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By Rebecca A. Clay
In the 5 years since SAMHSA launched
the Screening, Brief Intervention,
and Referral to Treatment (SBIRT) Initiative,
the program has increasingly become
an integral part of medical practice
in clinics, emergency rooms, and other
treatment settings.
The acceptance and value of the SBIRT
approach is evidenced by the large
number of patients screened, the decrease
in their substance use, and the recent
adoption of billing codes by insurance
companies and Government payers that
enable treatment providers to be reimbursed
for these services.
“We're seeing a lot of positive
results,” said H. Westley Clark,
M.D., J.D., M.P.H., Director of SAMHSA's
Center for Substance Abuse Treatment
(CSAT).
The approach focuses on individuals
who use drugs or drink more than they
should but aren’t yet dependent.
The idea is to screen everyone who
comes into a participating primary
health facility, clinic, emergency
room, campus health service, or other
venue. For those who need it, information
and tools are offered to help stop
substance use issues before they escalate. (For
details, see SAMHSA News online,
January/February 2006.)
So far, CSAT has funded a dozen college
campuses, 10 states, and 1 tribal organization
to develop SBIRT demonstration projects.
Lessons Learned
SBIRT’s
approach is simple, and its findings
are definitive.
Almost a quarter of those
screened have substance use problems. SBIRT’s
state and tribal grantees have screened
more than 600,000 patients so far.
Twenty-three percent of them have
substance use problems. “On
college campuses, the prevalence
is even higher,” said Tom Stegbauer,
Ph.D., lead public health analyst
in the Division of Services Improvement
at CSAT.
At one grantee school, for example,
the percentage of students reporting
binge drinking was 60 percent. And
it’s not just substance abuse
issues that these individuals face,
Mr. Stegbauer added. With substance
use comes a host of potential medical
problems, he explained, from diabetes
to behavioral health disorders.
SBIRT works. Thanks to SBIRT, many
of these individuals are making big
changes in their lives. At the 6-month
followup, for instance, almost half
of the participants in the state and
tribal SBIRT programs who were consuming
alcohol at inappropriate levels reported
that they hadn’t had a drink
in the past 30 days.
More than half of the participants
who were using illicit drugs or misusing
prescription medications had stopped
that behavior.
SBIRT saves money. The literature
reports a four to one savings with
the SBIRT approach, said Mr. Stegbauer.
In a 2002 study published in the journal Alcoholism:
Clinical and Experimental Research (Vol.
26, No. 1), for example, researchers
found that every dollar invested
in an SBIRT-like approach saved $4.30
in future health care costs.
Some SBIRT grantees are experiencing
even more dramatic results. In Texas,
for instance, an analysis of 853 SBIRT
participants revealed that the approach
saved the Harris County Hospital District
more than $4 million in the year after
the patients received services. Emergency
room usage dropped, explained Mr. Stegbauer.
There
also was a shift from inpatient to
outpatient treatment, which is much
less costly. “This was a performance
study and not a research project, but
we were pleased with the outcomes,” said
Mr. Stegbauer.
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New Billing Codes
“The SBIRT initiative isn’t
just about funding services,” said
Dr. Clark. “It’s also about
changing policy to ensure the approach’s
sustainability.”
New billing codes that allow practitioners
to be reimbursed for providing SBIRT
services are a key way to achieve that
goal. CSAT and a team of experts helped
draft proposals that became a reality
in January.
Current Procedural Terminology (CPT)
codes allow providers treating privately
insured patients to be reimbursed for
providing SBIRT services. Because by
law Medicare cannot cover screening
unless it’s mandated, the Centers
for Medicare & Medicaid Services
(CMS) created “G codes,” which
offer reimbursement to providers serving
Medicare patients. “H codes” allow
reimbursement for providers serving
Medicaid patients.
“The next step is to ensure
that states adopt the H codes in their
Medicaid programs,” explained
Research Professor Eric N. Goplerud,
Ph.D., Director of Ensuring Solutions
to Alcohol Problems at the George Washington
University Department of Health
Policy in Washington, DC. Dr. Goplerud
worked closely with SAMHSA and key
stakeholders to help get the codes
established.
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Next Steps
In the coming months, SAMHSA plans
to award up to four new Cooperative
Agreements to states and/or tribes
to demonstrate how SBIRT works in various
settings. The Agency also plans to
award grants to teach medical residents
skills to incorporate screening and
brief interventions into their clinical
practice in primary care settings. (See
SBIRT Funding Opportunity.)
In addition, SAMHSA will provide trainings
on the use of the new billing codes
for health care providers as well as
billing and coding professionals and
office managers. Educational materials
also are in development to build awareness.
SAMHSA will continue to work with
the field to provide guidance on upcoming
SBIRT programs and on how best to use
the codes for reimbursement.
In the near future, CSAT will be sponsoring
state SBIRT policy academies designed
to help states incorporate SBIRT into
their continuum of care.
As more information becomes available, SAMHSA
News will keep you informed
on the progress of these efforts
to expand the SBIRT model nationwide
through training, grants, and other
venues.
For a descriptive, “at a glance” chart
of information about the new codes,
visit SAMHSA’s SBIRT Web page
at www.sbirt.samhsa.gov/coding.htm. 
See
Also—Screening
Works: Update from the Field
About
SBIRT »
SBIRT
Funding Opportunity »
SBIRT
Resources »
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