Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery.
Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery.
Since opening our doors a little more than a year ago, we have tried every day to create a special treatment center that people want to come to for exceptionally high quality, individualized care at an affordable cost. Built in to our DNA is a ferocious desire to continuously focus on getting better at what we do in order to achieve our goal. We believe this is the only way we will survive in a highly competitive market, particularly given our desire to remain independent of anything or anyone who could get in the way of a laser like focus on quality of care. We have to want to be the best at what we do every single day, and willing to make changes when changes need to be made if it means our patients will benefit.
Outcome surveys and measurements help us accumulate and respond to the data we need in order to operate in this manner. Another arguably more effective and much simpler “tool” is just listening and paying very close attention to our patients when they provide thoughts and feedback. “Add a water cooler, we need a process group on Fridays before the weekend, the group size is too big, we need more “skills” groups”… This is information we must have in order to remain focused on continuous improvement. Fortunately we have a culture which encourages and supports all of us who have thoughts and ideas which can make us better as a recovery community. Pray this never changes.
Our patients are our customers. They are the ones whose interests must always come first and they are the ones who will either make or break the future of SCH. We know this, and we respect this. Our relationship with our patients is a professional relationship where very specific and predetermined protocol guides the nature of what is expected from both parties in the exchange. We provide the service, they hopefully get better and they pay us ideally for the value we are providing to them and their families.
When collecting patient satisfaction surveys last week one of our patients was insulted when referred to as a “customer”. To this person, the word, “customer” seemed to imply that it was just about the money… It is not all about the money but money is being exchanged and with that comes responsibilities inherent in such an exchange. The word, “patient”, on the other hand, implies “they” are sick and “we” are not… Yes our patients are here for help and our clinical care team is here to provide that help but we are all in this together and at the end of the day we are all just people who are doing our best with what we were given to survive in what can often be a challenging and beautiful world.
There is a lot written on the pluses and minuses of using the words, “patient” or “customer” when referring to people who receive healthcare services. Attached below is something from Yale’s Business School of Management on the topic which is interesting. Read it HERE
Whether we use the word person, patient or customer, the fact of the matter is we all need input from those we serve in order to be the best that we can be. It is critical not only to our success as a business but more importantly for patients and their families, which at the end of the day is our guiding principle. Asking questions is only part of it. Having the courage to change the things we can is what makes the difference.
As I was enjoying time with friends and family last night in Boston, I was asked the following question by a woman who is a Chief Healthcare Economist for The Office of Inspector General, US Department of Health and Human Services:
How do we get rid of the fraud and abuse in the substance use treatment industry, particularly with the atrocities happening in many sober homes and the over prescribing of medically unnecessary (and addictive) drugs which are being prescribed to some of societies’ most vulnerable citizens (addicts)?
The AIG recently participated in the largest health care fraud enforcement action in Department of Justice history. Hundreds of people were charged across multiple states involving over 1 billion dollars in fraudulent claim filings. In one noteworthy fraud scheme, a medical professional in Texas was charged with over-prescribing medically unnecessary narcotics to patients, some of whom died from drug overdoses. The doctor allegedly fraudulently billed Medicare and received more than $1.2 million in reimbursement. READ HERE for some quick facts on the action, and HERE for the official press release from the DOJ.
As I was thinking about how to answer this question to this woman who is probably 20x more intelligent than I am, what did come to mind is something along the lines of…. “It is no wonder insurance companies put us (as providers) through such rigorous and time consuming scrutiny in the form of questioning just about every decision we make and every action we take. All we are doing is trying to get what we often feel is the bare minimum amount of coverage for our patients and provide them with the best possible care, and yet they don’t ever seem to be on our side….”
For sure much of the intense scrutiny we get as providers in behavioral health is due to a lack of parity, stigma and shame and the misguided belief by some that addiction is a choice rather than a disease. However, much of it is also due to the fact that there are alot of really bad people out there capitalizing on our nation’s drug addiction epidemic by committing crimes and grossly taking advantage of very sick and vulnerable people. And insurance companies are dead smack in the middle of it.
