Quality Improvement

The Overlooked Addiction

February 20, 2018 11:49 am

The need to address the opioid crisis is clear, thanks to the relentless media spotlight. But at the same time, the societal burden of alcohol abuse is growing yet has garnered little attention. Why?

On Feb. 9, as part of a budget deal, Congress passed $6 billion in funding over two years to deal with the opioid crisis. This measure was greeted as good news by policy experts, although it was recognized as falling far short of what’s needed.

Media coverage of the opioid epidemic is ubiquitous. Given the magnitude of the problem, this coverage is well deserved, especially if it sparks action. But the focus on opioids has overshadowed a problem that has been affecting lives and families long before “opioid” was a household word, a problem that is quietly getting worse in certain segments of the population: alcohol abuse.

A Major Cost Concern

Our focus here is on improving the value of health care, so that’s what I will address now. A new study from the National Institute on Alcohol Abuse and Alcoholism (part of the National Institutes of Health) documents the impact of alcohol abuse on healthcare spending. The rate of alcohol-related visits to U.S. emergency departments (EDs) increased by nearly 50 percent between 2006 and 2014. That increase far outpaced the rate of growth in ED visits for any cause during that period. Also, the cost of providing care more than tripled, rising from $4.1 billion to $15.3 billion. 

At a time when reducing unnecessary ED utilization is a priority for many healthcare organizations, it seems clear that reducing the number of alcohol-related ED visits is an opportunity area, to say the least. Stopping the revolving door means going beyond standard ED protocols to incorporate steps such as attempting interventions and referring patients to treatment programs. That’s no simple task due to both the nature of substance abuse and the persistent nationwide shortage of substance abuse providers and available beds.

But the underlying issue is that alcohol abuse is not getting the attention it deserves from the media, policymakers, or traditional healthcare stakeholders. The consequences of the jump in alcohol-related ED visits go far beyond the ED. Even a single alcohol-related visit is a predictor of chronic alcohol-related issues for an individual. Over time, excessive alcohol use can lead to the development of chronic conditions such as heart disease, liver disease, and dementia.

And chronic conditions are the single biggest driver of healthcare spending. Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for more than 90 percent of total Medicare expenditures. Contrast that with the reduction in Medicare spending in a hypothetical scenario where the joint-replacement bundled payment initiative is scaled up nationwide—just 0.01 percent of U.S. national healthcare expenditures in 2016, according to HFMA estimates. There are better targets for cost reduction efforts.

An Overlooked Problem

The questions that must be asked are: Why isn’t alcohol misuse a much talked-about issue? Why is mainstream media not focusing on alcohol like it does on the opioid issue? Why are politicians not focused on alcohol misuse and treatment? Why isn’t the healthcare industry focused on it as a high priority?

Is it because alcohol is so interwoven into our society? Is it because most of the people in these cohorts use alcohol socially and without issue (while some in these groups, as in society at large, do have an alcohol problem—6.2 percent of adults have an alcohol use disorder, according to the 2015 National Survey on Drug Use and Health)? Is it because it’s “chic” to drink wine but not so chic to surreptitiously take pills? 

Given that chronic conditions, especially behavioral health and substance abuse, drive the cost of health care, why are we not headlining this major cost driver every day?   

Coming to grips with these questions and navigating this territory will require leadership, collaboration, and, not least of all, courage. It will also require going beyond the headlines to understand and address community needs, even when that means tackling longstanding issues that lack breakthrough treatments or poster children, like alcohol abuse.

We are on the cusp of a new era of collaboration in health care—and collaboration is the single best lever for bringing about change. The time to address undertreatment of alcohol abuse is now.

Joseph. J. Fifer, FHFMA, CPA, is president and CEO, HFMA. Follow Joe Fifer on Twitter @HFMAFifer.


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