Patient Brokers, Who's Responsible and What Can be Done?: Part 1

By now I’m sure many if not all of you reading this are familiar with the terms “patient broker” or, “client broker”.  If you are not what the terms refer to is an individual who for a fee, paid by a treatment facility, will make a referral to that facility.  The way that this often works is that the broker “identifies” an addict in need of help, and then the broker starts calling treatment centers and negotiating a fee for placement.  These fees can be in excess of $5000 dollars per client. Thus referrals are made not based on clinical need, therapeutic fit, or really in any way meaningfully tied to the interests of the patient.  Rather these placement decisions are being made on the financial incentive for the facility and the broker. I want to spend a few minutes today sharing with you my thoughts on this problem and perhaps begin to describe a better way forward for our industry and our patients.

The Hydra of Our Industry

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Sly And Cunning

Patient brokers come in many different forms.  Many are individuals with no professional background in addiction treatment at all.  These individuals quite literally will troll 12 step meetings, local detoxes, and in some instances even the local skid row,  trying to identify individuals who are suffering from addiction and desperate for help. When they find somebody they approach them under the guise of being able to help them find treatment. Many represent themselves as working directly for treatment centers when in fact they do not.  They will assure the individual addict that they can get them help, that they can get them to a safe place, that they can help them get sober. When the addict, desperate for a new life, agrees to seek treatment, the brokers work begins. The broker will begin calling treatment centers.  Leading not with questions about the therapeutic validity of the facility’s work but with the insurance information. The most valuable are those with PPO insurance with out-of-network benefits. the line between this sort of activity end human trafficking seems murky to me.

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Not all patient brokers are this blatant, or have quite this level of amorality.  Many come in the form of professionals. Some are Therapeutic Placement Consultants, some are Interventionists.  Brokers of this stripe will charge a family anywhere from a few hundred to a few thousand dollars with the promise, again, of being able to help an addict to recovery.  After collecting money from the family and doing their work they turn around and “sell” the human being to the highest bidder. Often times in this sort of arrangement it is not on a per head basis.  Rather payment comes in the form of large year end “bonuses”. I know of one program that pays their “best” therapeutic placement consultant $50,000 at the end of the year. I try not to be a cynical person, but it is hard for me to see how a many thousand dollar payment would not influence placement decisions.   Many times these financial arrangements are not disclosed to the families of the addict. By not disclosing this information the family is not in a position to make a free and informed decision. I want to be clear that in no way am I alleging that all placement consultants or all interventionists operate in this way.  There are many highly competent, highly trained, and highly ethical individuals in both of these positions across the country. I have had the pleasure of knowing, and working with many.

The Buy-Side

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Bad Actors Ruin It All

The bad actors in the industry give anyone trying to do a professional job with high standards of conduct a bad name.  It would be very easy to just cast blame at the brokers and say that they are the problem. This, in my view, is not true.  They are without hesitation a part of the problem, but only a part. Another part of the problem are the facilities who work with these individuals.  In any transaction the “buy” side has as much culpability as the “sell” side. If collectively treatment centers refused to buy patients the brokers would have no one to sell to, and the problem would go away.  The persistent nature of this issue appears to be a reflection of an inadequate understanding on the part of treatment facilities of how to engage patients and their families in a meaningful way, how to create meaningful relationships with clinicians and other providers who are already engaged with the population of addicts.  In some ways it is a failure of innovation on the part of treatment facilities. As long as facilities continue to be willing to buy their patients there will be individuals willing to sell them patients.

 

Root Cause

I believe that the problem runs even deeper than these two aspects.  The true nature of the problem is associated with the stigma we as a community still have in regards to those suffering from addiction.  Many in our communities, in the face of the science attached, still want to believe that if an addict wanted to change enough they would.  As a consequence of this belief they view (often unconsciously) addiction as a moral failure, or a failure in character. As a result our communities are less concerned with how addicts are treated when compared to the care and concern we express toward other sufferers of chronic disease.  Can you imagine an oncology hospital “buying” cancer patients, or a memory specialist “buying” patients suffering from Alzheimer's without public outrage? I have a hard time imagining such a situation. What then is the difference? All are chronic diseases, which cause massive destruction to the lives of the suffer and those tied to them by affection.  The difference, as stated above, is in the way society views these diseases. If we want to change the outcomes for those suffering from addiction we need to change the way, we as a society, view addiction. We need to end the stigma.


 

Moving Toward A Solution

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How do we move toward a solution?  The most immediate answer I see to this dilemma is to raise the bar of entry into the industry for professionals.  In any domain, a low bar of entry allows bad actors in. We need to adopt a standard of professionalism across the industry.  We need increased oversight and licensing requirements for those working in the field. By doing this we will make it harder for those with bad intentions to get in, we will be able to identify and stop them sooner, and will make it more transparent who can be relied on.  This will only happen when our industry demands it of ourselves. If we do this it will give us time to change the stigma attached to addiction. It will restore the public’s faith in us as a means of recovery for those suffering from addiction.

In the next part of this series we will be examining the proposed state bill in Arizona that is currently under consideration, and whether or not it will adequately address the problem.  In subsequent segments we will present interviews from each side of this issue. I believe that it is only in honestly facing a problem that we can begin to heal from it. We can and must do more.


 

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


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