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Charts 10 - 14 



Chans 10 through 14 highlight the differences in length of stay for Medicaid patients with and 

 without a secondary diagnosis of substance abuse ~ by substance, by age and sex, and by 

 selected diseases and conditions. As noted in the methods section, our estimates of the 

 additional days of care required to treat patients with a secondary diagnosis of substance abuse 

 are limited by the medical reporting of these problems. 



Cigarette smoking is rarely if ever recorded as a secondary diagnosis: yet, for some conditions 

 such as pneumonia continued heavy smoking lengthens the course of recovery. 



Even for alcohol and drugs, studies show that as much as 60% of cases with secondary 

 substance abuse problems go unrecorded. If true, many patients who have a substance abuse 

 problem are incorrectly placed in the category of patients with no secondary diagnosis; since 

 they have a longer average length of stay (ALOS), they artificially inflate the ALOS for the 

 category without a substance abuse diagnosis, thus reducing the true difference in length of stay. 



Moreover, the data can demonstrate a longer length of stay for many diseases where substance 

 abuse is a comorbid condition, but they cannot portray the greater intensity of care that many 

 of these patients must receive as a result of a substance abuse problem. As discussed above, 

 many of the additional bum days may be spent in the Intensive Care Unit (ICU) where additional 

 costs per day are much higher than the $750 average daily cost we used to compute cost 

 differences in length of stay. This also understates the cost of substance abuse to Medicaid. 



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