUSIONS
  Other than admission weight, there were no significant clinical differences between AN and EDNOS participants. 95% responded favorably to interdisciplinary treatment. Length of stay could be reduced with earlier admission of malnourished patients. In spite of effective services, reimbursement by insurance companies remains inadequate for patients with ED hospitalized on medical units.
authors.affiliation: Section of Adolescent Medicine and Sports Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030-2399, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kalisvaart
authors.forename: Albert C
authors.initials: AC
authors.lastname: Hergenroeder
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D000856:Anorexia Nervosa / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D001068:Feeding and Eating Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data* / Q000639:trends; D007902:Length of Stay / Q000191:economics / Q000639:trends; D016014:Linear Models; D017063:Outcome Assessment, Health Care; D011567:Psychiatric Department, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome