Trauma surgeons back alcohol programs

Trauma surgeons would be willing to establish alcohol intervention programs at trauma centers if there were no insurance barriers for patients who consumed alcohol.

A new study found that most trauma surgeons and state legislators believe that trauma centers should screen patients for alcohol and drug use and offer counseling to those who screen positive. But surgeons apparently are reluctant to do that, because one in four of the 98 surgeons surveyed nationwide had been denied insurance payment because drug or alcohol use was documented, according to the study in the September issue of the Journal of Trauma Injury, Infection, and Critical Care.

The Uniform Accident and Sickness Policy Provision Law, a model law that more than two dozen states have adopted, allows insurers to exclude coverage for alcohol- and drug-related injuries. Most trauma surgeons did not know that UPPL statutes existed in their states. Although surgeons lacked knowledge of state law, some did experience alcohol-related insurance denials, the study said.

The denials appear to affect screening practices. Only about half of the surgeons routinely measure blood alcohol concentration, even though 91% of them said it is important to determine that about a patient.

Screening injured patients for an alcohol problem and providing a brief intervention can reduce subsequent alcohol use and hospital readmissions, the study said. The majority of trauma centers do not provide such screening and intervention.

The study found that 82% of trauma surgeons would work with their trauma center to set up a brief alcohol intervention service if there were no insurance barriers.

"Trauma surgeons want to do this. It's better patient care," said Larry M. Gentilello, MD, the study's lead author and chair of the Division of Burns, Trauma and Critical Care at the University of Texas Southwestern Medical School in Dallas.

Of the 56 legislators surveyed:

• 89% agreed that alcohol problems are treatable and that counseling can help patients.
• 62% favored banning alcohol-related exclusions in medical expense policies.
• 50% said that if the UPPL were repealed, trauma surgeons would be more likely to screen and recommend alcohol counseling to patients.

In 2003, physicians at the AMA Interim Meeting voted to support state medical and specialty societies and public health groups to repeal laws that permit insurance companies to refuse to pay for emergency department treatment for intoxicated patients' injuries.