Ethics (Reprise)

Building Trust- Ethics in Addiction Treatment

David Lisonbee, CEO, Twin Town Treatment Centers

Trust is the basis of effective treatment; without trust, therapeutic outcomes are improbable. Researching the operative elements of successful addiction treatment reveals that it is the therapeutic alliance between the treatment provider and client-patient is THE essential therapeutic ingredient. Therapy styles, teaching content, techniques, philosophies, strategies, models have little effect beyond the establishing a relationship between the person being help and the other helping. If the provider or facility providing help is not trustworthy, they are not effective. Without trust, doors are closed.

Quid pro quo kickback schemes paying for patient referrals and/or fee-splitting between providers to enhance referral and revenue volume are obvious breaches of ethical conduct. Call centers, internet brokering sites, and toxicology lab revenue sharing scams have become pervasive in a profession and business which is ultimately built upon trust. All addiction treatment providers are painted with the same cynical brush when a few value money over integrity

How many times have we heard about a family being misled about the costs of treatment when the provider of treatment posted that they accept insurance? The provider actually accepted out-of-network insurance payment, where contractual accountability can be avoided. Unnecessary services, exorbitant charges, and inducements to receive services are common-place. How many families receive bad news twice when their loved one checks out of treatment early and the provider will not refund the unused portion of what was paid toward that treatment?

Rather than contracting with a cost-effective laboratory to provide medically necessary urinalysis testing, some providers and labs are charging upwards of $1000 for a $5 lab or confirmation on a daily basis. The bill is then sent to the medical benefit to conceal it from utilization review. These revenue enhancements create a need for greater oversight or more aversive market consequences.

Treatment and recovery should represent the best of what we have to give, not the dark motives of selfishness and greed.

Twin Town Treatment Centers recommends to fellow providers to post ethical standards on websites to hold ourselves accountable and provide a benchmark for the public distinguish those who maintain such standards. Rather than racing to the bottom, we’ll set ethical standards from which the public and purchasers of healthcare can distinguish.

Standards we set for ourselves and our fellows:

  • Refusing to accept/ pay referral fees or contract with referral mills (internet websites) to increase rates of patient enrollment. The patient and family geographic location, and the clinical needs expressed by the patient and their family are always considered when forming disposition/ referral plans.
  • Refusing to mislead patients and their families with statements such as, “We’ll take your insurance and we will accept payment arrangements for the unpaid balance”. In situations where the patient and their family are misled at enrollment, they are later shocked by bills which may exceed tens of thousands of dollars. The reality all along was that the insurance would have only paid for only a few days of residential or out-of-network treatment.
  • Refusing to contract with the patient or family for a “flat case-rate” for the entire course of treatment. Under flat case rate agreements refunds are frequently refused and the unused funds are pocketed.

Set ethical and quality standards which exceed the norm:

  • Provide only cost-effective treatment which is quality monitored.
  • Before admission, provide full financial and service disclosure, and secure voluntary informed consent. Avoid surprises.
  • Seek to protect the dignity and confidentiality of each client patient and their family members.
  • Document and provide the treatment that is billed.
  • Respect and protect clinical relationships with current and/or prior caregivers. Avoid transferring clients from care of therapists, counselors, psychiatrists and/or physicians. COORDINATE care with community professionals rather than setting up competitive or fragmented systems of care.