What No One in the Addiction Treatment Industry Wants to Tell You: Care Levels
Television shows, advertisements, and the publics general understanding of addiction treatment lead many to think that inpatient treatment is addiction treatment. Here is what you should know.
People walk into treatment centers because they are looking for help. During this initial period, treatment center staff do not know the needs of the potential patient or their family. To gather information and determine appropriate care, addiction treatment programs complete a series of appointments that allow their full understanding of the patient’s history, needs, and goals. It is not until after they have gathered and analyzed this information that they are able to make an accurate care level recommendation. After proper assessments, recommendations are relatively accurate. There are cases in which the care level is not effective or circumstances change for the patient and they are referred to higher levels of care. In other cases, patients quickly drop down in their care level with positive outcomes. In theory, various patients should enter programs at various points across the care-level-continuum based solely on their needs and circumstances. Makes sense right? No one is the same, needs are different, severity is different, resources are different, circumstances are different, and so on.
Unfortunately, this process is not always followed and many individuals find themselves being whisked away into an inpatient program far from home, a residential program, or any higher care-level that may not be appropriate for their medical, clinical, and logistical needs. In fact, the reverse can also occur. There are instances where lower-levels of care are recommended in order to obtain a new patient despite the fact that the patient’s needs implicate a higher level of care than the program can provide. Here are some common scenarios:
Real Stories from Patients
A patient comes into our program. After multiple appointments, it is determined that the care level needed is higher than the partial hospitalization we can provide (our highest care level). A clinical team member calls a referral source that likely meets the needs of the individual based on our assessment and hands the client the phone. The representative (who identified themselves as neither a clinical or medical professional) asks the patient what they were looking for. Without any information outside of the patient’s response of, “I need to find help for alcohol dependence”, the staff member informs the patient that they need inpatient treatment. The problem was the fact that without any history or assessment an individual at that program made a clinical and medical judgment. In these cases, the clinical and medical needs are often far from the underlying motives. While the patient did need an inpatient level of care the staff member had no way of actually knowing that; nevermind they were not qualified to make care-level recommendations in the first place.
Another patient that entered our program had transferred from another program after their first three days in treatment. The client, without being assessed, was placed in an outpatient program. The program conducted a drug and alcohol urine screen at the initiation of care. Three days later, after receiving the positive results of the urine drug screen, the program informed the patient that they needed inpatient care and the staff member strongly recommended an inpatient on one of the coasts. The inpatient program was not covered by the patient’s insurance and was owned by the same organization as the outpatient. It is uncertain why a treatment center would expect a clean urine drug screen from a patient entering care (voluntarily) for chemical dependency. The results of the screen confirmed what the patient had self-reported during the intake process of the program.
In many scenarios patients are solicited for inpatient treatment somewhere far from home. It is uncommon to hear that patients have been referred to an outpatient program by one of these solicitors, yet a significant portion of those entering treatment, even for their first time, are not clinically appropriate for inpatient care. Those that do require inpatient care are often discharged without a feasible plan for continuing in an outpatient or aftercare program. It is common knowledge in the industry that patients who engage in outpatient or aftercare programs reduce their chance of recidivism by ~50%. Knowing this, it would be an important task to ensure clients are appropriately transferred to a lower level of care.
Even in the outpatient setting programs inaccurately direct patient care levels. Many require patients to enter at intensive levels to qualify for lower-intensity programs regardless of their clinical and medical needs. You might be asking, “how can more treatment be such a bad thing for clients?”. Consider this, engagement and time-in-treatment significantly impact outcomes. So the logistical and financial burdens associated with higher care levels can actually become barriers to the continuation of care or even entering treatment at all. For the program that forces patients into higher levels of care, it translates into higher revenue, in a shorter period of time, with less expense. This is not person-centered care.
The problem with Care Levels
The problem with care levels is that, financially, they are far from equals. The reimbursements for inpatient stays and higher level outpatient stays are drastically higher than those for general levels of care. More than that, the nature in which these levels of care are billed enables providers to employ personnel that are less qualified than at lower levels of care. Insurance will not pay for a counseling session with someone that does not hold a license with a minimum of a Master’s degree. However, when they are billed for a unit of inpatient, partial hospitalization, or intensive outpatient care, no criteria is specified as to who performed the services other than the overseeing medical professional who may have never actually met with the patient. This creates massive financial incentives for organizations to create top-heavy programs with low-quality services, so much so, that if you look at the majority of outpatient programs they are missing the lowest level of intensity, or offer a piecemeal aftercare program. These lower levels of care technically have the longest recommended treatment duration. This is exactly why you see many in-network addiction treatment programs running little more than AA and NA meetings while billing insurance. Isn’t that a free community resource? This is not to discredit AA or NA, these resources are excellent for those seeking help for alcohol and drug addiction, but they are already free and available to everyone. So, shouldn’t treatment centers be providing services that complement these community resources by providing aspects of care that patients cannot obtain from them?
The point is that individuals and families should do their research before beginning a program. If you feel the person recommending a program or care-level doesn’t recognize your situation or needs then they are probably not making a recommendation based on either. What the treatment industry doesn’t want you to know is that some of the most important parts of the treatment continuum cost the organization a lot more money than the revenue-dense higher levels of care and have the smallest reimbursements from insurance payers. Of course all levels of care are needed and fortunately, there are more programs appropriately assessing and determining care levels than those who are not.
Identify your needs before contacting programs. Ask how they are determining your needs, what their assessment process looks like, and what the treatment process looks like. The answer you should receive will be general in nature and will inform you that until an assessment is completed they cannot tell you with certainty what your treatment program will look like.