Monday, September 3, 2018

Parting The Red Sea


At God's command, Moses held his staff out over the Red Sea, and throughout the night a strong east wind divided the sea, and the Israelites passed through with a wall of water on either side.
Exodus, 13:17 – 14:29 

In December 2011, The Residential Eating Disorder Consortium was formed ostensibly to serve as a professional association for residential eating disorder programs. This organization is now generally known as  REDC (pronounced, “Red Sea”). Since I generally do not speak, nor even like acronyms or initials substituting for words, I will refer to them simply as the “Consortium.”

The Consortium markets itself with: “Membership in REDC is reserved for residential eating disorder treatment programs offering residential eating disorders treatment that meets REDC established standards.”

Amongst other goals, the Consortium represents that it “Promotes quality standards for residential eating disorder care.” It further represents that it “Conducts research regarding the effectiveness of residential eating disorder treatment,” and that it “Collaborates across programs to support access to residential care.” All noble and yet very subjective. So let's examine the manner in which the Consortium accomplishes these noble goals.

There are 23 members listed as part of the Consortium. (26 if you include the three entities listed under the Monte Nido affiliated families.)

The Consortium’s officers are:

Officer
Name
Treatment Center
PE Firm




President
Jillian Lampert
The Emily Program
TT Capital Partners
Vice-President
Jen Gorman
Discovery Behavioral Healthcare
Webster Capital
Secretary
Lee Neagle
Aloria Health
ED Management, LLC
Treasurer
Hassan El-Yousef
Carolina House
CRC Health Group -Bain   Capital

As one can readily determine, all officers of the Consortium are employed by Residential Treatment Centers (“RTC”) owned by Private Equity Firms.

The Directors of the Consortium are:

Position
Name
Treatment Center
PE Firm




Director
Kim Dennis
Suncloud Health
?
Director
Chris Diamond
Sunspire Health
Kohlberg & Company
Director
Vicki Kroviak
None
Tresoro Group
Director
Sam Menaged
The Renfrew Center
None
Director
Dirk Miller
The Emily Program
TT Capital Partners
Director
Ken Weiner
ERC
CCMP Capital Partners


When one remembers the Red Sea's membership requirements, it is curious that Dr. Kim Dennis of Suncloud Health is included as part of the Consortium. Suncloud Health is a private, outpatient treatment program for men and women located in Northbrook, Illinois. What makes Dr. Dennis’ inclusion in the Consortium of curiosity is the fact that Suncloud Health advertises that it provides private outpatient treatment alone.

Another curiosity is that Ms. Vicki Kroviak of the Tresoro Group is listed as a Director. On its website, the Tresoro Group represents, “Tresoro Group serves a range of clients, including founder-owned companies seeking advice on the strategic, infrastructure, and personnel transformations they must make to scale their business or secure additional investment; larger health care companies who are considering strategic acquisitions; and investors looking for guidance as they explore investment in the behavioral health care space.” It would appear as if the Tresoro Group is not even in the eating disorder industry but instead, focuses on private equity investments.

The Tresoro Group lists three (3) peer reviews on its website. One is from Jeffrey Bartoli, Managing Director of Centre Partners, a private equity firm. The second review is from Dan Davidson, a Managing Director at Coker Capital Group, another private equity firm. The third peer review … is from the President of the Consortium, Ms. Jillian Lampert. Ms. Lampert’s review in part read as follows: “Vicki emboldens and empowers people to make the right decision. She also has a keen ability to see a path through a messy, complicated situation. Then she builds buy-in, anticipates pitfalls, navigates through any resistance, and keeps the ship sailing on the right course.”

Still another curiosity is that Mr. Chase Bannister of Bannister Consultancy is listed on the Consortium's Ethics Committee. On the Bannister Consultancy website, it represents that,  “Bannister Consultancy, LLC is an independent consulting practice, providing thought-leadership for healthcare strategy & civic engagement. The primary mission of Bannister Consultancy is to catalyze advancement in healthcare policy, legislation, research funding and advocacy efforts in order to maximize access-to-care.” Mr. Bannister has been a tireless champion in the eating disorder industry for a number of years. Mr. Bannister is also not a residential treatment center.

