Dear Readers,

The use of electronic tools is improving outcomes in the behavioral healthcare field.  Whether via education, care coordination, recovery support, access to records or even access to care itself, technology is driving positive change. We urge all behavioral health providers to remain open and eager to learning and evolving as the next wave of new web-based services, mobile apps and behavioral health electronic applications (e-apps) hits our shores.  Of course, it is critical to balance innovation with a patient focus, particularly relative to confidentiality. 

In October, SAMHSA announced it is awarding grants totaling up to $25 million over three years to as many as 29 providers to expand the use of health information technology to increase access to behavioral health services.  The program aims to leverage technology to improve access and coordination of the treatment of mental and substance use disorders, especially for those people in remote areas or underserved populations.

This is great news for the behavioral healthcare field, and builds upon the HITECH Act federal incentive payment program to encourage Medicare and Medicaid providers to purchase and meaningfully use electronic health records. While this program is an important investment in the future of the healthcare system, the eligibility categories aren’t very inclusive of behavioral health. U.S. Sen. Whitehouse (D-RI), along with nine bipartisan co-sponsors, has since introduced the Behavioral Health Information Technology Act of 2011 to address that inequity.

We encourage you to pay attention to what your peers around the country are doing to capitalize on new technologies, read the new research in peer-reviewed journals that could impact your own practice and look for funding opportunities that could support your own electronic services.  Also, keep an eye on the broader marketplace: for perspective on how fast technology is impacting our worlds, it has been just 40 months since Apple launched its app store!

Sincerely,

Mohini Venkatesh
Senior Director, Public Policy

Dean Peterson
Director of the Center for Public Advocacy at Hazelden

RESOURCES & REMINDERS

Are Accountable Care Organizations a Fad, or the Future? New National Council Resource Helps You Find Out
On October 20, 2011, the federal government announced final rules providing guidance on how Accountable Care Organizations should be structured. These final rules could create a tipping point to help behavioral health provider organizations become part of the new healthcare ecosystem under health reform.

A new resource from the National Council outlines the key elements of the final rules and their implications for behavioral health providers. It answers the key questions:

• What really makes an ACO?
• Who can create and join an ACO?
• Where do behavioral health providers fit in?

The report also explains how behavioral health organizations can “ride the wave” and make the case for their participation in ACO. This report is the latest in our series helping provider organizations prepare for the changes ahead under health reform. To view additional resources, visit our website or check out our blog, MentalHealthcareReform.org.    

CMS to Hold National Provider Call on Physician Quality Reporting System & Electronic Prescribing Incentive Program
On Tuesday, December 20 from 1:30-3pm eastern time, the Centers for Medicare & Medicaid Services (CMS) will host a national provider call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on electronic health record (EHR) and registry based reporting  options that are available for eligible professionals (EPs) participating or looking to participate in the Physician Quality Reporting System and/or Electronic Prescribing Incentive Program. A question and answer session will follow the presentation.

The target audience for this national call is Medicare fee-for-service (FFS) providers, medical coders, physician office staff, provider billing staff, and vendors. Visit http://www.eventsvc.com/blhtechnologies/ to register. Registration will close at 12:00 p.m. eastern time on December 20, 2011, or when available space has been filled. The presentation will be posted at least one day before the call at:  http://www.cms.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section on the CMS website.

ASAM and CTI Announce Online SBIRT Training Course
The American Society of Addiction Medicine (ASAM) and Clinical Tools, Inc. (CTI) recently announced that an online SBIRT training course is available. This online training course will provide users with the training needed to appropriately screen for and identify substance abuse, plan and implement a tailored brief intervention, improve care management and referral skills for brief treatment or severe problem/addiction treatment, and will apply the SBIRT approach to substance abuse problems by individualizing these clinical skills to different patients.

SAMHSA Develops a Guide for Substance Use Disorder Counseling
SAMHSA’s “Scopes of Practice and Career Ladder for Substance Use Disorder Counselors” guide give learners the tools needed in order to appropriately screen for and identify substance abuse, plan and implement a tailored brief intervention, improve care management and referral skills for brief treatment or severe problem/addiction treatment, and will apply the SBIRT approach to substance abuse problems by individualizing these clinical skills to different patients. This guide provides a full range of responsibility and practices ranging from entry level to supervisory. Click here to view this guide.

