Muhammad Sair Khan
Addiction Treatment Outcomes Research: What We've Learned So Far
New research into the effectiveness of addiction treatment is changing the future of addiction care. These studies are revealing new details about what treatments and treatment combinations work, how many days of inpatient care are optimal for recovery, and what sort of aftercare leads to the best outcomes.
As more evidence comes to light, facilities are being pushed to adopt these practices by regulators, professional societies, and payors. Centers for Medicaid and Medicare will only cover certain treatments backed by research, with private payors typically following the lead. Keeping up on this research can help your facility navigate changing reimbursement and stay on the forefront of care.
Effectiveness of Patient Care Setting
One big driver of change within the addiction treatment industry is the move from inpatient care to intensive outpatient therapy. Multiple high-quality studies have shown that both types of care tend to result in the same levels of patient abstinence at follow-up.
However, outpatient care is much more cost-effective for providers, payors, and patients. It also allows patients to remain in their home environment and begin rebuilding other aspects of their life. Intensive outpatient care also provides longer-term care than inpatient care, even though it comes at a lower cost.
In the future, it is likely insurance companies will reimburse more for this level of care than inpatient care, making it a valuable service to offer to your patients.
After-Care Choices for Better Outcomes
Research is also finding that after-care is vital to long-term sobriety, leading to an increase in reimbursement for these programs. After-care may include alumni groups or individual follow-up that offers continuing support after more intensive rehabilitation has concluded.
Many insurance companies are now providing reimbursement for these programs, particularly if they are overseen by a physician or licensed clinical social worker. These additional billable hours provide you with more opportunities to improve your bottom line and your patient outcomes.
Best Length of Stay for Abstinence
Length of stay has also been vigorously studied to determine how long each patient needs to remain in care to see results. In general, inpatient stays should be no shorter than 90 days and outpatient care should last at least 130 days. However, patients with dual diagnoses or other circumstances may need longer care to see effective results.
Following American Society of Addiction Medicine (ASAM) Criteria can help you determine how long your patient needs care and at what level. The criteria use previous patient outcomes evidence to outline a strategy of care for each individual patient. In general, payors also follow this criteria to authorize care and determine reimbursement,
As the amount of patient outcomes evidence increases, it will shape the way insurance companies pay for treatment and likely change what treatments are offered at facilities across the country, shifting to longer outpatient care with aftercare support from shorter inpatient care. At Datapro billing, we can help you navigate these reimbursement changes and keep up-to-date on your billing practices. Contact us to learn more about the latest in payor reimbursement