Publications · 2021
Admission Practices and Cost of Care for Opioid Use Disorder at Residential Addiction Treatment Programs in the US
Health Affairs , 2021 · doi:10.1377/hlthaff.2020.00378
Overview
Posing as uninsured cash-paying individuals using heroin, we called 613 US residential addiction treatment programs. One-third of callers were offered admission before any clinical evaluation, often within a day. Up-front payments averaged over $17,000 at for-profit programs, roughly three times the nonprofit average, and aggressive recruitment practices were common, including at accredited and state-licensed facilities. The findings raise concerns that financially and clinically vulnerable patients may be routed into costly care without thorough clinical assessment of whether residential treatment is appropriate.
Abstract
The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.
Recognition & impact
Cited in policy & guidance3
- Speaking the Same Language: A Toolkit for Strengthening Patient-Centered Addiction Care in the United StatesAmerican Society of Addiction Medicine
- Public Policy Statement on Government Strategies to Foster Ethical Addiction TreatmentAmerican Society of Addiction Medicine
- Long-Term Treatment of Opioid Use Disorder with MedicationsThe Oxford Handbook of Opioids and Opioid Use Disorder
Media9
- As addiction deaths surge, profit-driven rehab industry faces 'severe ethical crisis'NPR: Morning Edition
- Auditing The Admission Practices For Opioid Use Disorder TreatmentHealth Affairs Podcast: A Health Podyssey
- Secret addiction treatment shoppers log hard sell tactics at some residential programsNPR (WBUR)
- BHE podcast, episode 017 – Tamara Beetham, Yale university PhD studentBehavioral Healthcare Executive Podcast
- America's response to addiction relies on fixing this websiteCNN News
- From sober mom squads to anti-anxiety workbooks: Do new AA alternatives work?The Guardian
- Teens in residential drug rehabs often don't get the most effective opioid treatmentNBC News
- Addiction policy treatment opioidNew York Times
- We need more meds, not beds, to help people recovering from addictionScientific American
Topics
- residential addiction treatment
- audit study
- secret shopper
- for-profit care
- treatment cost
- patient brokering
- consumer protection
- industrial organization
How to cite
Beetham T, Saloner B, Gaye M, Wakeman SE, Frank RG, Barnett M. Admission Practices and Cost of Care for Opioid Use Disorder at Residential Addiction Treatment Programs in the US. Health Affairs; 2021. doi:10.1377/hlthaff.2020.00378
Show BibTeX
@article{beetham2021admissionpractices,
title = {{Admission Practices and Cost of Care for Opioid Use Disorder at Residential Addiction Treatment Programs in the US}},
author = {Beetham, T. and Saloner, B. and Gaye, M. and Wakeman, S. E. and Frank, R. G. and Barnett, M.},
journal = {Health Affairs},
year = {2021},
doi = {10.1377/hlthaff.2020.00378},
url = {https://doi.org/10.1377/hlthaff.2020.00378},
abstract = {The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.},
keywords = {residential addiction treatment; audit study; secret shopper; for-profit care; treatment cost; patient brokering; consumer protection; industrial organization},
note = {Media coverage: NPR: Morning Edition, Health Affairs Podcast: A Health Podyssey, NPR (WBUR), Behavioral Healthcare Executive Podcast}
}