IN THE NEWS

Study Finds Connection between Unemployment Rates and Alcohol Consumption
While some previous studies found that positive health outcomes, including a reduction in excessive drinking rates, improve during economic downturns, new research finds that binge drinking and alcohol abuse and/or dependence actually increase with a rise in the unemployment rate.

The study, by University of Miami health economist Michael T. French and collaborators, uses panel data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) from 2001 to 2005, which is the most recent relative to existing studies.  It includes a rich set of measures on alcohol consumption that were not looked at in earlier studies, such as alcohol abuse and dependence. The findings are reported online by the scientific journal Health Economics in a study titled "Macroeconomic Conditions and Excessive Alcohol Consumption."

French and his team found that binge drinking increased with a rise in the state-level unemployment rate.  Driving while intoxicated and alcohol abuse and dependence also increased for both genders and across all ethnic groups.  Further, the consequences of the unemployment rate on excessive alcohol consumption was demonstrated for all population subgroups in the study, with African-Americans and those aged between 18 and 24 years displaying the largest binge-drinking effect.

The researchers also found that unemployed unmarried adults and adults with fewer children were more likely to demonstrate alcohol abuse and dependence. 

CDC study indicates overall drunk driving rates have fallen since 2006
According to a recent analysis by the Centers for Disease Control and Prevention, in which researchers looked at data from a 2010 national telephone survey of nearly 210,000 people, drunk driving incidents have fallen 30% since 2006 and 2010 incidents were at their lowest level in almost 20 years.

Noting that other studies have shown people are drinking more during the economic downturn, Dr. Thomas Frieden, CDC Director, posits that the decrease in drunk driving incidents signals that people may be turning away from bars, nightclubs and restaurants to do their heaviest drinking.  In an interview with the Associated Press, Dr. Frieden suggested “one possibility is that people seem to be drinking at home more and driving less after drinking.” 

While drunk driving numbers have fallen, they remain daunting.  Compared to an estimated peak of 161 million incidents of drunk driving in 1993, the CDC found that nearly 1 in 50 respondents admitted to having driven drunk at least once in the month prior to being interviewed, which scales up to more than 112 million episodes of drunk driving in 2010.  Dr. Frieden notes that “in fact, nearly 11,000 people are killed every year in crashes that involve an alcohol–impaired driver.”

Other findings in the CDC study:

• Men ages 21-34, who make up only 11% of the population, were responsible for 32% of all incidents of drinking and driving.
•  In general, men were responsible for more than four out of five drunk driving incidents in 2010.
   

Two Studies Highlight Alcohol’s Role in Exacerbating Other Serious Illnesses
Alcohol dependence is widely recognized as a chronic and fatal disease in its own right, but two recent researchers have highlighted the contributing role that heavy alcohol use plays in other potentially fatal diseases.

Research supported by the Finnish Foundation for Cardiovascular Research analyzed the uniformly required autopsies of victims of sudden cardiac arrest and cardiac deaths in Finland and found that only 78% of heart deaths were due to coronary artery disease, a buildup of plaque in the coronary arteries that is commonly assumed to be the cause of most heart attacks.  The primary causes of “nonischemic sudden death” (NSD, or coronary deaths not attributable to coronary artery disease) were found to be alcohol consumption and obesity.  Nonischemic heart disease is usually linked to a disease in one or more of the heart muscles, which causes the heart to pump ineffectively, reducing the transport of blood and oxygen throughout the body.  Some 23% of those deaths were independently traceable to obesity, while 19% of them were attributable to excessive alcohol consumption. 

Meanwhile, another study links heavy alcohol consumption with a greater risk of developing lung cancer.  Stanton Siu, MD, FCCP, of Kaiser Permanente in California presented a new study at CHEST 2011, the annual meeting of the American College of Chest Physicians.  Dr. Siu and his research team studied 126,293 people who provided baseline data from 1978 to1985 and followed them until 2008 to determine their risk for developing lung cancer in relation to a variety of suspected causal factors: cigarette smoking, alcohol consumption, gender, ethnicity, body mass index (BMI) and level of education.

