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Private centers: A picture of health?

Since the early days of alcohol treatment, America’s private facilities have looked like carbon copies. As recently as the early ’90s, if you checked into one in Georgia, Minnesota or California, you’d find a cookie cutter copy. That finding comes from a study of employee assistance programs and private treatment centers that Roman and his wife, Terry C. Blum, dean of Georgia Institute of Technology’s Dupree School of Management, conducted between 1988 and 1992.

“They had changed very little since they were first established. All of them were 28-day, residential programs based on the 12 Steps of Alcoholics Anonymous, period,” said Roman who, as a graduate student, met Alcoholics Anonymous’ famed co-founder Bill W., originator of the 12 Step program. “They were one-size-fits-all. They were essentially indistinguishable.”

Not any more.

More than half of the private rehab centers in a national study have added such things as motivational enhancement therapy to their traditional treatment program.

To successfully navigate the choppy waters of change in the insurance industry, private rehab centers must focus on what gives them a competitive edge. For example, when the study started, 81 percent of the centers offered in-patient detoxification and 69 percent offered residential treatment. By 2001, those statistics had dropped to 57 percent and 44 percent, respectively.

“It’s analogous to what’s happening in the rest of healthcare. People are being released from hospitals after much shorter stays,” Blum said. “Innovation is important for every company — whether it’s healthcare services or not.”

Many private rehab centers have augmented AA’s 12 Step program with newer treatments and welcomed a wider range of addictive behaviors into the fold.

“Centers have had to come up with a broader range of options,” Roman said. “Right now the menus of treatment are partially out of a sense of desperation because people are not going to be reimbursed for in-patient treatment. That’s what’s driven this movement away from one-size-fits-all program.”

The move to diversify appears to be good for the health of centers and patients. The closing rate among private substance abuse treatment centers has slowed. During their 1988-1992 study, Roman and Blum discovered that nearly one in three centers closed during those four years. But only about half that number — just 15 percent — closed while the National Treatment Center Study was underway from 1995 to 1999. (See related story about risks associated with closure, Risky Business.)

Since 1995, the researchers have conducted three “waves” of on-site interviews at treatment centers scattered across 38 states. A fourth wave is planned to begin this fall.

Each wave is followed every six months by a series of phone interviews with center administrators, clinical directors, marketing directors and, more recently, substance abuse counselors. Researchers probe for information in many sensitive or confidential areas that span business, financial, organizational and treatment practices. Questions ferret out specific information on patient recruitment and referral, staff burnout, revenue sources and administrators’ abilities to spot serious financial trouble on the horizon, to name a few.

Comparing data from discreet moments in time enables the researchers to capture “freeze-frame” snapshots of private rehab centers in the midst of growth and change.

With each new wave, the team, which also includes more than a dozen research technicians and graduate students, adds new dimensions to the study. For example, third wave interviews included scrutiny of how much centers are implementing treatment innovations. Although this wave of data collection was just completed in May, Roman and Johnson are already noticing changes among the centers.

“I think if you went out into the world and asked treatment center administrators, “What’s your single most important wish?” they would say, “Give us better reimbursement so we could engage in a better menu of treatment,” Roman said.

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