by Barbara Woods, LCSW, ACSW
With the advent of the current economic crisis, addiction treatment facilities across the country have faced greater challenges than ever before. Perhaps it is better said that individuals and their families seeking treatment for addiction have faced more challenges in finding appropriate and affordable treatment resources than ever before.
Across the country a number of programs have been forced to close, rendering access to treatment more difficult. Quality of care may have been compromised because of the fact that staff layoffs are at an all-time high in the industry. For example, a counselor who might have been accustomed to caseloads of six to eight suddenly has found that number increasing to eight to ten. Ask yourself: How does that affect quality of care?
Historically there have been fewer and fewer programs willing to deal with the frustration of navigating the managed care maze. Yet as the economy took a nosedive, individuals who in the past preferred to use personal resources to pay for treatment found themselves choosing to access their behavioral health benefits. See the problem? Feel their pain?
Casa Palmera, located in scenic Del Mar, California, did just that. A private, freestanding residential facility, it historically served individuals who could afford its higher cost of treatment on a self-pay basis. However, like so many other programs, the facility over the past year engaged in much reflection on how to increase or maintain census while not compromising quality. Our answer: change the treatment model, improve service delivery, and “they will come.”
Working with managed care
The first task on the agenda was to achieve accreditation from the Joint Commission. This was accomplished in August. The next task was to consider partnering with managed care to some degree. To date, Casa Palmera has achieved network status with three managed care organizations and has initiated this process with several others. Our goal remains to see no more than about 30 to 40 percent of our census reimbursement from managed care.
Regardless of network status, potential patients’ benefits are verified in advance and if they have out-of-network benefits, we have been successful in accommodating a large number of these individuals using these benefits or achieving a single case agreement. The point is that we’re willing to suffer the pain to accommodate more individuals seeking treatment. Today, Casa Palmera receives approximately 35 percent managed care reimbursement vs. self-pay, and census has grown exponentially.
Those familiar with managed care and the philosophy of crisis stabilization can appreciate that this also means a shorter length of stay much of the time. To accommodate this and to enable patients who depend on insurance to receive the best possible care, Casa Palmera chose to partner with managed care and created more of a full continuum of care for those who needed it. This arrangement allows patients to step down in respect to room and board expenses, but remain in the same therapeutic treatment programs. This has been accomplished through the use and support of local sober living homes.
Effective Jan. 1, 2010, Casa Palmera became a Patient Centered treatment program. Through partnering with the University of California-San Diego (UCSD) Department of Psychiatry, Casa Palmera now offers a treatment model that affords daily physician visits with doctors on our staff.
Medical director Shannon Chavez, MD, will be rounding on patients, leading the treatment teams as well as conducting patient groups and patient and staff lectures on an ongoing basis. In addition to Chavez, Vikas Duvvuri, MD, has primary responsibility for all patients diagnosed with an eating disorder; Joseph Shurman, MD, chairman of the pain program, sees all pain patients; and Jerry Ayers, MD, works with patients suffering from addiction. A.J. Foster, MD, our internist, sees all patients immediately upon admission to complete their history and physical. The result is that every day our patients have a face-to-face visit with at least one MD, and usually more than one.
Our physicians lead treatment team, as well as participate in a weekly physicians meeting led by the medical director. In today’s market, this is almost unheard of. We believe that this is the standard of excellence, and we are now actively involved in the research to document the benefits to our patients.
Additionally, we are now able to accommodate a patient who may present with higher acuity than we could successfully treat before, due to the fact that we can transfer those individuals to UCSD inpatient for stabilization. Then the patient is returned to Casa Palmera for residential treatment. The good news is that the same doctors are involved in the treatment given at both locations, and continuity of care is accomplished.
We believe the result to be improved quality of care, longer length of stay (whether funded through managed care or self-pay), better outcomes and a more satisfied customer. Those patients who might have been able to afford a 30-day stay out of pocket now can afford a longer stay because of the ability to combine insurance reimbursement with personal resources.
It goes without saying that this higher level of physician involvement adds expense to the overall cost of treatment. Yet we believe that one treatment stay as described above might prevent multiple readmissions and treatment stays, as a result of the higher standard of care being delivered in the initial treatment episode. Patients get their money’s worth and the cost of treatment at Casa Palmera becomes no greater than the estimated cost of repeated admissions to another program.
One measuring tool that tells us the standard of care being delivered is exceptional is the increased lengths of stay being authorized from managed care. This means that in the opinion of a managed care company, we are documenting and reporting that medical necessity is present and the length of stay is justified.
The question still to be answered involves the impact of healthcare reform and how parity will affect members’ ability to access treatment and get the level of care and length of stay needed to make a difference and increase their chances of treatment success. We’ll keep you tuned in.