Patient brokering, providing services and products that people not only don’t need but which are also potentially deadly for them and falsely billing for products and services that aren’t provided are serious crimes and serious ethical breaches. We should not be surprised that these same insurance companies who are victims to this kind of abuse are also the ones giving us what often feels like an unnecessary and unappreciated fight over providing the appropriate level of care for the appropriate amount of time based on our clinical recommendation as legitimate and trustworthy providers. Their eyes and ears have to be wide open. They don’t trust anyone. It makes sense, and it is extremely bad for those of us who are actually doing the right thing.
More importantly, the fraud and abuse is bad for patients. They are the ones who are hurt the most by this high level of distrust between payer and provider. They suffer because of the actions of a few really bad people. It is not right and it is not fair. They deserve more and better from the entire industry.
While I try my best to answer this question posed last night, I will say to the majority of us who are playing by the rules and in this for the right reason that the next time a UR rep from an insurance company makes us question why we come to work every day, try to have an ounce of compassion for them! Do continue to advocate and fight aggressively and passionately for your patients. Do not allow discrimination for what we know are treatable diseases to go unspoken. Call it for what it is and settle for nothing less than what your patients need. Fight the stigma and the shame. Prove to them that there is value in what we do! After all, there is value and recovery is possible. Many just don’t know it or believe it.
And understand that the sooner this fraud is eliminated, the sooner we can all work together to achieve our goals. The ideal scenario is payer and provider trust one another and can work together to achieve a similar goal that is in the best interest of the patient. Second to that is just being able to trust one another. Without some level of trust, we will never get anywhere. And we won’t have trust until this nonsense such as the Del Ray, Florida Sober House scene gets cleaned up once and for all!
Thank you Marta and Leemore for inspiring us to think about this issue, and thank you Kim and the whole team at SCH for working effortlessly as we try to make a difference in this world in the work we are doing.
Most Frequently Asked Questions-
How do I know if SCH is the right place for me? The answer to this question will hopefully come after an initial consultation with one of our qualified therapists. We know we are not the right place for all patients, we know its difficult to know where to go and we have excellent relationships with many other outpatient treatment centers throughout the country. We also know many people may need a higher level of care. Our goal is to help you find the best possible fit, and if that is not SCH, that’s ok. Our goal is to help you, and we will be the first to tell you if we think you could be better served at another facility or with a different level of care.
Can I get better care at a residential facility? The answer to this question is it depends on what you need and where you are in in your disease. Our goal is to provide the highest level of care possible in an outpatient setting, which we believe is far less disruptive for our patients and their families than residential treatment and of course far less expensive. That said, there is a great need for higher levels of care for many patients, and in some cases that is what we may recommend for people that come to us. Given Dr. Kim’s experience with residential treatment, we have excellent relationships with many throughout the country and we will help you find the right fit for you if a higher level of care is what would be best for you.
What do you mean by “integrated treatment”? This means we are aware of the connections between not only various behavioral health issues (co-occurring disorders) but also the connections between your addiction or mental health disorder and how it is likely effecting your medical health. We will assess and address not only the symptoms of your disease but also what is underlying and causing the disease and how has your total health been effected as a result. We will work with your primary care Dr., your dentist and any and all providers who are working with you as we create a coordinated care team around you and your condition as we seek to treat your whole person and not “just” one of your symptoms. We want to get to the root of what’s driving your self destructive behavior and we want to create a multi disciplinary treatment team that can help you recover and stay healthy (both mentally and physically) indefinitely.
What do you mean by “co-occurring” disorders, and do you treat just depression or just substance use disorder or do I have to have multiple disorders in order to come to SCH? We know from the data that many patients who present with a “primary” most often have more going on than just the one symptom. SAMHSA defines co-occurring disorders as: The coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorders. When we say we treat “co-occurring” disorders, this is our way of saying we recognize that many people struggle with recovery from eating disorders or drug abuse because of inadequate treatment of other mental health conditions. Trauma, for example, often lies at the root of many of these issues. Depression, anxiety and PTSD are also common co-existing psychiatric conditions. At SCH we have the experience and the knowledge to identify when this is happening, and we can treat it accordingly. That said, one does not have to have a “co-occurring” disorder in order to get treated at SCH.
Do you take insurance? Currently we are out of network and therefore payment is “self pay”. However, we are expecting to be in network with several major insurance carriers by the Fall. If you think SCH might be a good fit but need financial assistance while we are out of network, call us. We have several options that we have designed to help patients who need the financial help while we are out of network.
