Concerns over patient isolation, staff safety and licensing reciprocity between states as a means to address a shortage of care providers during a crisis were among the COVID-19-related topics discussed by a panel of industry leaders during a Friday morning session at the virtual National Conference on Addiction Disorders.
Concerns over isolation were a recurring theme through the early portion of the discussion.
“For many people in recovery from addiction, the foundation of recovery is based on community,” said Philip McCabe, CSW, CAS, DRCC, the president of NALGAP and a health instructor for the Rutgers School of Public Health in New Jersey. “That is definitely what has been interrupted. It’s unfortunate to use the term ‘social distancing’ when we need to use “physical distancing”. Loss of connectiveness is a trigger for relapse. Addiction and isolation go hand in hand. When people are isolated from support, there’s a greater chance for relapse in recovery.”
This was a particularly difficult issue for residential providers in California, said Pete Nielsen, CEO of the California Consortium of Addiction Programs and Professionals. The worry for many facilities early in the pandemic was the risk of bringing new patients in and having to quarantine them upon arrival. This created a difficult situation for the new patients, who were coming in for treatment and had to immediately isolate. Guidance from the local, state and federal levels has helped providers navigate that challenge, Nielsen said, but as the pandemic has worn on, a new issue has emerged: staff health.
“There have been quite a few facilities where it wasn’t patients who came down with COVID, it was staff,” Nielsen said. “What do you do then? We’re already a distressed workforce. Now you have a situation where you can’t find professionals to fill in the gaps. That makes it a difficult task.”
Community Medical Services, the multistate operator of outpatient treatment programs, has mitigated such risks by implementing proactive measures, CEO Nick Stavros said. Stavros shared an example of one of the organization’s facilities in Texas. A temperature check revealed one member of its six-person staff had a fever. The staff member tested positive for COVID. The remaining five members of the staff were then tested, and all five also tested positive. Still, just one staff member among the group was symptomatic, Stavros said, and had the organization not taken the step of testing all six staff members, it was easy to envision a situation in which COVID was spread to an untold number of patients by asymptomatic staff members.
Stavros said the use of telehealth, which CMS was already largely reliant on for internal matters pre-pandemic given its multistate operations, has helped. Patients are able to make fewer in-person visits to receive medication, while still maintaining daily connection with staff online to minimize isolation. Prior to the onset of COVID-19, about 20% of CMS’s patient interactions were conducted via telehealth, Stavros said. In May, it climbed to 88%.
Eric Bailly, LPC, LADC, a business solutions director for Anthem, said the insurer has seen a similarly dramatic shift to telehealth during the pandemic. Pre-COVID, less than 1% of Anthem claims for behavioral health services were virtual. After stay-at-home orders went into effect across the country, that number skyrocketed to 64%.
Bailly, who is also a licensed professional counselor in North Dakota and Colorado and a licensed alcohol and drug counselor in Minnesota, said a temporary easing of licensing requirements has enabled him to practice across state lines. As an organization, Anthem is supportive of efforts to create a situation where there is an ability to provide counseling or psychiatry across state boundaries, Bailly said.
McCabe, meanwhile, said that while such loosening of restrictions is needed during the COVID crisis, he has some concerns about making such changes permanent, given the differences in requirements for licensure in various states.
“While need is there…we need to be mindful that not every state requirement is equal,” McCabe said. “When we talk about reciprocity between states, I would be concerned about someone practicing in New Jersey, where we have strict guidelines for licensure, when they come from a state with lower guidelines and we feel they don’t meet qualifications.”