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Your list for 2012: leaders advise immersion primary care integration, in records.

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 co-occurring 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.


Whether youVe a healthcare professional running a treatment facility or a therapist EJ3 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 CARP 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 (lOPs) are flourishing because insurance companies are more likely to cover outpatient treatment. Its 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, its 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


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.

Through the adoption of Health IT, behavioral healthcare providers can significantly increase access to treatment for rural and other underserved communities that are often isolated and lack access to comprehensive, high-quality healthcare. However, to be an active participant in this new, integrated healthcare environment, it is important that behavioral healthcare providers begin now to explore the adoption of certified electronic health record (EHR) systems and other forms of technology to enhance or expand existing services.

In addition, its important to remember that Health IT goes beyond electronic health records. Providers also need to make good use of social networking and apps to improve access and provide follow-up services and monitoring. And, finally, creating and enhancing effective links between community-based behavioral health providers and health homes and community health centers are essential activities to ensure integrated care.


The primary imperative for addiction treatment providers is to routinely document their initial treatment outcomes. This has been a perennial problem that never has been addressed adequately by the field. While there have been some exceptions to this over the years, the field in general has not embraced outcomes-based treatment practices.

Research over the past three decades has consistently documented that the treatment continuum should cover a minimum of six months. For most clients, the bulk of this time falls into the realm of maintenance or aftercare. Many programs provide for one year of contact after the initial more intensive treatment. The failure to routinely document outcomes during this aftercare period has been a detriment to the field and to clients.

As a result, we have seen the promotion of "evidence-based" mandates and other efforts by state agencies to dictate practices that may or may not be appropriate for a given client population. Implementing the so-called evidence-based models does not guarantee optimal services for clients. In some cases, such implementation might supplant more effective programs that do not have the legacy of documented outcomes.

Another consequence of not documenting outcomes is that it enables critics to assert dismal estimates for recovery. A number of researchers and other "experts" have asserted very low recovery rates that might be relevant only to the poorer-prognosis cases. Pessimistic outcome estimations are likely to discourage those afflicted or affected by addictions from seeking assistance from treatment providers.

Finally, the lack of documenting outcomes on a routine basis precludes providers from making the case that treatment actually provides benefits that exceed the costs of treatment. Simple documentation of changes on such factors as healthcare utilization, legal problems and vocational functioning can document the fiscal returns as well as societal benefits of treatment to justify the treatment investment.

Documenting treatment outcomes on a routine basis can be a treatment asset and should be part of standard clinical practice. Such documentation can not only help improve treatment results, but also can support the investment in treatment services. The documentation can be done at virtually no cost beyond the clinical contacts required for quality treatment delivery. Free forms and procedural guidelines are available from Evince Clinical Assessments (evinceassessment[congruent to]

Continued failure to document outcomes will result in treatment providers1 inability to provide realistic expectations for clients, and the inability to justify the investment in treatment on the basis of fiscal returns and societal benefits. The latter will be increasingly important during economically challenging times.


Lots of questions, very few answers. One thing is certain: The substance abuse healthcare delivery system will change. For now, there are two areas I'd like to address.

Anticipating the move to electronic records, the outpatient mental health clinic where 1 work has recognized the need to bring clinicians up to speed with the technology. Not surprisingly our more senior clinicians may be particularly reluctant to embrace new technologies, so we're making the move toward electronic medical records in small, deliberate steps--ensuring buy-in from even our "lower-tech" clinicians.

We also have recognized the limitations of our existing hardware and software. Those upgrades are also being implemented in a well-planned manner, over the next two years. In short, we're taking a thoughtful approach to becoming well-armed when electronic medical records become a mandated reality.

Second, recognizing the increased use of medications in the treatment of addiction disorders, I'm in a holding pattern. I'm concerned that the pharmaceutical companies seem to base a drugs efficacy on short-term clinical trials, with not much attention given to the longer term.

For example, I see many people who take Suboxone (buprenorphine and naloxone) being completely unwilling or unable to get off that drug. While buprenorphine is evidently a wonderful detoxification medication, I'm concerned that "Suboxone docs" (and the pharmaceutical companies) are enjoying ongoing financial gain while patients have no viable "exit strategy'." In some cases, we're achieving harm reduction, but most Suboxone patients I have encountered seem to be using opiates or other drugs, falsifying urinalysis, selling some or all of their meds and generally eschewing a recovery lifestyle. (A caveat: This is strictly anecdotal evidence, based on observations of a small sample of people.)

Whether it is disulfiram (Antabuse), naltrexone (ReVia), injectable naltrexone (Vivitrol), acamprosate (Campral), the above-mentioned Suboxone or even methadone, I'm just not seeing the successes one would hope from such interventions. Clinical trials notwithstanding, where are the long-term outcome studies? Until those are available and revealing, I'll maintain my cautious approach to the "medicalization" of addiction treatment.


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


Lynn Sucher, MC, LPC, CEDS

President Treatment Consultants


Norman G. Hoffmann, PhD

Adjunct Professor of Psychology Western Carolina University


MORE ONLINE: To read what some members of our Addiction Professionals group on Linkedin said about the field's priorities for 2012, visit

Brian Duffy, LMHC, LADC-I Mental Health Counselor SMOC (South Middlesex Opportunity Council) Behavioral Health Services


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Publication:Addiction Professional
Date:Jan 1, 2012
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