What I find striking about most of us who work to help those struggling with addiction is an overall commitment to doing good – to the belief that with our work, we can truly transform lives. This is why the struggle of patients and families to find quality care – due to an influx of questionable providers, fraudulent business practices and online predatory marketing –is so abhorrent to me. This is also why the quest for standards and ethics in the sector is so important to me. Because of a lack of understanding about addiction as a chronic disease and the fraud that’s been making headlines, most recently on HBO’s Last Week Tonight with John Oliver, so many people believe that quality addiction treatment isn’t worth the cost or that treatment doesn’t work. We know from the 25 million Americans living in recovery, treatment works – we just must do a better job of helping people find it.
I recently returned from the annual leadership conference of the National Association of Addiction Treatment Providers (NAATP), the industry association of treatment providers such as Caron Treatment Centers. The talk at the meeting was about NAATP’s new Quality Assurance Initiative (QAI), a broad-based effort to address the poor care and outright fraud rampant in the addiction treatment sector.
The QAI will be the roadmap for the providers in the behavioral health and substance use disorder treatment sector. Combined with the new NAATP Code of Ethics, the QAI outlines 29 guidelines within eight core competencies that are the hallmarks of a high-quality, values-based treatment program deserving of the trust of patients, policymakers, healthcare workers, and payers. The competencies cover Operations, Admissions, Training and Credentialing, Billing, Discharge and Continuing Care, Outcomes Measures, Community Engagement, and Marketing and Visibility.
The final guidelines won’t be available until later this year, but already change can be seen in the sector. Several well-known addiction treatment “providers” are no longer allowed membership in NAATP for violating its code of ethics until they address and correct their noncompliant practices. The ultimate goal is to make membership in NAATP a signal to consumers, healthcare professionals, regulators, and payers that a provider is ethical and delivers quality care.
Caron has been a driver behind this effort, and we are whole-heartedly committed to implementing these guidelines when they become available in their final, approved form later this year.
This has been a long time coming, and the addiction treatment sector is picking up on themes outlined in Caron’s Patient Bill of Rights for Addiction Treatment. Shatterproof, the American Society of Addiction Medicine (ASAM), the Commission on Accreditation of Rehabilitation Facilities (CARF), and now NAATP have all undertaken initiatives to establish standards of care in addiction treatment.
As I explained to the attendees at my session on these efforts at the NAATP conference, as providers we need to stop focusing on what we shouldn’t be doing -- the illegal and unethical practices of the bad actors -- and look instead at what we should be doing -- implementing standards, outcomes, transparency, centers of excellence, disease management, and quality of care. Ethics shouldn’t be part of our conversation; it should be inherent to everything we do. We know we are doing good work. How can we do better?
Part of restoring the public’s trust in what we do is to embrace the changes put forth by NAATP and others. Addiction treatment providers should:
- Know the laws and ethics that affect the sector. NAATP can be a resource for this.
- Ensure licensure, accreditation, and certification for facilities, programs, and healthcare professionals. NAATP, ASAM, CARF, and JACHO are leading the effort here. Don’t mistake these as “window dressing.” These efforts are likely to have teeth.
- Implement a robust compliance program. Organizations need to hold themselves accountable for complying with all standards and laws.
- Improve quality and measure outcomes. This is happening at the state and local levels. Join the effort or take a leadership role.
- Keep the focus on patient care. Adopt a Patient Bill of Rights.
It is a privilege to be a trusted part of an individual and family’s recovery from addiction, and most providers in the behavioral health and substance use disorder treatment sector take this responsibility seriously. However, profiteering has often outweighed the sacred trust of families in crisis. The NAATP Quality Assurance Initiative is a step in reclaiming that trust.
By Doug Tieman