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Your checklist for 2012

February 27, 2012
by Gary A. Enos, Editor
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Leaders advise immersion in primary care integration, insurance payment, electronic records

Editor's note: Addiction Professional asked five leaders representing diverse segments of the addiction field to answer this question as 2012 began: “What is the one thing addiction treatment providers should do in the coming year to prepare for the changes occurring in healthcare?”

The variety of topics addressed in their responses illustrates the numerous challenges professionals face, but also the exciting opportunities awaiting many in a shifting treatment system.

Marvin D. Seppala, MD, Chief Medical Officer, Hazelden

Changes to our national healthcare system are influencing addiction treatment providers in multiple ways. The one thing that we can count on, that is consistent, is that addiction treatment is absolutely necessary, but how it is to be provided is being debated.

The Affordable Care Act recognizes the extensive healthcare costs associated with addiction. Federal plans for the future of addiction treatment emphasize screening and brief intervention in primary care settings; even treatment (beyond prescribing medications for addiction) in those settings is being recommended. Primary care physicians are ill-prepared for this role, yet recognize potential benefits. The one thing addiction treatment providers need to do in 2012: begin to align with primary care systems. 

This can occur whether you are a small outpatient program or a multi-state treatment system, and all parties will benefit. We need to integrate into the medical system as a whole, and they need our services. It really can be a perfect match, as addiction treatment providers can solve major problems for them and they can provide us with access to more patients.

If screening and brief intervention identifies someone in need of treatment, the healthcare system, under pressures of its own, often cannot take the time to address these issues adequately in a primary care office. The cost of a counselor is attractive compared to that of a nurse or a physician, and counselors bring expertise about addiction that is often lacking in the primary care setting.

We need to set up seamless referral systems, not unlike a primary care physician would do with a medical specialist colleague. Primary care is an ideal place to identify addiction: They are faced with the evidence of the problems in other illnesses; they are being asked for potentially addictive pain medications on a daily basis; and they see the stress in the families of the addicted. Addiction treatment providers can be a solution for primary care. The primary care setting also offers addiction treatment providers solutions to cooccurring medical and psychiatric issues.

Whether you place a counselor in a primary care clinic to do evaluations one day a week, use their offices for outpatient groups, or fully integrate your services into a major healthcare system, it is the right thing to do. It will result in better patient outcomes, it will establish new advocates for treatment, and it will provide you with more business. 

Lynn Sucher, MC, LPC, CEDS, President, Treatment Consultants

Whether you’re a healthcare professional running a treatment facility or a therapist in private practice, 2012 is the year of insurance. For years, many treatment professionals have been successful dodging the time-consuming black hole of insurance reimbursement. However, the days of strictly private-pay treatment may be a thing of the past.

We urge our clients to develop a payer mix, no matter if they are an upscale residential facility or someone in private practice. Clients who would never consider using insurance in the past for behavioral health services are now actively searching for professionals who will work with their policies. This means hiring or training staff that are able to check benefits, talk the language of insurance, understand the nuances of charting, and have the ability to be successful with the almost daily utilization reviews. It also means billing correctly in a timely manner and accounting for the sometimes lengthy payment collection process. And don’t forget the need to be accredited by CARF or The Joint Commission to become eligible for insurance panels.

In the past few years, insurance companies have become experts in denying residential treatment for individuals suffering from all types of addiction and mental health issues. However, intensive outpatient programs (IOPs) are flourishing because insurance companies are more likely to cover outpatient treatment. It’s important to know the trends in insurance in order to make changes that could mean the difference between being profitable or not.

If there is one thing we recommend to our clients this year, it’s to learn all the ins and outs of insurance billing, to develop relationships with insurance companies, and to hire staff that is capable of working within insurance guidelines. The bottom line is if we can work with insurance companies, we have a better opportunity of helping those who need treatment.

H. Westley Clark, MD, MPH, Director, Center for Substance Abuse Treatment (CSAT)

The Affordable Care Act is transforming and modernizing the nation’s healthcare system by providing greater access, more affordable coverage, and reduced healthcare costs. To facilitate this integrated and collaborative care, health reform requires the implementation of uniform standards for electronic exchange of health information by 2013. This is accomplished through Health Information Technology (Health IT), the use of computer applications to record, store, protect, retrieve and transfer clinical, administrative and financial information electronically within healthcare settings.