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Coping with complexity

December 11, 2012
by Gary A. Enos, Editor, and Shannon Brys, Associate Editor
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Having welcomed an influx of patients with increasingly complex clinical profiles from factors such as prescription drug misuse and prominent mental health diagnoses, many addiction treatment facilities still are trying to grasp the implications of health reform on the business side at the same time as they grapple with tougher clinical challenges.

Judging from many of the questionnaire responses offered in Addiction Professional’s 2012 Treatment Center Survey, providers are multi-tasking to the max in a time when many questions about the future of addiction service delivery remain unanswered.

For example, here is a sampling of replies to the survey question asking participants to elaborate on whether clinicians’ everyday work with patients has gotten more challenging over the past two years (74.2% of survey respondents overall said that it has):

    •    “More clients are dual-diagnosed, some with several mental health diagnoses. This instability makes the population more challenging to treat.”

    •    “Staff is paid less but expected to do more work with new challenges behaviorally coming in with clients.”

    •    “We are seeing more intense symptoms with our clients.”

    •    Patients are in need of comprehensive treatment that goes from inpatient through outpatient and individualized care. Most insurances are resistant to making the commitment of providing these modalities to maintain someone in recovery.”

This year’s survey, our fourth annual report on treatment center demographics and trends, yielded 136 responses to our online survey questionnaire from individuals who reported that they work in an addiction treatment facility (as opposed to a private practice or other health and human services operation).

While direct comparisons of survey data from year to year are not fully illustrative because the overall composition of the survey respondents changes each year, our 2012 results in many ways bear a striking resemblance to results for 2011, in areas such as levels of treatment offered, use of mind-body treatments as part of the clinical mission, and use of specific medication-assisted treatments.

Multiple challenges

This year’s survey responses indicate that addiction treatment center managers do not appear to be of one mind on the potential impact of health reform as the move to full implementation of the Affordable Care Act (ACA) in 2014 nears.

While 46.3% of respondents said that healthcare reform will increase the number of patients they see in the next three years, and only 9.1% said it will decrease the number of patients they will see, opinion is somewhat more split on the overall impact of the ACA. A less-than-overwhelming majority of respondents, 55.4%, said they believe the overall impact of full ACA implementation will be positive. This is arguably a fairly predictable response given the number of issues that still be ironed out in implementation, such as how essential benefits in health insurance exchanges will be enforced and whether parity mandates will have the teeth that seem to be missing so far in enforcement of the federal parity law.

In an interview with AP, Victoria Johnson, director of development at the inpatient addiction treatment agency Hudson Health Services in Salisbury, Md., said she would like to see health reform result in an expansion of available service levels—in that the basic medical assistance program in Maryland currently encompasses only outpatient treatment.

“The decision to seek treatment is never an easy one for those suffering from addiction,” Johnson says. “When they finally admit they need help, we need to get those people into treatment immediately.”

An interviewed survey respondent from California who at press time did not want to be identified for this article because of her program’s direct tie to a county government bureaucracy says that answers about the implications of health reform certainly are not arriving fast enough for some struggling smaller programs in the addiction treatment community.

“We hope somebody soon is going to come up with some answers,” says the California respondent. “We hear everything and all things about what’s going to happen. We’ve already seen some smaller private programs closing.”

The California respondent adds that amid the uncertainties surrounding health reform, program closures in mental health have been resulting in more complex cases presenting in the substance abuse services system.

“The mental health system is changing so much, so some of the referrals we’re receiving are not appropriate for us,” she says. “Our social workers don’t know what to do sometimes.”

Here is a sampling of responses to the question asking participants to elaborate on the most prominent effect ACA implementation is expected to have on responding addiction treatment programs:

    •    “We [currently] help patients access their benefits in an out-of-network capacity. More patients will have coverage and benefits.”

    •    “We are in the process of understanding the ACA.”

    •    Access for clients who would have fallen between the cracks, and possibly better aftercare affordability.”

    •    “It will allow more people to access treatment because more people will have insurance that covers treatment.”

Other responses

Here are some other trends in responses among the treatment centers participating in this year’s survey (51.1% of the responding facilities this year serve primarily a public-sector treatment population):

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