A very nice photograph of Mr. Bannister and Ms. Lampert, the President of the Consortium appears on the front page of the Bannister Consultancy website.

They are also both listed as officers of the Eating Disorder Coalition. The significance of the Eating Disorders Coalition is addressed further in this article.

Ms. Lampert and Mr. Bannister are also both members of, and are pictured standing side-by-side at the first meeting of the Weight Stigma Stakeholders Group in 2013. 

In March 2018, they co-presented at the Binge Eating Disorder Conference on weight bias and stigma and the impact on public policy and clinical care. 

In November of 2017, they made the presentation, “Gathering for Good: A Town Hall Event with the Eating Disorders Coalition for Research, Policy & Action” at the Binge Eating Disorder National Conference. 

In April 2018, they conducted a town hall meeting in Chicago at the Annual International Conference on Eating Disorders hosted by the Academy for Eating Disorders. 

In 2015, at the Iaedep Symposium, they presented, “The Bold & the Beneficent: Integrity of Care for Young People with Eating Disorders and its Intersection with Obesity.

Nonetheless, Mr. Bannister does not meet the Consortium’s membership guidelines. And yet, he is on the Consortium’s Ethics Committee. According to the Consortium’s own guidelines, its membership is limited to residential treatment programs. Perhaps exceptions are made for those who work with its president on many different presentations or work in private equity.

Misrepresentations regarding the Consortium’s “partnerships”

Of even greater concern is another misrepresentation, and ramifications of that misrepresentation, made by the Consortium on its website. The Consortium states:

The REDC Standards Committee has also been working with the AED Credentialing Task Force  to partner with an accreditation agency to implement the AED Credentialing Task Force CLINICAL PRACTICE RECOMMENDATIONS FOR RESIDENTIAL AND INPATIENT EATING DISORDER TREATMENT.

[emphasis added] The issue? When you click on the hyperlink for the AED Credentialing Task Force on the Consortium's website, it takes you to the AED website and a specific page which states, “Page Not Found.” When asked, a high-ranking official at AED stated that the AED Credentialing Task Force is no longer in existence and was not doing any work with the Consortium.

And yet, the arrogance of the misrepresentation goes far deeper. The overwhelming majority of the research into the “Working Draft of the Clinical Practice Recommendations for Residential and Inpatient Eating Disorder Programs” (“Working Draft”) was performed between 2004 and 2011. Those dates are significant because the Consortium was not even in existence during that time! The Working Draft was issued in early 2012. The Consortium was not even organized until December 2011.

The Working Draft mentions collaborating with the National Eating Disorder Association (NEDA) in 2004 and later with the International Association of Eating Disorder Professionals (IAEDP). Nowhere does the Working Draft even mention the Consortium. The Working Draft also states, “The clinical practice recommendations are the product of a 2006 stakeholders meeting and three work groups that met from 2005-2006.” The Consortium is comprised of clinical practice treatment centers. And yet, the recommendations were made five (5) years before the Consortium came into existence and well before any of the Consortium members were acquired by their PE Firm Overlords and Masters.

The Consortium had nothing to do with the Working Draft. But, the final arrogant “piece de resistance,”  is that the Consortium took the Working Draft, embedded it on their website and labeled it not as a draft but as a final product when the document on its face states it is a “working draft.” Further, the Consortium uploaded it to their website in 2016, long after the AED Credential Task Force had disbanded.

There is no credible spinning of this insidious and reprehensible misrepresentation that could bring enlightenment and integrity to the Consortium. However, let’s pursue other instances of their unethical or amoral conduct.

Other Questionable Representations

Investigation into other representations made by the Consortium raise additional questions and concerns.

In representations to various agencies of the federal government, the Consortium represents that they have more than a monopolistic control over the eating disorder industry.