Is Dr. Kim still working for Timberline Knolls in addition to founding and running SCH? Yes, she is doing both and she loves it. Currently, Dr. Kim remains a valued part of several of Acadia’s residential facilities, including Timberline Knolls. Dr. Kim will always have a special place in her heart for Timberline Knolls, its staff and its wonderful residents. She also has a solid relationship with Acadia’s management team.
What do you mean by saying you track “outcomes” and want to improve “value”? These are terms being used today at many large hospital systems such as Mayo and Cleveland Clinic and MD Anderson and with many payers as the healthcare system in the United States shifts from a “fee for service” reimbursement model which is based on volume TO a “value based reimbursement” model which is based on how well a patient does as measured by the outcomes being measured per dollar spent. In layman’s terms this simply means value is being measured by results, and more and more payment models are moving toward paying a provider for value than for volume. We believe this movement is one that ultimately results in better care for patients and at a lower cost because it aligns the goals of our patients entire care team with our patients and their payers (insurance companies) while at the same time eliminating waste and redundancy in our current healthcare system. For now we are set up just like everyone else with a fee for service model. However, with payers we are continually advocating for a shift from volume to value in what we treat. For our patients and their families, this simply means we are a provider who is willing and interested in being held accountable for our provision of care.
I listened to an interview this morning titled, “Building Clinicians’ and Non-Clinicians’ Trust and Respect”, by Thomas H. Lee, MD, MSc & Laura L. Forese, MD, MPH. It’s about building teamwork and trust within a healthcare organization, particularly between clinicians and non –clinicians at New York- Presbyterian Hospital. The article discusses the absolute need for high performing teams to have trust and mutual respect amongst all members of the team. Listening to this was not only insightful and right on point, but it helped put things in perspective for me as an Operations Director in a healthcare system that is tasked (and challenged) with a very similar initiative.
Where operations is focused on “boring” things like monitoring and reducing cost and measuring outcomes and optimizing operations, the therapists and doctors I work with are pretty much squarely focused on providing the best possible care they can. Though they understand the need for someone like me in the organization, I believe the cold hard truth of the matter is that they wish people like me would just get out of their way and allow them to work with patients and do their job.
Being a relative new comer to healthcare, I never thought that building trust and respect between clinicians and non- clinicians could be such a challenge. I suppose I should have known this “business” was like no other as I was sitting in Michael Porters Value Based Healthcare Class at Harvard Business School with probably some of the most brilliant physicians and healthcare leaders in the world back in January of 2016. Professor Porter was explaining concepts such of risk sharing and activity based costing (a fancy term for knowing where you spend your money) in very, very basic terms. As I sat there I remember asking myself two things; first, why is he explaining such basic material to people who are 100x smarter than I am and second, why are so many in the room so confused and or so resistant to running their “business” this way (which happened to be the only way I know how to run a business)? It all made perfect sense to me and yet I felt like a fish out of water. I acknowledge that medicine is unlike any business. In fact for those of us who believe we should all be given equal access, it can’t be like every other business. Regardless, I also believe that a healthcare system without 1) aligned goals amongst payers, providers and patients, 2) some level of transparency, 3) open competition, 4) accountability and 5) some form of risk sharing is a system that is simply not sustainable. It took someone with Michael Porter’s stature to make this case, and today I understand why.
Clinicians are trained to spend the majority of their waking hours focused on improving the quality of life for the individuals they are treating. They pour their own blood, sweat and tears in to their work and the work they do is arguably the most important work on the planet. They don’t want to burdened with one ounce more of paperwork than what they are absolutely required to do. They don’t want to spend time making sure that the equipment needed to provide the care is not only “the best” to get the job done but also affordable for the organization. They don’t want to waste precious treatment time encouraging patients to complete outcome surveys. They don’t want to spend extra time in an EHR system documenting data that is not necessarily relevant to quality of care but which is incredibly relevant to payers as they try to measure the value patients are receiving. They don’t want to spend precious resource time arguing with payers over medical necessity in order to squeeze out a few extra days of treatment for a patient in need. They hate this piece, and rightfully so. And many of them don’t believe they should share in any of the risk of whether or not their patients’ outcomes are successful.
Some of this will naturally be remedied as healthcare systems shift away from a fee for service model which rewards providers for volume to a value based model which rewards providers for the value they deliver. Some of it is necessary in order to make this much needed transition. And some will likely always be a part of providing care in a world that demands more and more out of all of us every single day.
