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
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.