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Quality ratings are coming to addiction treatment provider space


The nation’s addiction recovery centers will be rated by a patient advocacy group in an effort to better regulate an industry that’s under increased scrutiny during a time of increased demand.

Not-for-profit group Shatterproof announced on Tuesday that next year, a pilot program will measure how well addiction treatment programs in five states meet evidence-based best practices. The pilot is expected run for a year-and-a-half, after which it will be evaluated with the goal of expand the program to all states by 2020.

The rating system will use claims data, provider surveys, and consumer experience to measure care quality. Shatterproof has partnered with the National Quality Forum to recommend how to build a national rating system.

Shatterproof Founder and CEO Gary Mendell said the rating system will be similar to the Overall Hospital Quality Star Ratings system used by the CMS to inform consumers. Ratings will be public online, Mendell said.

Shatterproof hopes the rating system will be a step towards reforming an industry that has little oversight and many disreputable providers. The ongoing impact of the opioid epidemic has birthed a cottage industry that the U.S. Substance Abuse and Mental Health Services Administration estimates is valued at more than $35 billion. A growing number of operators have been cited for committing insurance fraud by funneling patients with commercial insurance to places with little to no actual care.

Currently there are no federal standards of care for addiction treatment operators. Many recovery treatment programs are unregulated, and most apply abstinence-based therapies such as 12-step that don’t use medication-assisted treatment, despite medication being considered the gold standard among experts.

Mendell hopes Shatterproof’s resource will help payers determine which providers to include in networks and inform state regulators’ decisions on state licensing, while providers will be able to share information on best practices.

Samantha Arsenault, Shatterproof’s director of national treatment quality initiatives, said the system will assess all addiction treatment programs located in the states that are participating in the pilot, including those that she described as not offering evidence-based best practices that are known to improve patient outcomes.

Mendell said ratings are just one initiative the organization is working on to help addiction medicine align with the rest of healthcare.

Last year, Shatterproof, which is considered the leading patient advocacy group, unveiled its National Principles of Care for substance use disorder treatment that included recommending patients get screened for substance use disorder in every care setting and expanding long-term outpatient treatment.

Other initiatives include payment reform to incentivize better quality care among providers, as well as training and education opportunities for both clinicians and consumers.

“This is about transforming treatment in the U.S.,” Mendell said.