In order to be on the right side of making care more affordable, more efficient and more accessible to all, an organization must instill a culture which recognizes the value of all constituents within an organization, both clinical and non- clinical. This is mission critical. With this clinicians can focus on doing what they love and what they do best and the rest of us can support them in providing the best possible care and value for patients and their families.
Tom Lee, the brilliant physician and true social revolutionary, does a great job with this interview. It touches on a lot of really great thought provoking insights and challenges. The first time I met Tom he told me and my colleagues that healthcare is in dire need of more people who truly understand and know how to optimize “operations”. I was with a friend who is a black belt in Lean Six Sigma and Tom was impressed (hard to impress Tom so we were thrilled!). The reality is a high performing team requires that all members are trusted, respected and valued for the work they bring. An organizations’ culture must nurture and promote this philosophy from the top down. There is no other way to succeed in today’s world of healthcare. Those who embrace this reality will survive while those who do not will eventually fade away.
The team at SCH is looking to align with like-minded treatment centers, mental health professionals and business leaders as we form an alliance designed to enable close collaboration around patient care and quality improvement initiatives in the behavioral health space- specifically the addictions and mood disorders space in which SCH operates. The name of the alliance is VMH, for Value in Mental Health. We are seeking to create an atmosphere in which we as healthcare professionals are able to openly discuss outcomes data with each other in order to drive an increase in quality of care, a decrease in total cost and data which clearly shows the value that we in the mental health field provide to patients, their families and their payers. Please contact David Newton at SCH to learn more.
If ever there was a time for mental health providers to work together to demonstrate, document and prove the value that our care provides, now is that time. The fact remains unfortunately that a relatively large percentage of people in our country simply do not want to pay for mental health services. Human behavior teaches us that people generally don’t want to pay for something if they don’t see the value in it. This is absolutely the case in mental health. Those of us who have done the research, who have lived with these diseases and/or who have treated these diseases know first-hand just how valuable and powerful proper and effective treatment can be. Lives can be saved, dollars can be saved and families can be saved. However, so many people don’t know this or they don’t believe it and as a result they simply don’t want to pay for it.
We see this being played out in Washington DC with the new healthcare act coming down the pipeline, which will inevitably cut funding for mental health treatment one way or another. We also see this being played out in the way treatment is currently paid for by managed care with the sometimes ridiculous hurdles they often put providers through. At SunCloud Health, we have had two cases in the past three weeks where managed care denied our right to submit clinical’s on two separate patients (who absolutely needed what we were recommending) based on their claim that they did not receive the request to submit clinical’s in a timely manner (Yes, you read that right). Drilled down for those of us who are forced to spend and waste countless hours on contentious “peer reviews”, the facts are as follows: We were initially and in our opinion unjustly denied for the requested level of care at the pre-auth stage, we opted to advocate for the patient and elected to escalate to the next level, we left the voice mail advising as much, we have proof that we left the voice mail, they denied receiving the voice mail and as a result they closed the case and refused to even consider the case for the level of care we recommended. They never looked at the additional clinical information available for review, they did not speak to anyone on our clinical team and they refused to authorize the level of care for the patient. Clearly they do not see the value in the care being provided. If they did, this would not happen this way. It just wouldn’t.
When a payer can get away with not paying for legitimate care based not on a patient’s clinical’s but rather a technicality such as they supposedly did not receive a voice mail, when more than 50% of the highest leaders in this country are debating not whether or not to cut access and funding to mental health but rather how to cut it and when some people still believe many mental health illnesses are choices rather than diseases, we most definitely have a problem.
Living in a country and in an economic system where we pay for goods and services based on the perceived value that we place on those goods and services, the most effective way to successfully address this problem is to prove to the world that there is in fact value in what we do. We know it’s there. Our job is to convince those who don’t know it or who don’t believe it that it is there. This is done with honest and reliable data and a clear message. It requires collaboration and cooperation between like-minded quality providers who deserve to be paid for the work that they provide not just because they feel like it but because there is real tangible VALUE in the service they are providing.