In an August 10, 2017 letter addressed to the Office of the Assistant Secretary for Planning  and Evaluation (“APSE”), the principal advisor to the Secretary of the U.S. Department of Health and Human Services, Ms. Lampert stated, “The REDC is a consortium of providers of eating disorder treatment, representing approximately 90% of the residential eating disorder treatment provided in the United States.”

In a March 6, 2018 letter addressed to the Office of Regulations and Interpretations of the Employee Benefits Security Administration, Ms. Lampert represented, “The REDC is a national trade association of eating disorder treatment centers, representing approximately 80 percent of the intermediate levels of care for eating disorders provided in the United States including residential, partial hospitalization, day program and intensive outpatient treatment.”

Prior thereto, in a March 6, 2016 press release issued on behalf of The Emily Program, Ms. Lampert represented, “One such group is the Residential Eating Disorders Consortium (REDC), which represents 85 percent of the centers and is proud to be leading the way in raising the bar for quality residential eating disorder treatment..”

The Inaccuracy of the Representations

With repeated representations of such a very high percentage, and the power that comes with it, one would understandably be inclined to review the raw data to determine if the numbers are remotely accurate.

When one considers the number of Consortium treatment centers listed as 26, using this number would translate to there are only approximately 6 other RTCs in the United States which are not members of the Consortium. And yet, we know this number, 6, is not remotely accurate.

If the representations made by the Consortium are meant to pertain to each individual outpost owned by the 26 members (a representation that may be regarded as deceptive since not every outpost includes residential treatment, nor are all outposts certified) that would mean of the approximate 75 treatment centers, using the lowest percentage represented by the Consortium would translate to 60 centers as belonging to the Consortium and only 15 which are not. And yet, we know this number to also be grossly inaccurate.

There are a number of residential treatment programs which accept federally funded payment programs and yet, are not welcomed as members of the Consortium. In fact, this “non-journalist” readily discovered 14 residential treatment centers which are not members of the Consortium. Other entities not listed and which are not included as part of the Consortium include:

1.           Children’s Medical Center of Texas (Plano);
2.           Stanford University Medical Center;
3.           University of Chicago Eating Disorder Program;
4.           UC at San Francisco Eating Disorder Program;
5.            Selah House at Indiana University;
6.            Avalon Hills;
7.            University of California at San Diego


If you include outpatient treatment programs such as Shoreline Eating Disorder Program and the Duke University Eating Disorder Program as well as all university related programs treating eating disorders on an outpatient basis, all of whom are not members of the Consortium, the integrity of the Consortium's represented numbers is exposed as being highly questionable. 

In fact, one can rightly question why no academic or university based residential treatment centers are included as members of the Consortium. Membership in the Consortium has already been exposed as being flexible. And yet, the most brilliant minds in the medical industry toil at these centers but are not welcome by the Consortium?

In short, even the most cursory research indicates the numbers represented by the Consortium are grossly inflated. When these grossly inflated numbers are presented to federal agencies, the ramifications of such false representations are potentially draconian and damaging to not just the eating disorder industry, but to all who suffer from this disease.

Further, if representations regarding the participation percentage in the eating disorder industry are grossly inflated, the alleged affiliation with an entity that does not exist, and membership requirements in the Consortium are routinely ignored, one can rightfully speculate as to what other representations are grossly inaccurate and the purposes behind such misrepresentations.

Even still, the Consortium’s influence and infiltration into the eating disorder industry extends further.

Eating Disorders Coalition

Founded in 2000, 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 as well as national and local organizations dedicated to health issues. It is the liaison with state and federal agencies, administrators, lobbyists and legislators

Its 2017 – 2018 officers are :

President – Bryn Austin – President-Elect, Academy for Eating Disorders
Vice President – Chase Bannister – Bannister Consultancy
Treasurer – Jillian Lampert – The Emily Program
Secretary – Millie Plotkin – Eating Recovery Center

Two of the four positions are held by RTCs owned in whole or in part by PE owned RTCs, The Emily Program and the Eating Recovery Center. The other position is not surprisingly held by Mr. Bannister, the confidante and close ally of Ms. Lampert.

