Screen, Treat, and Refer Patients with Substance Use Disorder in the Hospital Setting

Play Strategy

Substance abuse disorder, commonly called addiction, is a treatable chronic disease that is a significant contributor to health care utilization and poor health outcomes. It’s estimated that up to 60 percent of patients in U.S. Level 1 Trauma Centers meet the criteria for a substance use disorder. Inpatient treatment for substance use disorder can improve recovery time and decrease length of stay, escalations of behavior, and 30-day readmissions. But few hospitals have a service line for these patients that goes from hospital admission, including through the emergency department, to discharge and follow-up in the community setting. This Play can help you develop a service line for substance use disorder as part of developing your care model.

Play - addiction - mobile
How to run the Play
  1. Conduct an environmental scan to identify major addiction treatment providers in your area. Determine what levels of care they provide, how many patients they can take, and what insurances they accept, so that you can make referrals. Where possible, an in-person meeting can help facilitate referrals.
  2. Develop a standard screening process to identify patients with substance use disorder, using resources from the American Society of Addiction Medicine and the National Institute of Drug Abuse.
  3. Begin treating patients in the hospital and referring them for follow-up. This process should include a conversation with patients to ensure they understand and agree to the treatment protocol.
  4. Work with the finance team to develop processes to pay for addiction treatment and staff training.
Tips and tricks

Environmental Scan

  • When identifying service providers in your area, try calling your county behavioral health and substance use disorder authority to find out who they contract with.
  • Use the Behavioral Health Treatment Services Locator from the Substance Abuse and Mental Health Services Administration (SAMHSA). You can perform specific searches to find providers who provide medication-assisted treatment with buprenorphine and methadone.

Screening

  • The National Institute of Drug Abuse offers a Quick Screen and more in-depth assessment called the NIDA-Modified ASSIST to help identify patients who are at high risk for substance abuse and refer them for a definitive screening to diagnose a disorder.
  • In addition to the NIDA Quick Screen, you should also identify patients for further assessment by taking into take into account the patients’ behavior and/or presenting symptoms. For example, patients may be likely to need substance abuse treatment if they present with a high blood-alcohol level after a multicar collision; if they had an overdose reversal; or they have a chronic pain syndrome and have escalated behavior requiring intervention by patient relations or the nursing supervisor when asking for opioid-based pain treatment. Even if a patient did not receive a high-risk score on the Quick Screen, you should advance these patients to the next step in your screening process.
  • The diagnosis of substance abuse disorder can be made with the American Society of Addiction Medicine CONTINUUM computerized assessment. CONTINUUM allows hospitals to place the data in a federally compliant national database so they can measure the severity of addiction patients they’re seeing over time. CONTINUUM also allows for prior authorization for insurance coverage so that patients can be placed in treatment pending medical clearance and discharge from the hospital.
  • Keep in mind that patients with a history of opioid use disorder may need a different approach to pain management than continued use of opioid-based pain control.

 

Treatment of Substance Use Disorder

  • Treating substance use disorder right away has many benefits. It can ease withdrawal symptoms right away and help patients start on the pathway to recovery. For patients who are unstable, it can help them better engage with their providers and treatment plan.
  • For patients in in opioid withdrawal, any prescribing provider can prescribe buprenorphine to treat and stabilize the patient without a special license or waiver.
  • Though the opioid crisis is in the spotlight, alcohol use disorder still affects more people. Hospitals can also treat acute alcohol withdrawal and develop a pathway for initiation of outpatient treatment or placement to an appropriate level of care.
  • Where possible, it’s helpful to integrate this care pathway in an electronic medical record order set.

 

Financing the Service

  • Financing inpatient substance use disorder treatment isn’t much different from billing for other services. Have the CFO sit down with the state mental health and substance use division and billers from the local addiction treatment facility and learn how addiction treatment can be financed. Then use quality improvement methods to make the billing process as reliable as possible.
  • You may find that the CFO needs to weigh in on the funding of training for staff on stigma and how to interact with patients suffering from substance use disorder.
  • Consider collecting data on the costs of not addressing substance use disorder, including longer length of stay and higher readmission rates.

 

Additional Resources