To show value, we must be able to effectively and clearly show people the results (or outcomes) of the treatment we provide, and the cost to achieve those outcomes. And we must do so in a way that our patients, their families and their payers can easily understand and in a way where they can compare our services against one another so as to determine what each of us do well and what we may not do as well. It is only with this perspective that comes with being able to compare products and services that people will be able to confidently assign a value both to what we provide as an industry and as individual providers.
To actually do this, we need collaboration among ourselves as providers and we need the buy in from payers who hold all of the claims data to agree to do the analysis with the data that they have and the results that we will provide them. Together, we need to agree on a standardized set of outcome tools that we all use and we need to pool as much data as possible so as to make a convincing case. We need to be ready and willing to learn from the measurements we will be taking as we learn what we do and do not do so well, and to work to continuously improve where we can. We MUST be willing to shift our mindset and our business models from being rewarded for the volume of services that we provide to being rewarded for the value that we provide our patients and their families. We must be willing to share in some of the risk with our patients and their payers, which simply means we do better when our patients do better and we don’t do as well when they don’t do as well (due to something that was or is in our control). We should we interested in having patient representation on quality improvement teams, as patients know sometimes better than we do where we can improve. Where we can take our cooperation a step further and create mutually beneficial alliances which optimize and leverage our strengths, we should do so. And of course we need to continue to advocate for our patients and their families every chance we get.
An inspiring article was released this month from ICHOM, an international consortium based in Cambridge which measures, documents and publishes meaningful health outcomes, about a group of hospitals in the Netherlands that decided to form an alliance that would enable close collaboration around patient care and quality improvement initiatives. The group is called Santeon and what they have been able to accomplish by taking many of the steps mentioned above is simply remarkable. Though they are not in the mental health space, there are still many lessons to be learned and the path they took toward changing the paradigm is one that at the very least is worthy of looking at.
The business of healthcare has changed a lot in the past ten years. Providers are being held more and more accountable for our provision of care than at any time in recent history. The shift from paying for value over volume is one that has moved in to many area of healthcare, and it is one that mental health providers should embrace arguably more than any other specialty. Payment for our services is currently under attack from just about every angle and this is primarily because we have a very difficult time showing people just how valuable and powerful our services can be. By working together and changing the way we do business, we can address this attack head on. And the beauty is that while we do this we will not only save ourselves from the attack on everything that we do, but we will improve quality of care, we will reduce total cost and we will do our part in providing as much access as possible to patients and their families who are in dire need of our services.
Click here for the ICHOM article on Santeon.
Mental Health Awareness Month has been observed since 1949; and yet, mental illness is still poorly understood and highly stigmatized in our country today.
Unfortunately, the vast majority of people continue to believe that psychiatric disorders are “made up,”” instead of viewing them as very real, potentially fatal, brain diseases. The truth is mental illness deeply impacts all aspects of a person’s life—their relationships, identity and behaviors.
Possibly the greatest hindrance to widespread understanding and acceptance of psychiatric disorders is that they cannot be seen physically (in many, but not all psychiatric illnesses). What’s more, unlike cancer or other medical diseases, mental illness cannot be identified via an x-ray or blood test. Therefore, a man hobbling on crutches with a broken leg is shown mercy; bystanders might assist by opening doors or carrying items. Conversely, a woman lying in bed with crippling depression is often extended no mercy whatsoever; instead, she is perceived of as lazy and is encouraged to snap out of it.
In fact, depression is very commonly misunderstood in today’s world, primarily by patients themselves who tend to blame themselves for having the illness or being lazy (these are distortions associated with the disease!), and also by the very people that are most supportive of those with other medical illnesses–doctors and family members.
Often a mother, father, wife or husband incorrectly uses themselves and their own life experiences as a unilateral barometer. They may recall times when they felt sorrow or despair in their own lives. In time, the sorrow passed or the despair lifted. In other words, they ultimately “got over it.” Therefore, the tendency is to apply this same standard to the loved one who seemingly can no longer function. The problem is, the standard is not applicable. The individual weighed down by clinical depression can no more resiliently bounce back than the other family member can fly. The bottom line is this: if they could, they would; but they can’t all on their own. Give the family member who can’t fly an airplane and a pilot and off they go. Give the family member with debilitating depression good care (therapy, medication, supportive community) and they can recover.