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 and the eating disorder industry in general. One can also speculate that legislation which could help the eating disorder industry, the academic community and the disenfranchised as a whole is not being pursued since it would have the potential to financially harm the PE firms. If their past history is any indication, we also know that whatever representations the Consortium makes concerning legislative agendas can and should be met with a great deal of skepticism

Ramifications

The Consortium has taken over and is monopolizing the eating disorder industry. Private equity owned RTCs have proliferated and are now deeply imbedded in every aspect of the eating disorder industry save and except for the academic and research entities.

The Consortium currently has the ability to dictate the types of legislation proposed, the number of patients seen and treated (through expansion of treatment centers or abandoning patients in IOP programs) the non-enforcement of corporate practice of medicine doctrines, the exclusion of all government funded payment plans and the direction and course of the industry. There is little to no federal oversight and state-by-state involvement is sporadic, inconsistent or non-existent. The Consortium has the liberty, or arrogance, of believing it can make any representations and statements without fear of exposure.

The Consortium does not even reference the objective, third party research studies indicating family based, outpatient therapy as being the most effective treatment module for treating this insidious disease. These scientific based studies would drown the Consortium and those PE owned RTCs  in the Consortium much as the pursuing Pharaoh and his charioteers were drowned when God withheld his mighty hand and the Red Sea swallowed them whole.

The problems and issues within the Consortium are substantive and run deep. But even now, solutions and the ability to work with the eating disorder industry and private equity firms are still possible and can be implemented for the purpose of saving lives … and these proposals will be presented in the next article.







5 comments:

  1. HI Steven-
    This is very disturbing but not surprising when you follow the money. I’m looking forward to part 2. I do wish this blog post was written in a more concise manner as your very important information got bogged down. I would love to see this rewritten as a press release type format. Every parent, patient, treatment provider, treatment agency, hospital, and legislator needs to read this information. Also, in regards to their misrepresentation of percentage of treatment centers that are members of the consortium - if you could post actual number of treatment centers in US (specifying what kind they are such as privately owned, university affiliated etc) and compare that to those listed as members and state the actual percentage - I think it would make it easy for readers to see how misleading their numbers are. Thank you for your passion to be an advocate. My deep condolences on the loss of your daughter.

    ReplyDelete
  2. Steven, great article! I would add that my experience is the EDC is not at all interested in engaging parents/caregivers other than having us show up to lobby days. They do not promote FBT and they do not publish any peer-reviewed outcome studies like many of the academic centers do.

    ReplyDelete
  3. As a longtime critic of RTCs as a "higher level of care," and of the influence of for-profit clinics on the economics of advocacy, policy, training, and treatment, you'd think I'd be cheering for all you've concluded here but I actually see much of the issues and people you've mentioned here and come to different conclusions. I think we do need to examine, quite critically, the financing of advocacy. I also think that building our arguments on facts matters, and we need to examine our own conclusions critically. The problems in the field are real, and progress tragically slow, yet I find the most progress through direct and principled -- and mutually respectful -- engagement. My views on this are not well-loved by those on the extreme ends of these arguments but I stand by them. I welcome others to join me, and F.E.A.S.T., to get these matters seen and addressed together. We have more power and voice -- and a clearer strategy -- as a group, I believe. I invite you and your readers to help inform our advocacy and work together!

    ReplyDelete
    Replies
    1. Laura, I am curious as to whether your very well-reasoned remarks are coming from you, the individual and yes, respected warrior in the industry, or is that FEAST's official position as well. Regardless, I do thank you and everyone for reading and continuing to fight for the lives of our loved ones.

      Delete
    2. Steve, When I was chairman of the board of F.E.A.S.T., there was no official position with respect to how best to advocate for improvements in the treatment of eating disorders. On the one hand, some advocates work to try to convince professional providers to make changes in how they go about treatment. Other advocates, on the other hand, have come to the conclusion that the professional community has so many problems that parents are well-advised to avoid professionals altogether and tackle their kid's anorexia nervosa without including a professional in the process.
      Regards, Chris

      Delete

New Site

Because of various issues with blogger being unable to link with various social media outlets, I have begun posting at the following embedd...