Addiction Professionals Say Health Reform May Not Increase Access to Treatment

A 2010 survey of substance abuse treatment providers showed a field that expects continued barriers to patient access despite health care reform, especially as funding sources change, Addiction Professional magazine reported Nov. 1, 2010.

The 27-item online survey, which was conducted by the magazine in September and October 2010, received 363 respondents from treatment facilities. It covered types of treatment offered, patient characteristics, drugs of choice, and business trends. Respondents represented many levels of care and types of clients served; most (61 percent) served clients that were publicly-funded, primarily Medicaid, while about one third said they did not work with third-party payers.  

Although the majority (55 percent) of respondents said they had seen an overall increase in their client censuses in the past year, fewer than half (47 percent) projected patient volume to continue to grow in the next three years, in spite of expected changes to health care because of a workforce shortage and fears that public dollars for treatment —  in particular the federal block grant for substance abuse — could disappear.

“There will be fewer sources to pay, and services will be reimbursed at lower rates,” said one survey participant, William LaBine, who directs the Jackie Nitschke Center in Green Bay. LaBine’s agency has had to diversify its client base and funders as public sources of funding have declined.

“We have to get more of an employed client with health insurance,” LaBine said.

One provider described it as an uncertain time for providers. Jim Curtin, of New Jersey’s Daytop Village, an adolescent treatment facility in New Jersey, said the impending changes were similar to those brought by managed care. 

Only about 40 percent of providers said they were using an electronic health record system. Curtin said money was the barrier for his agency. “We’ll need some [financial] assistance,” he said.

Asked to name the leading drugs of choice among their clients, slightly less than half of the survey’s participants named alcohol, followed distantly by stimulants. Marijuana ranked low on the list, but over 50 percent of the respondents reported an increase in the incidence of marijuana dependence, and Curtin said it was the number one drug of choice among the teens his program sees.

Referring to marijuana, he said, “I don’t think we’ve seen an appreciation of the problem of dependence.”

In response to a question new on the survey this year, 27 percent of the survey participants said their agencies had encountered clients on the autism spectrum.

Substance abuse treatment medications were offered at over half of the providers represented. Most common were buprenorphine, acamprosate and oral naltrexone.