What an individual struggling with depression, anxiety, or any one of the other myriad psychiatric disorders truly requires is treatment; for many people this includes medication, which can help with the physical aspects of what the brain needs to recover from depression. Regrettably, due to the ongoing stigma associated with mental illness, people routinely fail to get the help they need. Sometimes they refuse to seek therapy due to the shame they feel about seeing a counselor or psychiatrist. Certain segments of the population are particularly vulnerable to this fear of stigma. Those in the military frequently go untreated due to the fear of jeopardizing their careers. Mothers, afraid their children might be taken away by a social service agency, are also often reluctant to seek care. Professionals many times avoid treatment because they have a career to tend to. Doctors and nurses do likewise because it’s their job to take care of others, not to receive care themselves.
Fortunately, due to initiatives such as Mental Health Awareness month, we have made strides in the area of eating disorders and substance use disorder. Today, the public has a greater understanding and appreciation for the complexity of these two illnesses. Now, if we can just promote greater comprehension surrounding other mental illnesses like depression and PTSD, perhaps the blame and stigma might be lifted and people could get the support they require and deserve.
On April 10, SCH was proud to send a representative to Congressman Peter Roskam’s office (US House of Representatives, Illinois’s 6th district) to discuss the value (financially, morally and otherwise) of providing people with mental health treatment. This topic is of particular importance in today’s political environment given the movement to overturn The Affordable Care Act and more specifically the discussion around eliminating what is referred to as “Essential Health Benefits” in some insurance policies. The discussion was initiated by Nancy Meier Brown, President of Meier Clinics Foundation, and we were joined by representatives from Timberline Knolls Residential Treatment Center, NAMI DuPage, Northwest Community Healthcare and Linden Oaks.
What we all know is that healthcare today in this country is a complete mess. With total spend at nearly 20% of our GDP and with a system that is fragmented, unorganized and full of waste, what we have today is unsustainable and we all deserve better. A system that is more fully integrated, more organized and measured based on its results is what we believe is the long term solution. What many don’t know, apparently, is that some don’t feel like mental health deserves the same treatment as other illnesses and diseases, as if disease of the brain somehow isn’t on the same level as disease, for example, of the heart. Though we all know someone who has been touched with one form of mental illness or another (from depression to substance use disorder), the fact of the matter is many still don’t feel these diseases deserve the same level of compassion and treatment that other diseases have received for decades. Maybe it is because of stigma or maybe it is because of the ignorant belief that mental illness is often a “poor choice” rather than an unavoidable disease. For those of us in the room with Congressman Roskam last week, frankly we simply do not understand why or how we are even discussing eliminating mental health benefits given what we know and see every day, and what the data and literature all support. Yet the conversation is happening, and that is why we were there last week. To plead a case that needs to be plead.
Hopefully in an attempt to support our case, we were asked at the meeting to present the Congressman with some facts as to why it makes sense to continue to fund mental illness treatment. Though to us this is intuitive and we don’t see cardiologists being asked to make the case for why heart disease treatment should be covered by benefits, the data he asks for exists, and we will of course oblige him with his request. That said, this is yet another wake up call for all of us that our world of caring about those who struggle with behavioral health issues is under utter attack at the moment. The parity law is great, but there is no parity, and things appear to be getting even worse.
Some of the data we will be presenting is as follows.
First of all, proper treatment works. For major depression, panic disorder and obsessive compulsive disorder rates (of improvement) are about 70%. This is comparable to rates of improvement for people who suffer from physical disorders, including diabetes and asthma at 70-80%, cardiovascular disease from 60-70% and heart disease at 41-52% (12).
The National Institute on Drug Abuse estimates that every dollar invested in addiction treatment programs yields a return of between $4 and 7$ in reduced drug related crime, criminal justice costs and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1! (13).
The US Department of Health and Human Services estimates that for every $100,000 invested in treatment for substance abuse (measured in California, New York and Washington), there are savings of $484,000 in health care costs and $700,000 of crime costs were shown to be avoided. (14) In a comparison of medical expenses of Medicaid clients who received treatment, the following savings were noted (measured in Washington): $170.00/month for patients receiving inpatient; $215/month for those in outpatient treatment, and $230/month for those receiving medication assisted therapy (specifically methadone). In California treated patients have been shown to reduce ER visits by 39%, hospital stays by 35% and total medical costs by 26% (14).
Just by integrating medical and behavioral services, The National Council for Behavioral Health estimates that between $26-$48 billion can potentially be saved!
