Why is your facility better than theirs?
Addiction treatment and mental-health providers across the state of Colorado are collectively shaking their heads in disappointment as they reflect upon images of FBI agents raiding a Sovereign Health’s treatment facility and an associated urine screening laboratory in southern California. The reasoning behind the collective head shaking is that many people within the industry have been frustrated with both the implementation and follow-through of ethical standards addressing the fact that we are in the business of saving lives and not in the business of selling beds and filling urine cups. Sovereign Health’s leadership is presently in the spotlight for abandoning that narrative and, though it feels easy to direct our collective frustrations at them, I want to caution us all before we start pointing fingers.
Sovereign is just one of many treatment providers in litigation across the country. The broader industry - including sober living homes - is currently under the microscope for allegations ranging from insurance fraud to patient brokering. Recognizing that some providers are actively misrepresenting and fraudulently billing for services makes me think we need to take a look inward as treatment providers within the state of Colorado. Instead of pointing our fingers at others and the institution(s) they work for, I want to ask the Colorado treatment community collectively, why we believe our facilities are better than theirs?
Ethical Pitfalls to be aware of in an admissions call
Before advancing this discussion and asking some tough questions that we all ought to be considering, I want to first write about the complex nature of an admissions call. What I hope to convey in this extended discussion is the fact that there are many potential pitfalls to consider when adhering to an ethical framework. Above all, a company like Sovereign Health may very well be a great company, but to maintain the highest level of ethics, it requires that all employees are bought-in, so to speak, at all times. It only takes one ethical concession from a single employee to bring down a well-established brand and a single admission call is laden with ethical pitfalls.
If you’ve never been on the phone with a family in distress over their son or daughter, mother or father, or even a friend, it can be quite easy to think that many calls coming into a program like Sovereign Health are misguided and dishonest. The reality is that when you are listening to a family member on the other line who is clearly suffering from the emotional and, at times, physical pain brought about by someone’s continued abuse of drugs and alcohol or ongoing mental health issues, let’s face it, we are only human, and those phone calls are going to pull at our heart-strings regardless of us having established ethical standards. Meaning, concessions in-regards-to costs, buying insurance policies, providing treatment, etc., can easily be made when we are enmeshed in these emotional calls.
Naturally, we are all employees of some program and, when we believe in the program we work for, we instinctively want to get the individual who is suffering into our programming.
After all, does it not feel good to bring in more revenue that is, from a business perspective, needed to continually employ the many members of our organization(s) as well as our individual well-being? Does it not feel good to know that you are giving some family peace-of-mind?
I don’t know about everyone reading this, but I want to put food on my table and provide for my family just as much as my competitors do. The admissions line goes silent from time-to-time though and knowing that the admissions call not only ensures continued food on your table, but that it also ensures continued food on your fellow employee’s tables, these external pressures increase our susceptibility to making ethical concessions when the next call comes in. So, we may recognize a treatment facility as a premiere facility, but at the level of employment anyone of us are prone to making fear based concessions given external pressures like putting food on the table.
If the admissions call was not complicated enough already, maybe the admission is not appropriate for your specific level of programming. If we can honestly make that judgement, I believe relationships within the industry complicates admissions further. The question being, are we referring to friends or are we referring to programs? This back-scratching mechanism is laden in this profession. With over 20,000 treatment programs to refer to, it’s easy to refer to established relationships, but much more difficult to fully know, say, ten facilities and how they both function as a business model and how their clinical program works.
Ethical considerations are certainly more complicated than these three different examples, but I wanted to briefly paint the picture that ethical pitfalls are abound. Brokering of patients and their lives is a clear violation of ethics, but ethics goes beyond the clear lines we hold in the sand. There are many gray areas within ethics that can lead to very dark matters, some of which we see every day in this industry and without further consideration.
Ethical Pitfalls within the Holistic Approach
Nearly every conference I’ve attended throughout the country provides seminars and lectures on ethical and unethical behavior within this industry and for good reason. Many marketers and professionals alike talk about those suffering from substance use disorder and mental health disorders as if they are a part of some buffet style menu. Of course, this is not their sole intention, but I’ve met many professionals who have said, “there are enough people to go around in this industry” as a way of diluting the need to compete in the way that this industry does, but more positively, as a way of promoting collaboration. Yet, the use of such language is a painful reminder that although we are in the business of getting people well and collaborating, we are also in the business of filling our plates, and in many cases, mainly without considering the ramifications for how we fill said plates.
