By Alison Knopf
Does for-profit status connote anything at all about the quality of treatment, about how well patients are cared for, about the responsibility of the program to the community, or about whether the program requires self-pay or takes insurance? It does not. “What I have found in my dual experience, as a patient advocate and as a provider, is that there are good and bad in both profit and not-for-profit OTPs,” says Zachary Talbott, MSW, MATS, who until recently was with BayMark Health Services.
Some for-profit (otherwise known as proprietary) opioid treatment programs (OTPs) are self-pay only—these are likely to operate in states that don’t allow Medicaid to pay for treatment. Not-for-profit OTPs that operate in those states are also usually self-pay only.
Comparing OTPs: What Matters Is the Staff
“To my knowledge, there are no head-to-head comparisons for OTPs, but it’s not as if not-for-profits are the holy Grail,” said Mr. Talbott, noting that salaries of chief executives at not-for-profits like the American Red Cross are astronomical.
“We need a balance of different models,” said Mr. Talbott. “As someone who has opened and owned and worked in for-profit programs, it’s best to have various models.”
There are some funding opportunities that are open only to not-for-profits. This was not true of the SAMHSA Opioid STR funding, which could go to for-profit OTPs, if the recipient state agreed to allocate the funding to OTPs. But it is true of some grants that come from SAMHSA, and some that come from other public funders.
What really matters—the heart of any OTP—is the staff, said Mr. Talbott. “This is true of any program, public or private, profit or not for profit,” he said. “Who is the program director, and what is the organizational culture within the same larger entity?”
Mergers and acquisitions have driven most of the OTP growth over the past decade in OTPs. Mr. Talbott’s programs—Counseling Solutions Treatment Centers— were acquired by BayMark last year, and while they are for-profit, there were no signs that they cut corners on treatment.
But sometimes the acquisitions make for hugely different programs within the same company. For example, there are two OTPs that are drastically different in reputation, located within two hours of each other, acquired and currently operated by the same entity. The staff working there—of which a majority came with the programs—are the reason for the differences.
It is important for executives at for-profit chains to be aware of where problems from rapid expansion can lead, if good training isn’t involved.
Spending—and Justifying It
If you are a small independent OTP—for-profit or not—and you want, for example, to send some staff to the AATOD conference, you could, without worrying that your profit margins will be a bit down for that quarter. Once you are part of a big program, with bean counters, you may have to justify every dollar you spend.
A whole other category in the for-profit sector is the private equity situation, which is growing throughout all of health care, including OTPs. “I think the jury is still out, on what private equity means for our field,” said Mr. Talbott. “I hope it means something positive.”
Training Quality Staff Is Essential
But regardless of whether the funding comes from private equity or a private investor or a mammoth not-for-profit that decides to invest in OTPs, it takes time to train and develop quality staff. This is particularly true in OTPs, and it’s why expansion can’t take place overnight.
“This is a niche treatment,” said Mr. Talbott. “We strive for therapeutic presence—for patients to know that they’re in a safe place, a place where they are cared for.” He’s one of the first ones to call for expanding treatment, but as Mark Parrino (AATOD president) himself pointed out, if methadone treatment is expanded before quality staff can be recruited and trained, it may fail.
Mr. Talbott left BayMark on good terms in May. Someone who credits his own long-term sustained recovery from opioid use disorder to methadone treatment himself, and an advocate, he started Counseling Solutions Treatment Centers in Chatsworth, Georgia and Brasstown, North Carolina, in 2015 and 2016, respectively. For more stories about him in AT Forum, go to