222 



Chart 17 



In an era of competition, prospective payment and cost-consciousness, patients with comorbid 

 substance abuse problems are less attractive to most hoq>itals. Since they are likely to use more 

 resources, they may be less profitable to the institution than a patient without such 

 complications. Patients perceived as socially and financially undesirable can place a hospital at 

 a competitive disadvantage. 



This problem can be seen most dramatically with respect to Medicaid where some form of 

 prospective payment is used as the basis for reimbursement. For example, as Chart 17 

 indicates, patients with a secondary diagnosis of alcohol or drug use have an average case mix 

 index that is 41 % higher than for those patients without a secondary diagnosis. The case mix 

 index is a measure of resource consumption for patients for a given group of diagnoses and often 

 serves as the basis for payment. However, these patients stay on average 68 % longer in the 

 hospital than patients without a substance abuse problem. Thus, they may be more expensive 

 than level of reimbursement would reflect. As a result, those hospitals that have a larger share 

 of patients with substance abuse as a comorbid condition may be at serious financial 

 disadvantage. This, in turn, makes such patients less attractive, and limits their access to 

 hospital care. 



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