Thanks to Nancy Meier Brown for including us in this discussion, and thanks to the Congressman for taking the time to meet with us. Clearly there is a lot of work to be done, and it will be done. We have no choice. Our patients and their families deserve every ounce of time we can devote to advocating on their behalf. Please join us in the fight.
The world places a high value on certain things–money, happiness, thinness (sadly), comfort and security, to name a few. However, in our fervent efforts to pursue such conditions in our lives, we often neglect an essential underpinning to any living experience worth having: values. When we live unconsciously, blind to our values our lives become unbalanced. The same is true for people who profess to value certain things, but their actions tell a very different story.
Lack of balance is rife throughout our society. The business man striving so hard to get to the top in order to make huge amounts of money–for noble reasons that are applauded by society–to pay the mortgage and keep his kids in private school. The woman, who could easily be married to this man, who must be “perfect”: thin, industrious, beautiful, with equally perfect children involved in every possible after school sport and activity.
The truth is, this lack of balance is sustainable for a while. But soon, our business man, having sacrificed time with his family, time in the gym or stress-relieving sports to spend more time in the office, begins to rely on alcohol earlier in the day, and even more at night, simply to relax. And our woman, unable to cope with her many self-imposed demands, starts taking Adderall to keep up with her hectic schedule.
Even this offers a modicum of sustainability. But in the end, when we lose balance and succumb to self- destructive and addictive behaviors designed to sustain us in our unbalanced, achievement at all cost-oriented lives, we can find ourselves in a place we don’t want to be.
Without a single doubt, I lived this way as a young woman. In the end, no achievement would ever be enough to sustainably anesthetize the pain that arises from living a life disconnected from real values. In college and medical school, when I was fully in the throws of an eating disorder and getting more deeply sucked into alcohol, my only priority was becoming a doctor. Various moments of clarity, fostered by loved ones and strangers alike, helped me to see that left unchecked, my eating disorder would kill me before I’d ever graduate from medical school. My priorities were off, and my life was unmanageable–despite the fact that I was still showing up, and meeting the demands, of school. From as far back as I can remember, it never occurred to me that my health and wellness needed to be my first priority.
In my recovery I have gained a whole new respect for the necessity of balance. This concept grew in importance as my life got more and more abundant–a career doing what I love, a dog (another living thing to love and take care of), marriage to a man that I love with step-children I also love, and most recently, the grandest gift I’ve experienced in recovery, motherhood.
My work has been, and always will be, tremendously important to me. I have personally worn the chains of addiction, which is why I choose to spend my professional life helping others to gain the freedom that I enjoy. Today, I am firmly and consciously rooted in my values, with my own recovery and health topping the list. My behaviors and choices reflect my values (most of the time!).
Beginning SunCloud is one example of this in my life. Not only is it consistent with me keeping a positive work/family balance, it has given me the latitude and opportunity to fulfill a long-held dream: to create a fully integrated treatment center that offers the comprehensive care required to help people truly heal, one that values health and wellness first and foremost for every single patient and family–a place with values that are aligned with mine.
The customer is always right…
By: David Newton, Director of Operations
“The customer is always right” is a slogan by which most successful businesses live and die. We learn early in our careers that we must listen to “the voice of the customer.” “No” is a word we don’t use when talking with customers, and a disappointed customer is one who will likely not be around for very long. Solving problems and providing solutions for customers is what lies at the essence of all successful business, and as we do so we want a happy customer whose interests are aligned with ours and who feels taken care of and listened to. Business people have entire departments (sales) dedicated to making sure that the customer is not only “always right” but also that they are never told “No” and that ultimately, they are happy. Success is optimized when there is alignment and a “Win-Win” dynamic in place. In this respect, medicine is not unlike any other business. We are solving problems by saving lives. We want positive outcomes for our patients and we do well if they do well. We too want happy patients, but not at the expense of quality of care, and this is where things differ.
As stewards of knowledge that our patients may not have and having taken the oath to place others interests above our own, we simply cannot make every patient happy all of the time. We want them happy, if for no other reason than a happy patient is one who is more likely to stay committed to long-term recovery. However, it’s not that simple.
