NAATP annual meeting: Measure what you're doing

Last week's annual leadership meeting of the National Association of Addiction Treatment Providers (NAATP) focused on the quality assurance guidebook coming out from the organization (see “NAATP releases draft guidebook for residential treatment providers,” ADAW, April 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32334 ). It culminated with a visit to Capitol Hill (see story, p. 3).     

AAC statement on NAATP lawsuit

As the National Association of Addiction Treatment Providers (NAATP) was beginning its annual leadership meeting May 6, American Addiction Centers sued the organization in federal court (see “AAC sues NAATP for defamation,” ADAW, May 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32362 ). We wanted to provide further information on the lawsuit (which we linked to in our story last week). Below is a statement provided exclusively to ADAW by AAC May 15.     

Membership doubles,and NAATP plans more on ethics and outcomes for 2019

The National Association of Addiction Treatment Providers (NAATP) has culled its membership, removing members who don't comply with its ethics guidelines — mainly for marketing purposes. But rather than reducing its total numbers, this move has doubled membership, from 450 in the fall of 2015 to more than 900, NAATP Executive Director Marvin Ventrell told ADAW last week.     

Hill Day: The three big ‘asks’ from NAATP

At the “Hill Day” event that marked the end of the annual leadership conference of the National Association of Addiction Treatment Providers (NAATP), 120 association members went to the Senate and House of Representatives to make their case. “I felt it would be successful if we had 50 members who stayed the extra day and did the Hill visits,” Mark Dunn, NAATP policy representative, told ADAW of the May 8 visits. So he was thrilled that so many went.     

NAATP keeps focus on parity

We need to move beyond the principle of parity into the practice of parity.” These words from Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), in an interview with ADAW last week are a sign of the frustration with how parity — the Mental Health Parity and Addiction Equity Act (MHPAEA), which guarantees that substance use disorders (SUDs) will be treated no differently from medical and surgical claims in the world of reimbursement — has been a real‐world disappointment to patients and providers alike.     

NAATP members work to support staff during changes of pandemic

Members of the National Association of Addiction Treatment Providers (NAATP) — treatment programs both inpatient and outpatient — are still open for business. In fact, business is booming, NAATP told ADAW last week. This is good for patients, and good for providers, but at the same time, it's stressful for staff. Employers are working to combat this stress by helping to obtain personal protective equipment (PPE) — masks and gloves — for staff. In addition, they are trying to ramp up with telehealth, provide supports for staff and keep paying attention to the needs of patients. Demand for treatment is increasing, as drinking is going up as well.     

NAATP to court: AAC doesn't have a case

Citing “actions that it had every right to take, statements of opinion it had every right to make, and the actions and the conduct of third parties” for which it had no control or responsibility, the National Association of Addiction Treatment Providers (NAATP) filed a motion to dismiss the complaint against it by American Addiction Centers (AAC) filed in May (see ADAW, May 13, May 20).     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Briefly Noted

The biennial International Drug Policy Reform Conference, sponsored by the Drug Policy Alliance and held Nov. 7–9 in St. Louis, Missouri, was full of varying sessions on harm reduction and reform — 45 of them in all. An article by Filter editor Will Godfrey summed up his perspective — he was the only print reporter so far to have covered the entire conference. We asked him what his feeling was about the prospects for treatment and harm reduction working together, as they have in the past. “There's plenty of friction, but there can and should be rapprochement between the harm‐reduction and traditional treatment communities,” he told ADAW. “Many people in the harm‐reduction movement pursue traditional recovery, and there are treatment folks who support harm reduction. All should be trying to save lives and empower people. Harm reductionists' legitimate concerns about mainstream treatment include its coercive or controlling deployment, its frequent eschewal of evidence‐based practices and its promotion of abstinence at the expense of stigmatizing people who use drugs. Treatment advocates often overlook that most people who use drugs are fine. And in any case, everyone must be free to choose their own path.” But the fact that two approaches — one more radical than the other — coexist still is bound to make some treatment providers uncomfortable. After all, some of the speakers said that even supervised consumption sites are unfair to drug users, who have no need to be “supervised,” and instead should be free to use drugs. All viewpoints were there. “There's constant debate in the harm‐reduction movement about working to change systems that inflict harm from the inside, versus calling for radical reforms from the outside,” said Godfrey. “I think both approaches are simultaneously necessary.” Not everyone saw the conflict. “I have to say that I didn't see an anti‐public health movement there at all,” Maia Szalavitz, who is writing a history of harm reduction and is respected in both harm reduction and some, at least, treatment camps, told ADAW. “There has always, of course, been tension between activists and researchers and between people who want to fight within the system and those who want to tear it all down.” For the Filter article, go to https://filtermag.org/drug‐policy‐reform‐movement/ .     

‘Incentivizing Recovery’ follow‐up: White paper was a ‘first step’

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17).     