Of the 1,852 people who developed lung cancer during that period, cigarette smoking remained a strong predictor of all types of lung cancer; however, heavy alcohol consumption (> 3 alcoholic drinks per day) also increased the lung cancer risk, with a slightly higher risk related to heavy beer consumption as opposed to wine and liquor.
 
“Heavy drinking has multiple harmful effects, including cardiovascular complications and increased risk for lung cancer,” said lead researcher Siu, MD in a news release. “We did not see a relationship between moderate drinking and lung cancer development.  So it appears probable that most middle-aged and older moderate drinkers have coronary artery protection and no increased risk of lung cancer risk."

New Study Assesses Public Health Costs of Excessive Alcohol Consumption
Excessive alcohol drinking is the third leading cause of death in the United States, leading to 79,000 premature deaths. Among other things, binge drinking causes increased disease and injury, property damage from fire and motor vehicle crashes and lost productivity. Although the public health impacts of excessive alcohol consumption are known, its economic cost has not been assessed for the United States since 1998.  Using data from 2006, a new study in the American Journal of Preventive Medicine by Mathematica assessed costs for health care, productivity losses, and other effects, including property damage associated with excessive drinking. On a per-capita basis, the economic impact of excessive alcohol consumption is approximately $746 per person and is attributed mostly to binge drinking.

Data Spotlight

• The percentage of adults with no health insurance is the highest on record, with 17.3% of adult’s uninsured in the third quarter of 2011, according to a new poll by Gallup.  Three years ago, in the third quarter of 2008, only 14.4% of adults lacked health insurance.  Gallup cautions, however, that the record high also coincides with a methodological change that samples cell-phone only respondents, who tend to be younger and thus more likely to be uninsured.  Thus, a portion of the increase could be linked to that change.
• More than 188 tons of unwanted or expired prescription meds were turned in during Prescription Drug Take-Back Day on October 29 at 5,327 sites around the country. Click here to read more.
• Mental health and substance abuse treatment spending declined as a share of overall health care spending, according to a recent SAMHSA study, falling from 9.3% in 1986 to 7.3% in 2005.
• The National Alliance on Mental Illness (NAMI) found that 28 states and Washington, D.C. have cut nearly $1.7 billion from their mental health budgets since the 2009 fiscal year, despite the increased demand for services during these difficult economic times.
• A new study by the Consumer Electronics Association says 36% of consumers would be interested in sending health data to their doctor via a wireless device, 33% are interested in managing their health records online and 32% would be willing to consult with their doctor via online video.
• The death toll from overdoses of prescription painkillers has more than tripled in the past decade.  The CDC found more than 40 people die every day from overdoses involving narcotic pain relievers, and four times as many prescription painkillers were sold in the U.S. last year than in 1999.
• Between 1999 and 2008, the number of young adults ages 18 to 24 hospitalized for combined drug and alcohol overdoses increased by 76%, reaching 29,202 cases in 2008. Researchers calculated that the costs of hospitalizations among this age group for alcohol and drug overdoses exceeds $1.2 billion annually.
  
   

GOVERNMENT AFFAIRS UPDATE

NIH Announces Results from a Study on the Treatment of Prescription Opioid Addiction
According to a recent study, people addicted to prescription painkillers reduce their opioid abuse when given sustained treatment with the medication Suboxone. Suboxone is a combination of buprenorphine, which is used to reduce opioid craving and naloxone, which is a drug used to counter the effects of opiate overdose.  Results of the study show that approximately 49% of participants reduced prescription painkiller abuse during Suboxone treatment. This success rate dropped to nearly 9% once Suboxone was discontinued. This study, published in the Archives of General Psychiatry and was conducted by the National Institute on Drug Abuse, was the first randomized large scale clinical trial using a medication for the treatment of prescription opioid abuse.

 “The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” said NIDA Director Nora D. Volkow, M.D. “However, once the medication was discontinued, patients had a high rate of relapse – so, more research is needed to determine how to sustain recovery among patients addicted to opioid medications.”

CDC Report Says That Smokers Want to Quit but Ignore Treatment
While nearly 70% of people who smoke say they want to stop, a new report by the CDC says that in the past year only about 32% of smokers used counseling and/or medications that could help them quit.

