ER patients with substance abuse treatment need incur higher health care costs

Emergency department patients with unmet substance abuse treatment need generate much higher hospital and emergency department charges than patients without such need, according to a new study to be published today as an advance online publication of Annals of Emergency Medicine (Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study).

Researchers led by Ian Rockett, PhD, from West Virginia University’s Department of Community Medicine and Center for Rural Emergency Medicine found that emergency department patients with unmet substance abuse need are 81 percent more likely to be admitted during their emergency visit and 46 percent more likely to have reported making at least one emergency department visit in the previous 12 months. Their utilization of emergency medical services accounted for $777.2 million in extra hospital charges for Tennessee in year 2000 dollars, representing an additional $1,568 for each emergency patient with unmet substance abuse treatment need. In this statewide study, less than 10 percent of the emergency department patients needing substance abuse treatment were currently receiving it.

“We predict that systematically addressing substance abuse problems in emergency departments would produce major savings in time, resources and costs,” Rockett said. “In exacerbating the workloads of very busy hospital staff, emergency patients with unmet substance abuse treatment need add many millions of dollars to annual health care costs. Our research findings speak to the importance of identifying them as substance abusers — either for a brief intervention or to refer them to substance abuse treatment as appropriate. The emergency department visit itself can represent a teachable moment for a patient.”

The researchers estimated that 27 percent of adult emergency department patients in Tennessee have unmet substance abuse need. Compared to patients without substance abuse treatment need, patients with unmet need were younger, more likely to be male, and uninsured or enrolled in TennCare, Tennessee’s Medicaid-waiver managed-care program. The study was a cross-sectional survey conducted in seven Tennessee hospitals between June 1996 and January 1997.