January 3, 2000
Do insurance policies discourage doctors from counseling patients on alcoholism?
Concerns about the legal right of insurance companies to deny patients coverage for injuries due to alcohol use may be discouraging physicians from screening and counseling their patients on the risks of alcoholism, according to a study by physicians at Harborview Medical Center to be published in the January 2000 issue of the Journal of Trauma.
Impairment caused by consumption of alcohol is a leading factor in trauma, with studies showing that as many as 50 percent of trauma patients have positive blood alcohol levels at the time of their injuries. When trauma patients are screened for alcoholism, as many as 44 percent test positive for chronic alcohol abuse, making it the most common chronic illness among these patients.
“Our research has found that brief, motivational interventions in the trauma center setting can be effective in reducing a patient?s drinking afterwards,” explains Dr. Frederick Rivara, a University of Washington (UW) professor of pediatrics, director of the Harborview Injury Prevention and Research Center and principal investigator in the study.
Despite this fact, the current study shows that physicians are reluctant to have such discussions with patients out of a concern that insurance companies will deny coverage to patients whose medical records indicate they were impaired by alcohol at the time of their injuries. This perception, Rivara says, is well-founded.
“Unfortunately, physicians? concerns about the implications of screening for alcohol abuse appears to be based on the firm legal reality that exists in most states,” Rivara explains. “In these states, an insurance carrier can deny a claim for coverage of injuries sustained under the influence of alcohol just as the carrier can deny coverage for self-inflicted wounds after a suicide attempt.”
While acknowledging that broadening insurance coverage to include care of injuries involving alcohol would adversely affect the premiums paid by others, Rivara points out that alcohol abuse and dependency is a disease, and insurance premiums should be based on risk sharing for all diseases.
Rivara and his fellow researchers outline new strategies for providing screening and counseling for trauma patients with alcohol abuse and dependency:
* Change regulatory statutes to prohibit exclusion of insurance coverage for injuries due to alcohol use. A similar legal change has been done nationally to end the practice of excluding coverage for “pre-existing conditions.”
* Require alcohol screening for all trauma patients, as has been done in Connecticut, where hospitals must now establish protocols for screening these patients for alcohol and substance abuse.
* Record information about alcohol abuse on a separate part of the medical record. Release of this information would be determined by a hospital “gatekeeper” familiar with confidentiality and substance-abuse issues.
* Assign specific chemical-dependency counselors to screen all patients. Federal confidentiality regulations protect information collected by personnel whose primary function is substance-abuse screening, treatment or referral.
* Change hospital “consent of care” forms to not give blanket information to outside agencies, such as insurance companies.
“Physicians? overriding concern should be to care for their patients in the best possible manner,” Rivara says. “Failing to pay attention to alcohol abuse in a trauma patient could be viewed as being as negligent as failing to diagnose and treat hypertension in a middle-aged man with heart problems. The legal barriers that discourage physicians for providing proper care should ? and must ? be challenged.”
In addition to Rivara, the study was written by Dr. Larry Gentilello, UW associate professor of surgery, and UW research assistants Sara Tollefson and Elizabeth Tesh.
