Alcohol screening, counseling, and medication treatment among older adults with heart failure: A missed opportunity.

OBJECTIVE: Both alcohol use and heart failure (HF) are prevalent among older adults. Alcohol can affect heart muscle, electrical function, blood pressure, and interact with common HF medications. Alcohol screening, brief counseling, and medications for alcohol use disorder (MAUD) are evidence-based and reimbursable by Medicare, but it is unknown whether older adults with HF receive these interventions, the details of these interventions, and if clinicians are reimbursed for them. This study identified instances of claims-documented screening, brief counseling, and MAUD receipt, as well as the sources of these services, among older adults enrolled in Medicare fee-for-service (FFS) in 2 years following HF diagnosis.

METHOD: Data are from Health and Retirement Study 2010-2018 linked with FFS claims 2008-2020. We calculated the percentage of respondents (n=1,232) that received claims-documented screening and, among those with alcohol use outside guidelines, brief counseling and MAUD following HF diagnosis. For services received, we calculated percentages by venue, clinician specialty, whether the respondent previously visited the clinician, and clinician participation in an Accountable Care Organization (ACO) contract.

RESULTS: Only 20 respondents (1.9%) received claims-documented screening. All screenings occurred in office settings. Most were administered by internal medicine specialists, clinicians that respondents previously visited, and clinicians not in ACOs. No respondents received brief counseling or MAUD.

CONCLUSIONS: Interventions for alcohol use above guidelines are uncommon among older adults with HF, indicating a missed opportunity for intervention. Further, clinicians are seemingly not capitalizing on the reimbursable nature of these services; additional support for providing, documenting, and billing for these services is warranted.