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Treatment Providers: Unfairly Targeted or Rightfully Villainized?

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at October 14, 2015

Last month, a colleague of mine published on his blog at The Florida Healthcare Law Firm (Jeff Cohen, Esq.) an article he entitled “Addiction Treatment is a Story in Search of a Villain.”  I keep coming back to that post in response to the daily news I read about fraud in the health care industry, which we locally focus upon the Substance Use Disorder industry in particular.

In his very well-written response, Mr. Cohen writes about the misinformation and “entertainment” value (or lack thereof) of modern media, and in particular, news stories about the Substance Use Disorder treatment industry.  He writes:

The “story” being sold by the paper, however, created a story with a villain (the providers of services to people in recovery from drug and alcohol addiction) and a “victim” (people receiving care for addiction). 

In the drug and alcohol treatment space, there are serious elements of the truth that are missing, because they don’t sell, such as:

  1. The treatment industry is undergoing a huge change because they’ve expanded from providing psychotherapeutic services to providing medical services;
  2. Insurer challenges and law enforcement activity is a huge wake up call to an industry that needs to be woken up to compliance and viewing medical services in the same way traditional medical service providers view them—driven by scientifically validated and documented medical necessity. Physicians have played within these boundaries for many years, but treatment providers are new to what’s required to provide medical services;
  3. Providers that make a lot of money from treating people in recovery do so almost entirely because they do a good job and know how to manage their expenses.  Our community does not yet believe the healthcare providers ought to work solely for non-profit organizations and be part of a “healthcare clergy” (“If you really cared, you’d do it for free”);
  4. Insurance companies have been masterful in managing the PR related to the treatment industry. In an era of record-breaking insurance company profits, they often don’t have any policies and procedures about how many or how much of anything people in recovery should receive, but then refuse to pay and point the finger at providers.  And ironically, many treatment providers beg payers for such guidelines and have approached them to contract (at lower rates than the insurers are paying!);
  5. Insurance companies decide how much to pay for services, not the providers; and
  6. Neither treatment center owners nor those in recovery speak with one voice and have no effective political/legislative power. Insurance companies, however, have enormous political and legislative power.

I am glad to hear the “other side” say it so eloquently, particularly the part about how we continue to view profit motivations within the provision of behavioral health care services as the antithetical to care.  Granted, there are massive, unregulated abuses in the industry, and I am disheartened, in part, that our government is allowing the insurance companies to play “police officer” rather than fair application of policy and law.

Equally, I understand the 12 Steps and that one such step is that  persons are not to make money from providing service to others.  This seems to be the friction point between people who are established in their recovery and the modern Substance Use Disorder treatment industry (which, by the way, President Obama made sure was a part of compensation under the Affordable Care Act).

What “treatment” is, or is not, remains the issue that needs to be resolved in a collaborative approach between clinicians, policymakers, and the insurance providers.  What we are paying for needs to be standardized. The paradigm of treatment can only change within, else the insurance lobby will do it for us.

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