Act or React? Rehab Industry Transformation

florida healthcare lawyerBy: Jeff Cohen

By now, it’s not news in Florida that drug and alcohol recovery providers are staring devastation in the face as payers continue to mount non-payment offensives.  As payers one by one march on the industry and starve providers of cash flow for operations, many providers can be expected to shut down.  To make matters worse, as the popular media continues to act as a conduit for gross misrepresentations of industry providers, the public’s affection for the industry can’t be expected to improve.  This makes the future look especially bleak for the industry, and yet the silence and stillness of providers is baffling.

Given the breadth of the payer problem (many simply aren’t paying providers), why are we not seeing a slew of lawsuits filed by providers?  In nearly 30 years as a Florida healthcare lawyer, I’ve never seen a healthcare sector so hammered by insurance companies.  And I’ve never seen it unanswered in court.

The media is (perhaps unwittingly) complicit as well.  Not long ago, there was an article in a local newspaper that reported about the owner of a provider who had not been charged with wrongdoing, a tox lab that had been sued by a payer (with no response from the lab in court or to the reporter) and statements about large reimbursements made by insurers to providers (especially for tox lab services).  The article failed to mention that reimbursement is set ENTIRELY by the insurance companies, even for out of network providers.  Oops…  This fact and every other meaningful fact was left out.  The media is schizophrenic on the topic of addiction.  It demonizes addicts, and then attacks the providers trying to help addicts by claiming that ALL providers are in it for big bucks and nothing more.  I suspect insurance companies enjoy the media carrying their water as they sit back reaping enormous profits, partly derived from unpaid claims to legitimate providers providing needed services.

On a long term basis, this sector’s survival will depend on one thing that has eluded them for way too long:  working together.  The irony is that industry providers have divided and conquered themselves; and now they’re easy pickings.  They have no unified voice to answer media misstatements, no body to dialogue with payers, no voice to weigh in on lawsuits that ought to be filed (on their behalf and on behalf of patients), no way of proposing and influencing legislation and no way of defining and agreeing on quality care.  They are reaping what they’ve sown—isolation and weakness.

The long range fix isn’t anything novel or innovative.  It’s just an organization that is focused on at least the above.  Physicians have it with the Florida Medical Association.  Hospitals have it with the Florida Hospital Association.  Physical therapists, optometrists, chiropractors, dentists and every sector of the healthcare industry, other than addiction providers, has a tax exempt organization (a 501(c)(6)) that does this essential job.

The truth is that the addiction treatment industry in Florida is facing annihilation in the foreseeable future.  And those professionals that rely on the industry (tox labs, marketing and lead generation businesses) ought to share the concern.  Unless providers step up, take action and build an advocacy organization, they will be crushed and patients who are already underserved will have even fewer options than they do today.

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