In my 10 years of managing detox and treatment programs, I have had the pleasure of working with thousands of clients and hundreds of staff. In my leadership positions I have followed two directors who thought the way to the future was to eliminate the past. At their respective treatment centers, these directors had effectively banished all Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) speakers and support, either under the guise of HIPAA or in favor of modern treatment practices such as Matrix model treatment.
At L.E. Phillips-Libertas Treatment Center, our orientation is more inclusive. The way to the future is to honor our roots, and our collective foundation. We recognize and celebrate the wonderful strength that 12-Step organizations have given our work. There are no better, more complete, more supportive organizations than AA and NA. They are there 24/7; they provide structure, friendship and camaraderie; and they have been the backbone of recovery for millions of people. They are foundational to our work.
Yet as a “cunning, powerful and baffling” disease, addiction will continue to cost this country billions of dollars and untold misery. Medical research will continue to develop new tools to assist us against addiction. It is our job and our ethical responsibility to utilize these new tools—not instead of our traditional approaches, but with our foundational institutions intact to help more people achieve true lasting recovery. A journey begins with the first step.
Located in Chippewa Falls, Wis., L.E. Phillips-Libertas is a hospital-based detox and chemical dependency treatment center with a full continuum of addiction and mental health services. We are located in a separate facility on the St. Joseph’s Hospital campus. While our current building (46 beds) and operation is 34 years old, the sponsoring organization, the Hospital Sisters of St Francis, has been working with addictions for 125 years.
The Sisters began with loggers, fresh from the logging camp with a fistful of money. Then in the 1940s, they sponsored treatment centers for affected priests. Throughout this journey, the feisty Sisters continually embraced new methods and opportunities to help underserved populations. At St. Joseph’s Hospital, they responded to new technology and medications. Today is no different, with our focus now being on the extended-release formulation of naltrexone (Vivitrol).
Vivitrol is not the only medication-assisted therapy our organization uses, but it quickly has become an important tool for a number of reasons. It does not have some of the issues associated with other medication tools (including Suboxone, methadone and Antabuse) and is helpful for use in both opiate and alcohol addiction. It is non-narcotic and non-addictive, and it does not give patients a “high,” so it fits better into our program than some of the other options do.
Early implementation factors
Vivitrol is prescribed medication, and having doctors on board is a key element to early adoption. We began by using Vivitrol on patients who were the most difficult—those for whom we thought we had done it all. They are the reluctant ones, the ones who couldn’t seem to land on their feet, the frequent fliers. They are hard on staff and themselves, losing a little more hope with each readmission.
Having a willing doctor and patient are only two components necessary to make this successful. The real success has to do with making this treatment available to as many patients as possible. To do that requires the buy-in of the rest of the facility. It requires systems change, education and risk-taking, in bringing all staff along on the journey.
Everyone in the organization has to recognize and understand Vivitrol: what it does, how it affects the brain, and the plan for making it available. To do this, we relied on a Vivitrol representative to help educate the entire staff. This effort included use of lunch and learns, as well as use of expert help (psychiatrists and nurses) to describe Vivitrol’s potential.
We trained everyone: support staff, nurses, counselors, leadership, CNAs, CD technicians, and our patients. We realized that in order for patients to make good choices, they needed to understand addiction as a brain disease and how this treatment could serve as a tool to enhance recovery. We do not do this by becoming Vivitrol robots—instead, we recognize that we are more effective when our toolbox has multiple tools.
Amazingly, everyone in our organization gets this, mostly because everyone experiences the same frustration of not having enough tools to treat chronic addiction.
At the cost of about $1,200 per monthly injection, cost has constituted a considerable hurdle. We began to better understand billing codes and differences between clinic and hospital, inpatient and outpatient benefits, hospital and retail pharmacy.
Currently in our community, Wisconsin Medical Assistance, BadgerCare, and managed care health maintenance organizations (HMOs) all authorize and pay for Vivitrol. In addition, most commercial insurances include it either as a pharmacy or medical benefit.
As our payment sources vary widely, we have worked to develop different processes and procedures to ensure payment, so working with our business office has become even more important. A section of our insurance worksheet for billing a commercial insurance company looks like this:
Is Vivitrol (Naltrexone XR) a covered benefit? Yes___ No___
If yes, is the benefit:
Medical ___ Pharmacy___
(Pharmacy means OP only at MD’s office)
Prior Auth needed: Yes___ No ___
CPT codes J2315 x380 mg dose and 96372 x 1 for administration