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Centers use flexible approaches to survive

November 1, 2009
by Gary A. Enos, Editor
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2009 Treatment Center Survey shows facilities mixing tradition and innovation

The addiction treatment facilities that participated in Addiction Professional's inaugural Treatment Center Survey refuse to be stifled by a weak economy or a stubborn adherence to traditional ways of operating. These treatment centers are shedding unproductive units and procedures, and are marrying the new with the old in ways that many wouldn't have imagined even a decade ago.

The online survey conducted in September and October shows, for example, that while 74 percent of responding facilities consider the 12-Step philosophy to be the guiding principle of their clinical services, most also wholeheartedly embrace the brain science behind the field's recent discoveries on medication treatments. Fifty-three percent of respondents said their facility offers medication treatments for addictions, with buprenorphine for opiate dependence cited most frequently as part of treatment services.

In all, leaders from 98 addiction treatment facilities completed the 39-question survey on treatment populations and service and business trends. Sixty-two percent of the respondents said they were with facilities that serve mainly a population receiving publicly funded services, through sources such as Medicaid and state block grant funds. Thirty-eight percent said they were with facilities that serve mainly a client base with private resources, such as private insurance or self-pay resources.

As might be expected, there was some variation in survey responses based on these two broad categories of providers. For instance:

  • Centers serving a privately funded population were more likely to exclude the third-party insurance market altogether, relying in their case on self-pay. While nearly one-third of private-sector centers replied that they do not work with third-party payers, only about one in five public-sector facilities exclude the insurance market.

  • A significantly higher percentage of centers identifying as serving a privately funded population report using medication treatments, perhaps a reflection of the presence of a medical director in many of these facilities-and possibly medication cost barriers for public-sector facilities and their clients. While 25 of 36 responding private-sector centers reported using medication treatments, only 25 of 60 public-sector centers said they offered medications.

A typical example

George Joseph, CEO of treatment centers Spirit Lodge and The Right Step in Houston, works in an organization that blends 12-Step principles with adoption of the latest best practices in brain science.

“If there was just one solution, believe me, I'd love to know what it is,” Joseph says. “We're always trying to sharpen our tools. We're always striving for perfection in our service delivery.”

Joseph stated in his completed survey that his organization has seen an upturn in business and an increase in the average census over the past year, despite the economic difficulties facing Texas and the nation. He attributes the growth in part to the newer Spirit Lodge and its minimum 35-day, cash-only program, as well as to overall pricing adjustments in the organization.

But Joseph adds that his center, like many others, has had to engage in some deft maneuvering in order not to get swept up by the economic tide. “We closed some underperforming operations,” he says, citing as an example a transitional living program called The Next Step that was showing small margins. He also has observed that several large treatment organizations that have a strong presence in other states have had to retreat from ambitious efforts to expand into the Houston market.

“Programs are being smarter with their money,” Joseph says. “In the past, maybe they could be a little frivolous.”

In all, 43 percent of survey respondents said their facilities experienced no change in business this year, with 30 percent saying they saw a decrease in business and 27 percent saying they saw an increase in business. Facilities serving mainly public-sector clients were slightly more likely than facilities serving a privately insured or private-pay population to report an increase in business over the past year.

Only one in five respondents overall said this year's average census vis-à-vis total capacity was lower than previous years' averages, with about two in five each saying their census either had increased or stayed the same this year. Public-sector facilities were significantly more likely to report an increase in their average census.

And respondents overall were nearly evenly split on the question of whether the economy has forced their treatment centers to postpone or cancel improvement projects such as expanding treatment space or buying new furniture. One area that Joseph says has posed a particular challenge in recent years involves a shrinking labor pool in his state. He and 43 other survey respondents said hiring qualified clinical staff has become more challenging over the past two years, with only 17 respondents saying it has become easier and the others saying the situation hasn't changed. Joseph points out that the number of licensed chemical dependency counselors (LCDCs) in Texas dropped from a high of 9,000 about five years ago to as low as 4,000, and has recently crept up to only about 4,500.