PE Owned RTCs and the Military ... Admittance Verboten

We owe an enormous debt of gratitude to those who serve or have served in our country's military, as well as to the families of those individuals. Whether protecting our freedoms in foreign fields or making contributions here at home, the value these men and women bring to the American workforce and our way of life is beyond measure.

Sylvia Mathews Burwell, Former U.S. Secretary of Health and Human Services and President of American University

So long as I'm Commander-in-Chief, we will sustain the strongest military the world has ever known. When you take off the uniform, we will serve you as well as you've served us - because no one who fights for this country should have to fight for a job, or a roof over their head, or the care that they need when they come home.

          President Barack Obama

The U.S. Military is us. There is no truer representation of a country than the people that it sends into the field to fight for it. The people who wear our uniform and carry our rifles into combat are our kids, and our job is to support them, because they're protecting us.

Tom Clancy, Author

On the battlefield, the military pledges to leave no soldier behind. As a nation, let it be our pledge that when they return home, we leave no veteran behind.

Dan Lipinski, U.S. Congressman (Illinois)

It is difficult to imagine a greater calling involving selfless service at potentially great personal risk, than the call to serve your country. For some, it is a possible path out of poverty. Some are motivated by a patriotic fervor. Some believe it may help them find clarity, purpose or strength that they had not been able to previously embrace. Whatever reason, the potential, the likelihood of them being placed in harm’s way is the reality faced by every military person each day they serve. Is there a more noble calling?

When they return home to their loved ones, society’s debt of gratitude that must assuredly be extended to them must not shrink because of inconvenience or reduced profitability. And nowhere is this debt of gratitude more profound than in insuring we provide the best medical and mental health care available to our service personnel.

With regard to our service members suffering from eating disorders, the eating disorder industry has the highest duty, derived from a sense of moral and ethical obligation, to provide the best care available.

The Stars and Stripes Journal recently reported that eating disorder diagnoses among military personnel are up 26 percent over a five-year period, according to a new military study that suggests the actual incidence of such illnesses is even higher. The study, published in the Defense Health Agency’s Medical Surveillance Monthly Report, found that incidence rates had risen steadily from 2013 to 2016.

This study further found military service could increase the risk of developing an eating disorder due to potential exposure to trauma and the need to meet physical fitness and weight requirements. The study found, “It is well recognized that factors that increase emphasis on weight and shape elevate the risk of eating disorders among both women and men.”

Similar to civilian populations, trauma, including post-traumatic stress disorder, is associated with eating disorder risk in service members. However, military personnel are uniquely exposed to combat trauma and trauma associated with sexual assault, which is high in the military. These experiences may present their own risks for the development of eating disorders and associated symptoms.

The types of food available to military personnel during deployment are different than those when not deployed. Switching from Meals Ready-to-Eat (MREs), which are high calorie ready-to-eat packages of food used in combat when organized food facilities are unavailable to “regular food” that is consumed when individuals are at home could contribute to eating disorder symptoms.

With what we know about eating disorders and the unique risks faced by our service members, our resolve to attend to their health care needs both during their active service and upon their return as well as their dependents must be of paramount importance. And yet, the eating disorder industry has shirked its moral and ethical obligation in the most egregious manner.

Tricare and our Service Members

Tricare is the health care program for service members, retirees and their family members around the world. Tricare provides comprehensive coverage to all beneficiaries including health plans, special programs, prescription drugs and dental plans.

Tricare is managed by the Defense Health Agency under the leadership of the Assistant Secretary of Defense. It states that its mission is to enhance the Department of Defense and our nation’s security by providing health support for the full range of military operations and sustaining the health of all those entrusted to their care. It states its vision is to be a world-class health care system that supports the military mission by fostering, protecting, sustaining and restoring health.

There are approximately 9.4 million service men and women and their families who are currently enrolled to receive Tricare benefits. And of these 9.4 million, the number who can utilize these benefits to receive care from Private Equity owned Residential Treatment Centers is … ZERO.

Private equity owned residential treatment centers (“RTC”) hold themselves out to the general public as being elite, of being a gold standard, of providing the highest quality of care. On each of the their websites, they present a glowing picture of health, that their patient’s well-being comes first and foremost and that they utilize only “evidence-based” treatments. One RTC laughingly represents that “… 99% of parents of child/adolescent patients report that treatment at Eating Recovery Center was helpful, and 97% would recommend Eating Recovery Center to other families in need of treatment.” These statistical representations are made on their website.

And yet, these RTCs have closed their doors to our heroes, our service members and their families.

Part of the reason lies within the policies of Tricare. Tricare states that it only pays for medically necessary treatment and treatment that is considered “proven.” As a result, and for some “undisclosed reason,” Tricare does not pay for treatment at “freestanding” eating disorder centers. However, Tricare does state that it pays for necessary eating disorder treatment… just not at “freestanding” eating disorder centers.

Not all PE owned RTCs are freestanding. For example, in Texas, ERC Dallas is housed on location at the Baylor Scott & White Hospital in Plano, just north of Dallas. ERC’s parent company could approach Tricare, comply with Tricare requirements and become an authorized Tricare service provider.

Naturally, this begs the question that if the treatment regiment provided by these freestanding RTCs is considered the “gold standard,” if it is strictly “evidence-based,” if their treatment regiment is “proven,” why won’t Tricare amend its standards to reflect that services rendered by freestanding RTCs are now covered? For that matter, has the eating disorder industry even approached Tricare to negotiate the manner in which freestanding RTCs can be taken under the Tricare wing?

In 2000, the eating disorder industry organized the Eating Disorders Coalition in part, to spearhead and chart a path on legislative and administrative issues. The Eating Disorders Coalition was formed to advance the recognition of eating disorders as a public health priority by purportedly building relationships with Congress, federal agencies and nation and local organizations dedicated to health issues. Certainly, the ED Coalition is the ideal entity to handle negotiations with Tricare representative and overcome any and all hurdles to allow our service members access to the presumed, “elite” of eating disorder treatment.

However, of the four current officers, two work for PE owned RTCs, and a third is inextricably intertwined with one of those members.

With PE owned RTCs having control over the ED Coalition, one cannot help but speculate as to which entities set the agenda and legislative priorities for the ED Coalition. One should also wonder whether legislation that would necessarily help the eating disorder industry as a whole, but which could reduce the profit margins realized by those private equity firms is even considered let alone pursued? Why hasn’t the ED Coalition aggressively approached Tricare about freestanding eating disorder treatment centers?  Why do Moody’s, S&P and Bloomberg reduce a corporation’s rating if they accept government reimbursed program?

Our service men and women lay their lives on the line. They put themselves in harm’s way. And yet, PE owned RTCs, along with the ED Coalition, whose mission is purportedly building relationships with Congress, federal agencies and national and local organizations dedicated to health issues do not see fit to negotiate with TriCare so that treatment rendered by freestanding RTCs are accepted within the TriCare program.

Apparently, protecting our freedom, our very way of life, by giving themselves up as the ultimate sacrifice to be offered on the altar of freedom is not a significant enough sacrifice to enable them to be treated by these self-proclaimed gold standard, freestanding RTCs.

To call such oversight or ignorance "reprehensible" would be charitable.