In treating those who struggle with addiction and other behavioral health issues, we find ourselves at this crossroads nearly every day; patients who want medications that we know aren’t good for them and patients who need more care than what we might be able to provide are two issues which come up regularly. Another is optimal group size for treatment. Deciding what to recommend to a patient becomes even more challenging when there is not necessarily a correct and incorrect answer. For instance, what exactly is the optimal group size for treating complex co-occurring eating and substance use disorders? Is it 6, 8 or maybe 10? The answer, it depends…. Deciding whether a patient needs IOP, PHP or Residential is another one where there is not always a black or white answer. ASAM has specific criteria for determining the appropriate level of care, but anyone in this field knows there is always some subjectivity as to what is best for the patient and that can easily lean either way depending on who is doing the analysis. Is it always the right decision to deny prescribing a stimulant such as Adderall to an addict? The answer is generally yes, as this medication is addictive in and of itself and it further dissociates people from their insides- all bad for the addict. However, it could be helping with ones ADHD, in which case there could be an argument made to keep the person on it.
At SCH we have disappointed several patients because Dr. Kim would not prescribe a medication which she believed would be harmful to the patient. We have disappointed several because they wanted very badly to join our IOP but our clinical team felt it was best to say no either because our group size was already too big to provide optimal treatment, or because we felt a HLOC (higher level of care) was more appropriate for the patient. These decisions have in all cases lead to “unhappy” customers, yet any good clinician who puts their patient’s interests above those of themself would have made the same decision. Making such decisions to say “No” to patients is one that is never easy, as we all want to help everyone, nobody really wants to turn anyone away and we are all human- it is hard to say “No”. However, good clinical care in this field requires “No’s” all the time, and with good clinical care comes good long term business.
Medicine is unlike any other business. It requires us to say “No” all the time because that is what is in the best interest of our patients. Of course we want happy customers! More importantly, we want healthy customers who can recover from these deadly diseases. In time and with recovery, our hope is that these patients will look back and be grateful for the course on which we helped them stay. For the team at SCH and because of Dr. Kim’s unwavering commitment to always doing what is best for her patients, we know nothing else.
The American public willingly exists under many myths: the tooth fairy is real; love always lasts forever; one size fits all. Belief in such myths is basically harmless.
This one is not: the myth of mental health parity.
Far too many people labor under the notion that insurance coverage for mental health issues is equal to that for problems of a physical nature. After all, wasn’t that legislated by the federal government a while ago?
Here’s the answer: no.
Every single day, we on the outpatient side of things, fight insurance companies to provide just one more day of care for those struggling with severe depression, an eating disorder, or substance addiction with co-occurring bipolar disorder or post-traumatic stress disorder. What does this translate into in real terms? Approximately $400 at the outside. And yet, a recent patient of mine, who was also a physician, told me about a surgical procedure in which the doctor elected to use a new semi-synthetic mesh product to close a patient’s abdomen, without making a single phone call to an insurance representative. The cost: $10K.
Due to much coverage by the media lately, there is now widespread awareness of opiate addiction throughout our country. This increased awareness is extremely positive on many levels. Yet again, a severe disconnect remains in the minds and hearts of insurance companies.
A patient of mine nearly died from an opiate addiction. On his current insurance plan, the co-pay for narcotic pain medications such as vicodin, oxycodone and morphine is literally nothing; it is essentially free. However, a prescription for suboxone, a medication that actually treats opiate addiction, requires a co-pay of $80 a month. Mind you, this is only after I, as his physician, spent 15-20 minutes on the phone with the insurance company to get the authorization required to treat him with this potentially lifesaving adjunct to his treatment.
Several roadblocks already exist for those with the disease of addiction. The stigma associated with substance abuse is very real and frequently proves a huge deterrent to accessing treatment, especially for those in the military. Moreover, instead of viewing addiction as a genuine illness, too many people continue to perceive it as a moral failing. Denial, a core symptom of many mental illnesses, keeps untold numbers of individuals from treatment. Add to this, a health care system that sets up serious barriers to both the patient and the treatment professionals and you have a perfect storm in which people remain addicted until they die, often due to overdose.
All of us need to be conscious of this ongoing injustice and question it whenever we can. Additionally, we must be grateful for groups like the Kennedy Forum, NAPHS, REDC and the Parity Implementation Coalition for working specifically and diligently on this issue of lack of parity. Only through both awareness and action will we witness much-needed change.
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