The majority of websites across the industry tout a “holistic” remedy that beautifully illustrates our buffet style approach. Treatment facilities come in all shapes and sizes with 30, 50, or even 100 beds available for those seeking treatment. Small or large though, most of them state they can help any adult 18 and older. And why not? When our heads tell us there are “enough people to go around,” it seems natural to create programs that do everything for every person. The reality is that a truly holistic approach is nonsensical.
First and foremost, it would be daring for a website’s catch-all phrase to be, “we personalize treatment for some, but not others.” Commonsensically, holistic considerations ought to be a standard. In reality, however, I believe holistic language suggests to the end user that there is no need to consider other programs, “we can handle your situation.” And maybe your program can handle a particular individual’s situation, but if all other websites are stating the same thing we get nowhere.
In that regard, treatment programs act more like hospitals, immediately available to those suffering, rather than being an individualized specialist to be referred to according to very specific diagnosis. We refer patients accordingly with heart disease, diabetes, cancer patients, etc., and so it seems natural that we take a similar approach as specialists rather than, “we do everything, call today.”
As far as I can see there are no god-like, holistic, turnkey solutions. The clients I’ve seen succeed are those that maintain constant clinical contact over the course of, at the very least, a few years. The fact that some programs are 30 days, 90 days, 180 days, years long, etc., means absolutely nothing and more often than not, these length of stay timeframes are merely reflecting insurance provider’s commitment to treatment.
Secondly, businesses are good at ensuring their longevity. If I were in the business of selling candy, I would want to make sure my ads attract the younger generations who lack awareness surrounding the impact of sugar on our teeth, not parents who disagree with candy because of their awareness of cavities and costs. The addiction treatment industry is no different. We have treatment facilities with beach front property, coed treatment for young adults, Olympic sized pools, massage chairs, blacked out Range Rovers, you name it. None of the above luxury items have anything to do with long-term recovery, but that hasn’t kept this industry from taking advantage of the instant gratifying nature of the addict in the way we would if we were selling candy to kids. We’ve even gone as far as putting pictures of lakes and streams in our brochures without actually having access to lakes and streams at our facilities.
Even further, within the state of Colorado, we justify as providers not collecting deductibles and out-of-pocket costs. The Florida Model of care, though valuable in many ways, is a major culprit behind these unethical practices. Every time a provider does not collect fees for their housing component, within this model of care, they are making a financial concession, from which, clinical dollars paid to their clinical setting by insurance providers then bleeds over into their residential component. And for some providers, this is routine.
Tougher Questions and a Commitment to Transparency
At Peaks Recovery, we get numerous calls from families who lack financial support, who lack insurance, and who, more importantly, know nothing about what RTC, PHP, IOP, and OP are as acronyms. They also know nothing about the facility they just called, all they know is that our AdWords(s) or website was the first to pop-up on Google and, in a potential state of desperation, called our program for help. That not only puts us in a position of power, but puts any treatment provider in a position of power when they answer that admission call. Thus, what we are selling in the end really does matter.
Sovereign Health is at the forefront of the ethical discussion right now, but what can we do as treatment providers in Colorado to not end up in the same conversation? Are we willing to consider the fact that we cannot help anyone and everyone 18 and older? Are we done making concessions related to deductibles and out-of-pocket costs? Are we done committing insurance fraud by sidestepping our obligation as Florida model providers to collect housing fees? Are we done referring to programs that we know make these concessions? Are we done treating people as buffet style fixings?
Ultimately, I want to ask, what makes us better Colorado?
At Peaks Recovery, we believe in transparency. If any provider within the state has sat down with me recently, they would know that we are invested in long-term recovery solutions as much as we are invested in our business practices. Moving forward, we look forward to continuing with these tough, ethical discussions to empower families and industry leaders to make better informed decisions about treatment and referrals.