Wednesday, January 13, 2016

Analyzing the Inner Workings of an Addiction Treatment Operation



Like any other business, a health care facility that provides treatment services to patients suffering from alcoholism and other drug addictions must operate like a well-oiled machine.  The professionals who run this type of agency are tasked, not only with the goal of creating financial solvency, but also saving lives.  Therefore, the operation leaves very little room for error without significant consequences.  Similar to other medical facilities, managing the day-to-day operations of a drug treatment center is a long and complicated string of processes that, if not followed properly, can result in either a loss of revenue or jeopardize patient care.  The only thing worse than a breach of protocol is the establishment of inadequate policies that lack the structure necessary to create a continuum of quality care that also perpetuates profit.

The information contained in this article is not the type of information that can be learned in school, but rather acquired by years of working within the field and encountering the many scenarios that present themselves throughout the course of time.

The Business
Notwithstanding the clinical aspect, the administrative aspect of running this type of business is extremely complex.  There is seldom a dearth of addicts that require treatment in any given area.  However, unlike other areas of the medical industry, many addicts are not interested in receiving treatment.  Some addicts have been known to lose everything they have in order to keep their addiction.  Even law enforcement agencies find themselves losing this battle when presenting probationers or parolees the ultimatum of going to treatment or going to jail.

If everyone who needed substance abuse treatment was in treatment, every rehab clinic would be tremendously successful.  However, since we are faced with the realization that many addicts are disinterested in recovery, facilities must be creative in order to keep numbers up.  Even when facilities are at full capacity, administrators are faced with the challenge of being paid by the worst payers on the planet…insurance companies.

Government vs. Private
From a financial perspective, government-run agencies have the luxury of sitting back and waiting for tax dollars to roll in to help keep the lights on.  Even not-for-profit organizations are able to receive grants to assist with operating expenses.  Private agencies rely solely on the reimbursement from insurance companies and patients who pay out of pocket.  This forces private facilities to operate more efficiently and to be more creative in terms of marketing their services.

There’s also a natural bureaucratic element that exists at treatment facilities that are run by the State.  If employees do something wasteful that loses money, it’s taxpayers’ money so there are less consequences.  When an employee does something that loses money at a privately-owned facility, they have to account to the business owner for the loss.  This forces a check and balance that we don’t often see at government agencies.

Employee Challenges
In corporate America, employees generally know that if their company does well, it’s good for them too.  When a company generates more revenue, there’s more money to go around so employees receive raises, offices get bigger and working conditions become more comfortable.  For some reason, in the substance abuse treatment industry, many employees lose sight of this fact. 

In the world we live in, money very often motivates people.  In the microcosm we call the substance abuse treatment industry, many people seem to be more motivated by recovery.  That doesn’t necessarily have to be a bad thing, as we all know that substance abuse counselors should be innate and inherent caregivers.  At a rehab center, employees should be interested in the progress of the patients.  However, they must also realize that the facility is a business and must make money.  Without money, the facility cannot remain in existence so that it can continue to help the many people undergoing treatment there.

As administrators, this may seem simple and basic to us but to our clinical staff, it may not.  There’s always a struggle to get clinicians to think about finances because their brains usually aren’t wired in that way.  It doesn’t mean that administrators are smarter than clinicians or vice versa.  It just means that their interests are not aligned.  Even many doctors in private practices seem to let their office managers tend to their money.  It’s a phenomenon that exists and must be properly dealt with in order to run a medical facility.

How do you get clinical employees to be equally as interested in the financial stability of the company as they are in the clinical stability of their patients? It’s not easy and sometimes seemingly impossible.  Some employees respond to employee incentives.  Consider paying your clinical staff a lower hourly rate and have them earn the rest predicated on how much revenue the facility generates each quarter.  This could be in the form of bonuses so they recognize that the company making money is just as important as the quality of care.

The Intake Process
Admissions is a critical function of the facility and if not done properly, it could result in major deficiencies. Not every patient assessment will lead to an admission, as some individuals simply don’t require treatment or the type of treatment they require is not provided at your facility.  One way to maximize business through admissions is to identify dual diagnoses.  For example, in addition to alcohol and/or drug abuse/dependence, a patient may also be experiencing mental health disorders or may be a victim/offender of domestic violence or sex offense. 

If you have these types of dual-focus programs, treatment at your facility could be more conducive to their recovery. If you don’t have these types of programs and find that your admissions department is assessing these diagnoses frequently, you may want to consider developing special programs for these patients.  Doing so could lead to more patients going to your facility specifically for those programs which could lead to an increase in revenue.

Referrals
In addition to patients finding their way to your facility on their own accord, many patients may be referred by other agencies or professionals within the field.  Conversely, your facility may be in a position to make outgoing referrals from time-to-time.  Both incoming and outgoing referrals are important. 

Incoming referrals should be tracked and monitored on a regular basis.  It’s important to know who is sending you your patients.  It’s also important to determine if smaller referral sources could be sending you more patients than they are.  Sometimes when a big referral source is unhappy about your services, they will issue a complaint.  Other times, they will just fade away.  If you’re not regularly monitoring the flow of referrals, you will never know which referral sources just stop referring.  You may also not realize which potential referral sources should be referring to you that aren’t so that you can make contact with them to discuss your company’s services.

Outgoing referrals are important from a business and marketing perspective as well.  If your operation is large and there are many employees at your facility, you may have less control over where patients get referred to.  If a patient requires treatment not provided by your facility or if they need to be referred as part of an aftercare treatment plan, it’s important that these patients are referred to facilities that you have a cooperative working relationship with, rather than your competitors.  If one facility is referring patients to your facility, they will expect referrals in return.  Not only is it important to reciprocate referral efforts with your allies, you certainly don’t want competing agencies to benefit from your employees who don’t recognize why they shouldn’t be sending patients to them.  As with incoming referrals, outgoing referrals must be carefully monitored for this reason.

Documentation
In an arena threatened by the possibility of malpractice lawsuits, documentation is critical.  When it comes to running this type of a treatment facility, documentation is all we have to either prove or disprove certain elements that are sometimes called into question.  To the legal world, if it’s not documented then it didn’t happen.  Employees must be trained to document incidents, progress, lack thereof and any other pertinent information that could be relevant.  Even if it doesn’t seem relevant at the time, it’s best to document certain events in some manner so it can be retrieved if necessary.

Regulatory commissions will also critique the manner in which your entire operation is documented.  A missing signature, date or diagnosis could be considered a violation of the regulations.  Sometimes documentation could make the difference between your facility being paid or not.  Certain states have been known to demand that payment be returned for subsidies, grants, Medicare or Medicaid reimbursements if documentation is inaccurate or insufficient.

Patient Retention
Launching a community-based marketing campaign to draw more patients to your facility should certainly be an important part of your operation.  However, keeping existing patients is equally as important as trying to find new ones.  It also costs less from a marketing perspective.  If your administrators haven’t discussed the topic of retention, it’s time to start thinking of ways to improve it at your facility.

In order to maximize your existing business, you must have a plan to keep the patients you have coming back.  This doesn’t mean treating them longer than they need to be treated.  It simply means engaging them when they do.  There are various ways in which to accomplish this.  Follow up, appointment reminders, social media, patient surveys, outreach, company newsletters, etc.  Anything you or your staff can do to improve your patients’ experience and keep an ongoing dialog will help to give them a reason to return.


For more information on how to improve the operation of an addiction treatment facility, please contact Ashlar Consulting Corporation at 305-849-9399 or visit www.AshlarConsultingCorp.com. 

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