Long Road to Recovery: Examining substance abuse treatment business

A growing business is a good thing, but sometimes growth points to the darker corners in society.

As the executive director of Synergy Recovery Center, Paige Tuck knows that incongruity well. Even with a background in substance abuse counseling and now leading a privately owned residential treatment center, she’s even a little surprised by the widespread need for her kind of business.

“As far as professional women coming through that state-assisted program, that wasn’t a good fit for them,” Tuck said. “They really didn’t have a place locally to go.”

The number of Missourians suffering from substance abuse is on the rise. The Missouri Department of Mental Health’s 2016 report found 419,000 people abused substances in 2015, a 5.5 percent increase from the year prior.

Pregnant women, adolescents, veterans, parents with dependent children and homeless individuals make up the patchwork of those statewide who seek treatment.

Locally, the need for treatment is strong. Sally Gibson, vice president of addiction services for Burrell Behavioral Health, said the organization has 250 people in its detox, residential support and outpatient programs at any given time.

“I’m not sure that it’s growing, we’re just identifying it quicker,” Gibson said of the statewide increase. “More people are seeking treatment because they know what the resources are.”

Kyle Mead, vice president for quality improvement at Heartland Center for Behavioral Change, said about 5,000 people annually go through the Kansas City-based nonprofit’s program. Heartland operates five offices in the Springfield area, serving those referred through probation, parole or Greene County’s drug court.

He agrees more people seeking treatment may be behind the higher numbers.

“We have not seen major changes in that number. What we see are changes in the substances – it’s a fluctuation,” Mead said.

Mead points to a 7-8 percent increase in admissions the past year relative to opiate and heroin use, a problem he said is exacerbated by lack of legislative oversight when it comes to patients shopping doctors for prescription drugs.

Gibson said the local opioid epidemic led to a four-month wait time for patient assessments at Burrell earlier this year. At one point, she said, addiction services answered 21 assessment calls in a single day.

“It’s a large problem, and if you have employers who say their workers can’t pass a drug screen, that’s an economic disadvantage as well,” Gibson said.

Cost of care
According to the Centers for Disease Prevention and Control and the National Drug Intelligence Center, the economic cost of alcohol and drug use disorders is $416.6 billion nationwide, factoring in productivity losses, crime, health care and traffic crashes. In Missouri, it’s $8 billion.

Comparatively, funds for treating substance abuse are significantly less. Last year, about $38.6 million from the state’s general revenue fund and $62 million through Medicaid and federal grants were allotted for treatment in Missouri.

“The populations that grants want to serve are homeless, pregnant, intravenous users – that’s their priority,” Tuck said. “If somebody came in and was a teacher struggling with alcoholism, they could be put on a wait list because they weren’t a high priority.”

Since last August, Synergy has treated up to eight women at a time on a 20-acre farm in Rogersville. The $1 million center operates similarly to such clinics as Passages, Promises and The Betty Ford Center.

Costs for care vary by the model. Shared and private beds at Synergy run about $500 a day, while Gibson estimates the cost of Burrell’s residential program at about $800 per day, with stays typically seven-21 days. Heartland costs break down to between $50 per day for outpatient care and $190 per day for residential care, according to Mead. Officials say Burrell and Heartland annually receive about $3 million each through state and federal sources as contracted providers.

Given the varied backgrounds of those in treatment, working professionals don’t go unrepresented. That’s why a year after opening in Rogersville, Synergy plans to add an outpatient clinic and counseling center in Springfield on Sept. 6 to serve those in more stable home and work environments.

“If you have someone coming in who was still working, took time off to get in and were taking care of children at home, it’s a different set of problems,” Tuck said. “They could do the outpatient treatment.”

Delayed pay
Since opening, Tuck said Synergy started working to accept insurance, which required certification from the Missouri Department of Mental Health’s Division of Behavioral Health and accreditation through The Joint Commission. The company paid the state about $1,000 and over $7,000 for accreditation.

Heartland doesn’t accept insurance, Mead said, noting most providers don’t cover the cost of outpatient services unless associated with inpatient stays.

“The reality is not everybody needs inpatient residential care, and it’s an extremely expensive approach,” Mead said. “We wouldn’t want to hospitalize someone who only needed outpatient care if it was a medical issue, and that’s kind of what’s happened in the behavioral world.”

The insurance option proved a double-edged sword for Synergy. Tuck said the company was able to take more patients, but the business was left waiting for revenue from reimbursements.

“At one time, I’m sure it was close to between $80,000 and $90,000,” she said. “We served some clients in April that we still haven’t been reimbursed for.”

Declining to disclose first-year revenue, Tuck said despite delayed insurance payments Synergy’s business has been going well. Over the last year, 54 women have gone through the program, which currently is full and has a handful more on a waiting list. Synergy also is planning a men’s residential center for 2017.

Meanwhile, the upcoming outpatient and counseling center in Springfield, which has cost Synergy about $15,000, is designed to remain in touch with the company’s residential patients, a third of whom are local.

On the importance of outpatient programs, Gibson said for an addict, recovery is a constant process rather than a cure-all.

“With diabetics we don’t say, ‘They’ve fallen off, we should stop treating them,’” Gibson said. “With addiction, there’s a moral component to it, and people think, “They’re still using, why are we even trying?’”