Briefly Noted

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf     

Briefly Noted

A project that began a year ago (see ADAW, Jan. 15, 2018), Shatterproof's rating system of addiction treatment programs took another step last month when the nonprofit announced it would start out with a pilot, now that it has $5 million. Saying the current addiction treatment system is broken, Shatterproof founder and CEO Gary Mendell said the project was made possible by funding from two foundations (the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation) and a coalition of five insurance companies. “People who need help for addiction don't know what to look for or where to turn,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in the Dec. 18 announcement of the project. “We are taking rating system best practices from health care and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care but also drive a long overdue transformation of the addiction treatment industry.” The Shatterproof Rating System will utilize data from three sources: insurance claims, provider surveys and consumer experience, with collaboration from the National Quality Forum (NQF), a membership organization composed of payers. Initially, the program will begin with a pilot, with analysis done by RTI International. “Consumers can find information and accurate data on the quality of nursing homes, hospitals, physicians and most other types of providers,” said Tami Mark, director of behavioral health financing and quality measurement at RTI International. “It's time that patients have reliable information on addiction treatment.”     

HRC and DPA on where harm reduction is,where it's going

As “harm reduction” increasingly becomes less grassroots and more established in governmental and organizational bureaucracies, ADAW asked representatives of two major groups — the Harm Reduction Coalition (HRC) and the Drug Policy Alliance (DPA) — about the current and ongoing role of harm reduction.     

Confidentiality of SUD records: History and final rule analysis from LAC

In less than 2 weeks, treatment providers and patients will see what happens to confidentiality. The final rule issued last month on 42 CFR Part 2 (“42 CFR Part 2 final rule: OTP input into PDMP, more law enforcement,” ADAW, July 20, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32778 ) will take effect. We talked to the lead private organization on this regulation last week about how we got here and where we're going next.     

Table of Contents

California OIG Blasts In‐Prison Treatment as a Waste of Money Leadership Change at Phoenix House Signals New Growth, National Influence New Head of ADP is Renee Zito AATOD Seeks Reconvening of Federal Opioid Treatment Panel NAATP Salary Survey Released: Resource for HR Directors Reader Responds to ADAW Article About Budget Coming up     

Clarification on Braeburn's CAM2038/Brixadi/Buvidal

In our recent article “Sublocade: Why a placebo arm?” (see ADAW, March 11), we referred to the investigational medication CAM2038, an injectable (weekly subcutaneous depot) form of buprenorphine that is competing with Sublocade in the buprenorphine market. To make the terminology clear, the name of the investigational medication, developed by Braeburn in partnership with Camurus (Braeburn's European partner), is Brixadi. In Europe and Australia, however, the product is approved and marketed by Camurus under the trade name Buvidal. The Food and Drug Administration (FDA) granted tentative approval to Brixadi in December 2018, but Sublocade has exclusivity. “Brixadi's clinical development program was designed with input from the FDA,” said Sonnie Kim, Pharm.D., Braeburn vice president and head of medical affairs, in an email to ADAW. CAM2038 was found effective in Phase 2 research (see ADAW, June 26, 2017). The most recent results were published in JAMA Internal Medicine ( https://jamanetwork.com/journals/jamainternalmedicine/article‐abstract/2681061 ). We regret any confusion. For more information, go to www.braeburnrx.com .     

Names in the News

The American Association for the Treatment of Opioid Dependence (AATOD) will be presenting the 2019 Richard Lane/Robert Holden Patient Advocacy Award to Zachary Talbott at the organization's conference in October. Talbott was selected by his peers for the award. Nominations were announced last month (see ADAW, April 15, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32331 ). Talbott has opened and directed new opioid treatment programs, and had “compassionate advocacy of people with opioid use disorder,” as well as “fierce dedication to our patient population,” according to AATOD's May 1 letter to Talbott announcing the award offer, a copy of which was obtained by ADAW. Congratulations!     

As HIPAA changes loom,patients demand continued confidentiality for SUD records

In last week's issue, we wrote about the plans by the federal Department of Health and Human Services (HHS) to weaken the Health Insurance Portability and Accountability Act (HIPAA), citing regulatory burdens and the need for information‐sharing (see ADAW, Jan. 21). The plans, detailed in a request for information (RFI) issued Dec. 12, throw a wrench into the plans by the “make 42 CFR Part 2 like HIPAA” movement, which would erase the federal confidentiality regulation protecting substance use disorder (SUD) treatment records by watering it down to HIPAA standards. Now, with even HIPAA seeming too burdensome, the need is even greater to protect the consent provision of 42 CFR Part 2 — which is basically all that's left after the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed information‐sharing for the vague “health care operations” without consent last year (see ADAW, Jan. 8, 2018). Last week, H. Westley Clark, M.D., J.D., dean's executive professor at Santa Clara University and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, made this abundantly clear in his comments to ADAW.     

Recovery Month will take place: Faces & Voices of Recovery will run it

Last week, we reported that the Substance Abuse and Mental Health Services Administration is walking away from its sponsorship of Recovery Month (see “After 30 years, SAMHSA walks away from Recovery Month,” ADAW, July 8, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32770 ). This is correct. However, what needs clarification is this: Recovery Month will still take place, hosted by Faces & Voices of Recovery. Philip Rutherford, director of operations of Faces & Voices of Recovery, told ADAW in an email last week that the organization “is excited to host the Recovery Month website, previously found at recoverymonth.gov .” The new site “will contain a repository for the 2020 Recovery Month digital assets, like graphics and display banners for anyone to download and use, and more. Equally as important, organizations will be able to post information about their events on the Recovery Month calendar.” These materials have “been a staple of the event for years, and Faces & Voices is pleased to be able to keep it going.”