Make us your home page
Instagram

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Good and bad news of alcohol use by emergency room patients

Up to half of the people treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say.

Here's the good news: A recent study found that a brief counseling session from the emergency room physician can discourage problem drinking.

Now the bad: Many health providers are reluctant to do alcohol screenings in the ER due to laws that allow health insurers to deny coverage for treating patients who've been drinking.

In the study, published online in the Annals of Emergency Medicine, nearly 600 emergency department patients who were identified as hazardous or harmful drinkers (defined for men as drinking more than 14 drinks per week or more than four on any single occasion, and for women as more than seven weekly drinks or three on any one occasion) took part in a seven-minute interview.

During the interview, an emergency department staff member described the link between alcohol use and the patient's condition as well as guidelines for low-risk drinking.

Compared with those who received standard care, patients who took part in the sessions reduced their average number of weekly drinks significantly as well as their episodes of binge drinking and of drinking and driving over the next 12 months.

"In the emergency department on a weekend, all the cases may be drug- or alcohol-related, and yet we don't do" screening and intervention, says Gail D'Onofrio, the study's lead author, who is chair of emergency medicine at the Yale School of Medicine. "Our goal is to normalize this in the emergency department."

But so-called alcohol-exclusion laws in more than half of the country — including Florida — permit insurers to refuse to pay for medical services related to alcohol or drug use, and that can derail hospitals' best intentions, experts say. Faced with the prospect of not getting paid by health plans for care, some emergency department personnel might sidestep the problem by simply not testing patients' blood or urine for alcohol.

Screening and counseling can be effective, says Larry Gentilello, a trauma surgeon who has published studies on injury prevention and substance abuse.

"Most of the people who are injured don't need to go into treatment," he says. "They aren't alcoholics or alcohol-dependent. That's why one counseling session can help them by talking about the risks of drinking."

The extent to which alcohol-exclusion laws deter emergency medical personnel from screening and counseling patients for alcohol or drugs is unknown.

The laws have a long history. Since 1947, more than 40 states have passed measures allowing health plans to refuse to pay for care if the patient's injuries occurred while he or she was under the influence of alcohol or, in some states, drugs. As people came to understand alcohol addiction and the possibility of treatment, however, it became clear that the laws were counterproductive. In 2001, the National Association of Insurance Commissioners recommended against them.

Since then, at least 15 states have repealed or amended their laws and now prohibit exclusions of coverage for drinking or drugs, according to data from the National Institute on Alcohol Abuse and Alcoholism.

Regardless of state law, self-insured companies that pay their employees' health-care claims directly can refuse to cover employees for alcohol-related claims.

The laws have ensnared problem and occasional drinkers alike.

Gentilello describes the case of a Seattle woman who was celebrating her 25th wedding anniversary and had a few glasses of champagne at dinner with her family. It was a rainy night and she was wearing high heels. As she and her husband tried to hail a cab, she tripped on a curb, fell and broke her ankle. In the emergency department, her chart noted that she had had a few drinks. Her insurer refused to pay. In 2004, Washington state adopted a prohibition on alcohol-related claims exclusions.

It's unclear how frequently insurers apply such laws to avoid paying claims. Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade organization, says the group doesn't know what its members do in this area. Cynthia Michener, a spokeswoman for Aetna, says that "to our knowledge," the company doesn't apply such exclusions. Other insurers, including UnitedHealthcare and Humana, didn't provide information about their practices when queried.

But a professor who has written about such laws says there are indications that health plans continue to use them to deny payment.

"There are tons of these cases," says Sara Rosenbaum, a professor of health law and policy at George Washington University's School of Public Health and Health Services. "The only evidence we have suggests that these cases go on."

"There's no reason to think that insurers, eager to hold down costs, wouldn't continue" to deny payment based on such exclusions, she adds.

51 Percent of adults 18 and older who drink regularly

50 Possible percentage of patients at emergency rooms under the influence of alcohol.

26 States that permit insurers to not cover policyholders at ERs who have been drinking (includes Florida, Alabama, Georgia, South Carolina).

Sources: CDC, NIAAA

Good and bad news of alcohol use by emergency room patients 05/02/12 [Last modified: Wednesday, May 2, 2012 8:10pm]
Photo reprints | Article reprints

Copyright: For copyright information, please check with the distributor of this item, Washington Post.
    

Join the discussion: Click to view comments, add yours

Loading...
  1. Hernando County Commission rejects plan for waste-to-energy plant

    Local Government

    BROOKSVILLE — After several years of discussion, many hours of staff time trying to negotiate a contract and questions about viability, the Hernando County Commission this week voted unanimously to turn down a contract with Freedom Energy Hernando LLC and abandoned the idea of having the county spearhead a …

     Commissioner John Allocco made the motion to deny the contract to Freedom Energy.
  2. Lack of parking for boat trailers causing turmoil along Port Richey waterfront

    Local Government

    PORT RICHEY — As Memorial Day and the summer boating season approach, the city of Port Richey finds itself in turmoil over parking along the city's waterfront.

    Gill Dawg restaurant owner Erik Suojanen, standing on property he owns across from his business, discusses a notice of violation he received from the city for allowing parking there without a submitting a site plan to the city.
 [Photo by Robert Napper]
  3. Tampa court hearing rescheduled for accused neo-Nazi jihadist killer

    Criminal

    TAMPA — Attorneys for Devon Arthurs, the alleged former neo-Nazi turned jihadist accused of shooting to death his two roommates, have asked to reschedule a court hearing that had been set for Wednesday morning.

  4. Parent of struggling DeVry University is changing its name to Adtalem

    Corporate

    Associated Press

    DOWNERS GROVE, Ill. — The company that owns one of the nation's largest for-profit college chains is changing its name.

    This 2009 photo shows the entrance to the DeVry University in Miramar, Fla. DeVry Education Group, which owns DeVry University, announced Wednesday that it will now be called Adtalem Global Education. 
[Associated Press file photo]

  5. NATO rolls out the red carpet, buffs its image for Trump

    World

    BRUSSELS — NATO is not only rolling out the red carpet for U.S. President Donald Trump in Brussels Thursday, the military alliance — which Trump once declared obsolete — has been busy repackaging its image and is ready to unveil a new headquarters worth more than 1 billion euros.

    U.S. President Donald Trump and his wife Melania arrive at Fiumicino's Leonardo Da Vinci International airport, near Rome, Tuesday, May 23, 2017. Trump is in Italy for a two day visit, including a meeting with Pope Francis at the Vatican, ahead of his participation in a NATO summit in Brussels on Thursday. [Associated Press]