20200722-LOC-SUD treatment

A new survey shows that the COVID-19 pandemic has been costly for drug treatment providers in New Hampshire.

The report, recently released by the nonprofit organization New Futures, surveyed 23 substance-use treatment providers statewide about how the pandemic has affected them in areas such as revenue and staffing.

Substantial financial losses were found across the board due to fewer patients coming in during the public health crisis, as well as canceled fundraising or income-driven events, according to President and CEO Michele Merritt.

Many of the organizations said this could lead to staffing reductions.And if the situation doesn’t improve, it could have serious implications for the state’s ability to fight the drug epidemic, according to Nelson Hayden of The Doorway in Keene.

Four of the organizations surveyed are from the Monadnock Region, Merritt said in an email.

None of the providers are identified in the report, and their names are not being released due to what New Futures spokesperson Bobbie Burgess described as an “unspoken understanding” that this information would be withheld.

The Concord-based health advocacy organization is calling on the governor’s office to allocate $15 million to $18 million to treatment and recovery organizations as part of the state’s pandemic relief initiative.

Merritt said the Monadnock Region already has a limited number of treatment providers, and reducing that capacity could mean longer wait times or prevent people from getting the services they need.

“The Monadnock Region, like other parts of the state, has worked for years to expand its substance use treatment and recovery services,” she said in the email. “The financial losses experienced by local providers threatens to undermine this progress and propel the region backwards in its fight against the addiction crisis.”

The respondents were surveyed in mid-May, and included small and large organizations, as well as independent providers.

Smaller organizations have between two to 10 employees, while large ones have 10 or more, the report says. An independent provider is the sole employee in a practice.

The report shows that more than 80 percent of the organizations that responded experienced an overall decrease in revenue from billing clients’ private and public insurers between January and April.

Medicaid billing accounted for a majority of that decrease, plummeting by nearly a quarter-million dollars from January to April across the 23 providers.

The month when providers were hit the hardest was April, just after Gov. Chris Sununu’s stay-at-home order was first issued, the data show. The drop in revenue from March to April averaged just over $20,000.

By October, the report projects, New Hampshire’s small and large providers — totaling 122, according to the survey — will have lost at least $6 million in insurance-billed revenue.

During that same period, New Futures predicts independent practitioners will have lost at least $446,485.

Hayden, executive director of Keene’s Doorway program, said insurance companies already don’t reimburse substance-use treatment at very high rates, so this sharp of a decline in billed revenue could lead to providers cutting services or shutting their doors altogether.

The Doorway — a grant-funded service opened in January 2019 and run by Cheshire Medical Center — is part of the state’s “hub and spoke” system to screen, assess and refer people to substance-use treatment and support services in the community.

And as a referral service, Hayden said, The Doorway has actually seen its numbers increase amid the pandemic, highlighting the need for drug treatment in the Monadnock Region.

But, since the start of the COVID-19 outbreak, he said, it has been drastically more difficult for The Doorway to find places to refer clients.

“Our mission of facilitating access to treatment for those suffering from substance use disorder has been greatly hampered by the closures, reductions in census, and inability to meet face to face with clients,” he said in an email. “Our ability to place clients in an appropriate level of care is impacted by the reduced availability.”

The New Futures report also found that more than 70 percent of organizations surveyed invested in new technology to keep clients safe during the pandemic, such as telehealth support, as well as glass barriers and cleaning supplies.

These investments had an average cost of $6,324.

Only nine of the 23 respondents said they spent money on personal protective equipment (PPE) by mid-May, likely due to many providers using telehealth services. The average amount those nine providers spent on PPE was about $3,000.

But as more entities reopen for in-person services, the survey says, New Futures expects the number of providers purchasing PPE to rise.

The loss of revenue and increased overhead costs due to COVID-19 left most respondents unable to hire staff from January to April.

Six of the providers had to lay off staff following the emergency order, two had to furlough staff, and one had to cut staff hours.

To survive through October, 12 of the 23 organizations surveyed said they will need to lay off or furlough additional staff.

Hayden, of The Doorway, said if the financial strain documented in the report continues at this rate, it could cause the state’s progress against the opioid crisis to backslide.

New Hampshire’s number of fatal overdoses skyrocketed starting in 2013 and 2014 as part of a nationwide epidemic and peaked in 2017 with a confirmed total of 490. Last year — with 415 reported by the state — marked the second year in a row that drug death numbers had dropped.

“This decrease was in part due to enhanced efforts to coordinate and implement various levels of treatment,” Hayden said via email. “If these services experience a 10-15-percent decline, how many more individuals may die?”

The Doorway is at 24 Railroad St. in Keene and is open Monday through Friday, from 8 a.m. to 5 p.m. Support through the state’s 24/7 hotline is available at 211.

Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.