The report shows that 52.4% of adult smokers tried to quit within the past year and that 48.3% of smokers who saw a health professional in the past year got advice on how to quit smoking. In this report, which was conducted by the National Health Interview Survey, more than 27,000 Americans were questioned about their smoking habits.

The findings also correlate with whether or not someone has health insurance. Those without health insurance are less likely to see a physician which in turn causes them to be less likely to be counseled about quitting, making the uninsured the lowest group to use medication when attempting to quit.

For people enrolled in Medicaid, whether they get counseling and /or can enroll in smoking-cessation programs and get medication depends on the state in which they live. CMS leaves it up to the states to decide whether or not to cover such programs. For those enrolled in Medicare, smoking-cessation coverage has expanded over the past two years and now all Medicare beneficiaries are covered. Among private insurers, coverage varies. However, under the health care overhaul, insurers will have to provide such coverage by 2015.

Smoking and exposure to secondhand smoke kills an estimated 443,000 Americans each year and causes about 130,000 cardiovascular disease deaths per year in the United States, accounting for approximately one of every six health care dollars. 

Supreme Court Agrees to Hear Health Law Case
The Supreme Court recently announced that it will hear the legal challenges to the Affordable Care Act (ACA) in its upcoming session. The move follows several conflicting decisions at the District and Appellate court levels, some of which upheld the law and others which struck it down. The following is a list of the legal issues that the Supreme Court has agreed to take up.

1. Is the individual mandate constitutional?
2. If the mandate is struck down, can the rest of the law stand?
3. Is the Medicaid expansion an unconstitutional infringement on states’ powers?
4. Do plaintiffs have legal standing to bring a lawsuit before the law goes into effect?

The Court’s decision on these four issues could have wide-ranging implications both for the future of health reform in the United States and the constitutional limits on Congress’ power. The oral arguments before the Supreme Court are scheduled for March, meaning that a decision will not be handed down for some months yet to come. Meanwhile, states and the federal government will continue their preparations for ACA implementation. For more information on each of these legal issues including their implications, take a look at a recent issue of our Public Policy Update.

Congress Contemplates Next Steps in Aftermath of Supercommittee Failure
As Congress returned from its Thanksgiving recess, lawmakers last week grappled with their next steps in the wake of the Supercommittee’s failure to reach an agreement on a $1.2 trillion deficit reduction plan. Most of these efforts have centered on minimizing the impact of automatic, across-the-board spending cuts that were triggered when the Supercommittee could not produce a plan. These cuts will go into effect in 2013 and will fall equally on defense and non-defense spending. Many important social safety net programs – for example, Medicaid and SSI – are exempted from the cuts.
Reports indicate that House Majority Leader Eric Cantor (R-VA) is working to build support for a new proposal that would reduce the impact of the automatic defense cuts by pairing a delay their implementation with a variety of measures that are widely considered to be “must-pass” legislation. Cantor’s plan would include $133 billion in spending cuts, a 1-year delay in the defense sequestration, a 1-year extension of unemployment benefits, a payroll tax break, and a “fix” for the scheduled reduction in Medicare physician payment rates. However, President Obama has threatened to veto any legislation that modifies the automatic cuts, and it is far from clear whether a majority of legislators would support such a bill.

Meanwhile, discussions continue among other legislators about how to reduce the deficit in the aftermath of the Supercommittee’s failure. A bipartisan, bicameral group fashioning itself as the “go big coalition” is holding meetings behind closed doors to discuss a $4-6 trillion deficit reduction plan. In addition, Representative Paul Ryan (R-WI) has suggested that he may try to replace some of the automatic defense cuts with a deficit reduction plan to be included in his outline for the 2013 budget. (With fiscal year 2012 already two months old, Congress and the White House have begun working on their budget proposals for FY 2013). Such a move could be largely symbolic, as election-year politics make it unlikely the Democratic-controlled Senate and the Republican-controlled House will reach an agreement on the same budget resolution. It is not uncommon for the two chambers to work from separate budget resolutions, smoothing out differences during their later-stage negotiations. 

For more information on the Supercommittee failing to reach an agreement and a more in-depth analysis of what this means for behavioral healthcare, click here. 

The National Council’s Addiction News Now is published monthly and is produced in partnership with Hazelden.