Addiction treatment centers have received scant attention in the national discussion of sectors most vulnerable to the economic effects of the coronavirus crisis. But leaders in the substance use treatment industry already are thinking ahead to long-term financial impacts, as they scramble in the short term to meet community needs under adjusted conditions.
In an interview Wednesday with Behavioral Healthcare Executive, a prominent treatment leader from one of the hardest-hit states said that if the public health crisis causes declines of 30 to 50% in patient census or complete suspensions of service, significant short-term financial relief will be needed.
“There will have to be an effort to maintain the [treatment] infrastructure, to keep programs viable for when we get on the other side of this thing,” says Scott Munson, executive director of Sundown M Ranch in Yakima, Washington.
Uncertainty over the potential trajectory of the virus adds to the industry's angst. While some providers have reserves to withstand a short-term downturn, “For a lot of the system, 30, 60, 90 days out, it's the end,” says Munson, who also serves as president of the dozen-member Association of Alcoholism and Addiction Programs of Washington State.
Financial relief would have to come in the form of federal dollars, Munson says, although states also would have a role in the allocation of funds. It does not appear that the substance use treatment community is called out specifically in the $2 trillion relief package that Congress and the White House negotiated this week and still requires final congressional action. The health care components of the relief package focus largely on hospitals and the procurement of medical equipment.
Impacts at home
In Washington state, which in recent days has seen an exponential increase in COVID-19 deaths but a more consistent pattern of new cases, Munson says there has been good communication between the addiction treatment provider community and state regulators. There has been some regulatory relief around providing telehealth services, he says, as well as some attention to giving short-term assistance to providers that rely on Medicaid funding.
Munson believes outpatient treatment providers will have some promising long-term opportunities through greater use of telehealth. However, “I have grave concern about the residential system across the country,” he says.
Munson says that within the information pipeline in the state's provider community, there is word that some agencies have limited or suspended operations, while there also is a not yet substantiated rumor that one residential program has closed permanently.
Meanwhile, the isolation at home that has been a fact of life in Washington for a longer period than elsewhere will likely fuel demand for services. First, Munson says, more restricted access to individuals' substances of choice increases the likelihood of withdrawal. In turn, will these individuals be able to enter detox, and can they be properly screened for the virus before admission?
Also, with family members spending more time together, substance-related problems that have been there for some time but relatively hidden will rise more closely to the surface. “It is a different conversation,” Munson says. The issue becomes, “We're all here and this isn't good inside the house,” he says.
Words of hope
Asked to share some positive news about crisis response, Munson cited “the emails I've gotten from my staff in direct patient services.” The comments have included, “What more can I do?” and “I'm willing to move into the facility to continue to provide services.”
“It's humbling,” Munson says.