Waste and fraud often arise as prominent topics in the discussion of health reform, with the reasoning that streamlining processes and eliminating dubious practices could make a major difference in reining in costs. An arm of the National Academy of Sciences reports that 30 cents of every healthcare dollar is wasted through unnecessary procedures, useless paperwork and the like—a $750 million heap of healthcare refuse.
For a change, addiction professionals don’t appear to bear the brunt of policy-maker or public scorn in general on this subject, but of course the field is by no means immune to scrutiny of its accepted practices. The data from the National Academy of Sciences got me to thinking about how addiction professionals perceive the issue of unproductive spending in the programs they’ve worked in or encountered. So in September I turned to our active and highly vocal Addiction Professionals group on LinkedIn, a group that as of this writing was poised to storm past the 6,000-member mark.
As usual, our social media members didn’t disappoint.
A counselor was reminded of once being asked to list on a job application the percentage of time he had spent on each of the duties he held in previous positions. He contributed to the LinkedIn discussion, “At that time I realized I was spending more time writing down what I was going to do and what I did than I spent actually doing it. There’s something fundamentally wrong with that equation, but it’s actually gotten worse, not better, since then.”
Sometimes professionals end up saddled with unproductive tasks because of an organization’s failure to spend in an important area. The owner of a recovery coaching business responded that too many clinicians in treatment centers end up getting bogged down in day-to-day tasks such as contacting vendors for repairs and making sure the transportation bus stays on schedule. The reason? “The treatment community, to save money, never hires true operational assistants or managers,” she wrote. “But they think therapists can do that task in their spare time. Another wrongly directed thought.”
Other LinkedIn responses clearly suggested that payment systems end up encouraging practices with at least questionable clinical usefulness. A consultant stated that one 60-day inpatient program that he visited was requiring that notes for each two-a-day patient session include a complete Mini-Mental status assessment. When he told the program’s clinical director, “They don’t change that much between sessions,” the reply was, “True. But this helps us get paid.”
And the same consultant recalled another exchange that serves as a reminder that this problem dates back more than a generation. He wrote, “I know back in the early ’80s I asked the CFO of one treatment chain why they bothered administering psychological tests to people in residential treatment when they knew the results were skewed” (since the thought is that after a period of sobriety, many of these individuals will score within norms on these psychological measures, he said). “His explanation: $600 per battery of tests.”
I’m interested in hearing more of your views on this topic. To what extent do you think wasteful or unproductive spending hurts addiction professionals’ work with patients, and/or the field’s overall status? If you consider this a significant problem, what do you think can be done about it?
Send your thoughts to me at firstname.lastname@example.org and we’ll continue this dialogue. Also, I invite you to join the Addiction Professionals group on LinkedIn if you haven’t done so already—there you can tap into some informative and spirited discussions of professional challenges on a daily basis.