As level-of-care criteria turn 20, effort to broaden their use intensifies

Twenty years since publication of their first edition, the Patient Placement Criteria for the Treatment of Substance-Related Disorders can generate a classic half-full/half-empty discussion in the addiction field. Do the criteria represent a success story because they are the most widely accepted standards for level-of-care decision-making in addiction treatment, or have they fallen short because they have not resulted in a uniform language for the continuum of care across every state and treatment organization?

The question doesn’t yield a simple either/or answer. But it is clear that the American Society of Addiction Medicine (ASAM) wants to make further inroads toward allowing the Patient Placement Criteria to have a national reach. To that end, ASAM has embarked on an agreement with The Change Companies, a multimedia information provider and consultant offering change-focused patient materials to treatment organizations, to establish a diverse product line featuring the criteria.

“The use and applicability of the criteria will become more and more important,” says Penny S. Mills, ASAM’s executive vice president and CEO, because of implementation of both insurance parity requirements and health reform’s insurance exchanges.

Under the business arrangement, which is expected to be launched with a three-year agreement between the professional organization representing addiction medicine specialists and the publishing and training company, ASAM and The Change Companies will co-brand a number of products with the Patient Placement Criteria as their foundation. ASAM sees several potential audiences for the criteria beyond individual and organizational treatment providers, including patients and criminal justice organizations (two groups that are strongly served in The Change Companies’ current product base).

Mills adds that the presence of criteria chief editor David Mee-Lee, MD, as The Change Companies’ senior vice president made the arrangement between the two organizations particularly attractive to ASAM.

Mee-Lee clearly sees potential in making the level-of-care criteria a national standard. “When people today say they ‘use’ the criteria, this has many different meanings,” Mee-Lee says. Some states with Medicaid managed care apply the criteria as the utilization management standard for services to that population, while other states recommend the criteria’s use among private providers or even require their use as a condition of program licensure.

But the criteria are applied prominently in only slightly more than half of the states at present. “They should be national,” Mee-Lee says.

Don Kuhl, The Change Companies’ CEO, says many of the public and private treatment sites that purchase products from his company have routinely asked for materials that can be used in conjunction with the ASAM criteria and their level-of-care dimensions. He says the company will explore many potential formats for products related to the criteria. “This [agreement] is not structured in stone at the start,” he says.

Mee-Lee sees the arrangement as enhancing ASAM’s ability to serve as an information provider for the addiction treatment field as a whole. “ASAM has done a great job getting respect for addiction medicine,” he says, but has lacked the resources for disseminating clinical information.

Past research has indicated widespread familiarity with the Patient Placement Criteria among treatment programs, although the criteria are not applied uniformly across programs.
As early as the mid-1990s, more than 70% of respondents in the National Treatment Center Study were reporting that they used the criteria in some way. At the time, for-profit providers were less likely to use the criteria, and the criteria were more prevalent in treatment systems with more challenging level-of-care placement options.

In data collected in 2005 by the National Association of State Alcohol and Drug Abuse Directors (NASADAD), it was found that two-thirds of state-funded treatment providers were required to use the ASAM criteria as their standard patient placement guidelines.