Legal Barriers to Alcohol Screening in Emergency Departments and Trauma Centers

By Chezem, Linda | Alcohol Research, April 1, 2004 | Go to article overview

Legal Barriers to Alcohol Screening in Emergency Departments and Trauma Centers


Chezem, Linda, Alcohol Research


As described in more detail in the accompanying article by D'Onofrio and Degutis, many patients admitted to emergency departments (EDs) and trauma centers have positive blood alcohol levels at the time of their visit. (For more information on the distinction between EDs and trauma centers and the patients they treat, see the textbox "Emergency Departments Versus Trauma Centers.") Research has shown that screening ED and trauma patients for alcohol use not only helps physicians make a more accurate diagnosis of patients' conditions and decide on an appropriate treatment plans but also may allow for brief interventions and referrals to more extensive treatment. Many clinicians believe that patients with alcohol-related problems may be particularly amenable to alcohol interventions while they receive acute medical care for an alcohol-related injury. Several studies have demonstrated that brief interventions delivered to patients who are being treated in EDs or trauma centers for alcohol-related injuries can reduce alcohol consumption and the risk of renewed alcohol-related injuries in those patients (for more information, see the article by D'Onofrio and Degutis).

Despite the apparent benefits of screening and brief interventions or referrals, only a portion of ED and trauma patients actually are screened for alcohol use and alcohol-related problems. One survey found that about two-thirds of trauma surgeons frequently determine the blood alcohol concentrations of their patients, but only 25 percent used formal screening questionnaires with some or all of their patients (Schermer et al. 2003). Thus, although the study's authors noted an increase in screening over previous years, a large number of patients who could benefit from screening still are missed. It is important to note, however, that this survey was conducted among trauma surgeons, who are more likely to see severely injured patients than are ED physicians, who see injured patients as well as patients with a. broad range of other medical problems of varying severity. Therefore, the findings of this survey may not entirely reflect the actual prevalence of screening in ED patients or the frequency of screening in EDs that treat trauma patients because there is no dedicated trauma center in the area.

In any event, the question remains why all trauma and ED health care professionals are not screening all their patients for possible alcohol problems. Several factors have been suggested as potential barriers to screening, including professionals' doubts concerning the effectiveness of interventions for alcoholism, lack of time and resources to conduct screening, increased health care costs, and concerns about patient confidentiality. In addition, health care providers may fear that because of existing laws, third-party payors (i.e., insurers) may deny reimbursement for medical services if a patient has a positive blood alcohol level at the time of the ED visit. Some observers have identified the legal provisions that deal with alcohol use and the insurance payment of benefits for medical care as a factor that may contribute to the failure of many medical care facilities, particularly EDs, to screen for alcohol abuse and dependence as well as other alcohol-related problems. For example, the previously mentioned survey among trauma surgeons found that 27 percent of the respondents felt that screening would threaten reimbursement of medical costs (Schermer et al. 2003). The following discussion explores this issue in more detail.

Insurance Laws and Reimbursement of Alcohol-Related Medical Claims

In the United States, the provision of health care benefits by insurance companies is considered one of the powers that the Tenth Amendment reserves to the individual States because it is not specifically listed as a prerogative of the Federal Government. (For more information, see the textbox "History of State Versus Federal Legislative Authority.") One organization that informs much of the States' regulatory and legislative work regarding the insurance industry is the National Association of Insurance Commissioners (NAIC), an organization of insurance regulators from the 50 States, the District of Columbia, and the four U. …

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