A Series on Kemet’s MAT Blog

You are a lone doctor trying to make a difference. You see people needing access to Suboxone in a structured MAT program. What are you to do?

There are three paths before you. health-illness.jpeg

Path 1: Cash Clinic

This is a relatively easy affair. You treat patients on a schedule of your choosing, write them prescriptions based on their need, and keep very minimal documentation of their health. You don’t need to hire counselors. And you can choose whether you want your patients to follow up with counseling (many choose not to).

You do not need a billing department. In fact, you can handle all the administration yourself. It’s as simple as putting patients’ money in your back pocket.

You might even choose to combine this with what you’re already doing in your urgent care, primary care, or specialty office. It is a “side hustle” for you anyway – you aren’t allowed to treat more than the national limit (either 100 or 275) that keeps you at part time in this role.

Patients end up paying $300-500+ per month to see you and cover the out-of-pocket for their medications. If they’re lucky they might be able to get their medications covered. That can help with some of the burden.

But overall, the lack of counseling (or at least, the lack of all the services in once place) keeps patients from reaching their best heights. Recovery rates at your clinic might approach 40-50% if you do a really great job.

Path 2: Accepting Insurance

This is not just a choice to accept Virginia Medicaid. The minute you choose to accept insurance for services, your office changes dramatically. You need to:

  • Pay for someone to help you with credentialing and wait 3-6 months to be allowed to accept the insurance

  • Hire a billing company (or billing staff internally)

  • Hire administrative help – to collect insurance information, have patients fill out additional documentation, and ensure that all paperwork is completed correctly

  • Develop extensive clinical protocols to demonstrate compliance to the insurers

  • Take time away from your clinical process to manage all of this – or hire someone else to do it for you

Patients have the cost of their treatment & medications covered. But you still aren’t accepting the bulk majority of people who need help for opioid addiction – the Virginia Medicaid population. They are still paying out of pocket.

Path 3: Accepting Virginia Medicaid 

This is the most difficult path for you as a lone physician. To accept Virginia Medicaid, you need to do everything described above to accept any insurance:

  • Pay for someone to help you with credentialing and wait 3-6 months to be allowed to accept the insurance

  • Hire a billing company (or billing staff internally)

  • Hire administrative help – to collect insurance information, have patients fill out additional documentation, and ensure that all paperwork is completed correctly

  • Develop extensive clinical protocols to demonstrate compliance to the insurers

  • Take time away from your clinical process to manage all of this – or hire someone else to do it for your

Virginia Medicaid puts additional requirements on providers who choose to accept their insurance:

  • Wait an additional 3-4 months to be approved by each Virginia Medicaid plan after being accepted in the traditional 3-6-month credentialing process with the state

  • Hire a counselor and a “care coordinator” to treat each Medicaid patient

  • Develop treatment programs that your counselor and “care coordinator” offer to patients

  • Accept lower reimbursement than traditional insurance for the same services

  • Hire someone to answer the phones after-hours

As a lone physician, the setup process alone for Virginia Medicaid is a lot to handle. Unsurprisingly, there are very few providers that accept Medicaid and offer MAT in Northern Virginia (or anywhere across Virginia).

This is why Kemet chose to open in Virginia. We want to do what is harder if it means we can expand access to MAT. Northern Virginia needs our help. We’re hoping other providers choose to follow suit.