A Program Dies ... And the Industry Weakens

First, apologies on my absence the past few months.  Grief is a curious emotion.  We can float along in a fog passing as life for the longest time and then, the permanence of a loss abruptly grabs our heart and our throat and threatens to squeeze the last vestige of life from us. And yet persevere we must and we shall.

On March 12, 2018, Texas Health - Presbyterian Hospital ("Presby") announced that it was discontinuing and closing its eating disorder program after being in existence for over 20 years.  Now, Presby is a not-for-profit hospital. It's last medical director, Dr. Melissa Pennington left the program in 2015 and Texas Health was unable to restaff her position.  And yet, one of the foremost research scientists in the United States specializing in the brain and eating disorders, Dr. Carrie McAdams of UT Southwestern was associated with the Presby program, spent every Thursday at the facility, conducted both parent and patient groups and was instrumental in the excellence achieved by the program.  Dr. McAdams' credentials and reputation are beyond reproach.

Eating disorders are approaching epidemic levels in the United States and abroad.  Of the 325 million people living in the United States, it is estimated (on the low side) that approximately 30 million people have or will have an eating disorder.  This exceeds the population in the State of Texas.

Its severity is similarly well known.  It has the highest mortality rate amongst all mental illnesses.  Once every sixty-two minutes, someone dies as a direct result of an eating disorder.  And yet, the oldest program in North Texas is closing their doors.  And it is time to conduct an autopsy.

In anticipation of the growing number of eating disorder patients, Presby expanded its facilities As a not-for-profit hospital, Presby accepted Medicaid, Medicare and Tri-Care.  However, it is well known that these government-subsidized insurance programs do not pay sufficiently to sustain an eating disorder program.  This is, in great part why the "for-profit" facilities do not accept these government based programs.  And in not accepting Medicaid, Medicare and Tri-Care, one cannot help but wonder how much that is perpetuating the myth/reality that this is simply a "rich little white girl's disease." The well-to-do, mainly Anglo parents of children have health insurance in place and the insurance entities are more than happy to continue to accept insurance premiums while looking at the slightest pretext to deny coverage safe and comfortable in the knowledge that their insurance contracts do not have to comply with the current accepted medical standards set forth by the American Medical Association and American Psychiatric Association.

Shortly after Presby's expansion, the Eating Recovery Center of Denver, which had just opened a facility in Plano, Texas, a suburb of Dallas, announced that it was supplementing its program by including a 24/7 in-patient unit.  ERC is a for profit, multi-state, multi-facility conglomerate.  It has the financial resources and marketing reach to take many patients with different types of insurance.  It also has the financial resources to buy marketing advertisements on different internet platforms.  In short programs like ERC are comparable to Wal-Mart putting Sears, Roebuck and Mom and Pop stores out of business.  But, at what price is a soul sold?

Questions need to be directed at the for profit programs such as: 

1. What is your recidivism rate?  

2. What is your leaving against medical advice rate?  

3. How often do your doctors make medical decisions and decisions regarding transitioning out of your program versus how often does the applicable insurance company make those decisions?  

4. How does your program minimize the use of potentially addictive, dangerous prescription drugs?  

5. In terms of recovery-based and evidence based terms, how does your program compare to academia based programs?  

6. Does your program utilize LPC interns and if so, exactly how are they supervised?

7. How many minority patients have you treated in-patient in the last 12 months?

8. What exactly is your protocol for coordinating treatment with the patient's treatment team when they return home?

9. Does your protocol for after-care include sending the patient's notes to the treatment team at home so the transition is smooth?

And yet, the issue which causes the greatest concern is ... whether the for-profit centers in some way perpetuate the cycle of treatment such that the patient feels comfortable with the treatment center ... and when the patient inevitably lapses and satisfies the insurance carrier's criteria for in-patient care, they are anxious to return to the place that brought them in their minds, the greatest comfort .. and all the while, they are merely cogs in the financial well-being of the for-profit facility.

Nefarious and unrealistic? Or ... is it.

After Presby's demise, I am not aware of any eating disorder treatment programs in the states of Texas, Oklahoma, New Mexico or Louisiana which accept Medicare patients.  That translates to approximately 40 million people in the United States, or approximately 12% of its population cannot get help unless they have some type of insurance in place which covers eating disorders.  And according to sources with whom I have spoken, this a growing problem universally across the country.  Large, behavioral for-profit facilities are getting exclusive and in-network agreements with insurance providers to the exclusion of academic single sites which combine state of the art thinking and progressive therapy with the latest research on mental health.

The eating disorder community is significantly weaker when the academic single sites are forced to close.  Perpetuation of the cycle of this disease results in more lives being ripped away by this insidious disease and no real solution or broad treatment protocols are allowed to evolve.  We cannot keep ignoring the biological and genetic causes of this disease while using our loved ones as "cannon fodder" for this disease.

The winds of change... the winds of litigation war are starting ... and will only get stronger.