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TCIV: ‘Cat-and-mouse’ games impact reimbursement

December 13, 2018
There’s a cat-and-mouse game afoot between addiction treatment providers and payers when it comes to reimbursement, but increased attention at both the federal and state levels, as well as a growing body of case law is helping to strengthen enforcement of parity laws, Nathaniel “Tani” Weiner and Ryan Morgan, of Polsinelli Behavioral Health Law Group, told attendees at the Treatment Center Investment & Valuation Retreat on Wednesday in Scottsdale, Arizona. “There is an evolution in our field that a lot of providers are feeling,” said Weiner. “Our point is there is an active cat-and-mouse game that is happening where the payers are imposing or changing rules on providers, who are needing to learn how to adjust and operate within those rules, simultaneously while learning where their opportunities are for maximizing the leverage they have, whether they are out-of-network, in-network, contract negotiations, somewhere in between, or even from a transaction standpoint.” Without a strong government mechanism for parity enforcement, payers have been less-than diligent at ensuring compliance, Weiner and Morgan said. Progress is being made though, Weiner said. In 2017, the U.S. Department of Labor conducted 187 investigations of potential noncompliance and issued 92 citations. The U.S. Department of Health and Human Services, meanwhile, offers a portal that assists consumers in determining if they have experienced a parity violation, and several states have taken their own steps at increasing enforcement. Ultimately, Weiner said, providers who feel they’ve experienced parity violations don’t necessarily need to seek litigation, but first look to negotiate a resolution with the payer instead. For situations in which agreements can’t be reached, rulings in recent court cases are starting to establish precedents and bring clarity to the issue, as well, Weiner said. “In the last two years, with the body of case law, we’re not just arguing in the abstract,” Weiner said. “You can actually say, ‘here’s the law in this area, and we’ll impose it on you if we have to.’ ” Marketing for the long haul Dan Gemp, president and CEO of Dreamscape Marketing, highlighted several trends that are impacting digital marketing in the addiction treatment industry, and he advised attendees to take a diversified approach to marketing for 2019 and beyond, and not become over-exposed to a single marketing channel. Google remains the largest referral source in addiction treatment, accounting for 84% of incoming business, but Gemp noted that it is organic traffic—not clicks from paid ads—that actually move the needle most. Gemp said websites and contact forms should be mobile-friendly, as 70% of searches today are now done on mobile devices. Treatment centers should market themselves with a long-term view in mind, Gemp said, as he noted several marketing vehicles that provide lasting benefits: Earned media coverage Thought leadership Content marketing An engaged alumni base Professional relationships Compliance and culture Compliance and culture were among the topics covered by Harry Nelson, managing partner of the Nelson Hardiman law firm and chairman of the Behavioral Health Association of Providers (BHAP), and Andrew Martin, MBA, LAADC, chief operating officer of BHAP. At a time for the industry in which suspicions are high thanks to the damage done by unscrupulous actors, operating in an upright manner and overcommunicating your organization’s values are critical, Nelson and Martin said. The duo favor a strategic approach to compliance over one that is fear-based. They added that providers should operate with core values of transparency, accountability and integrity, and work to build a problem-solving culture that seeks continuous improvement and to identify potential problems early. With that groundwork established, providers can boost their bottom lines by avoiding crowded market segments and developing a focus on specific clinical treatment models that fill gaps within the industry, an approach that is attractive to payers, employers and investors alike, they said.
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