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
Despite the simplicity
of SBIRT’s approach,
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 nervous 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.
“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
(GWU) Department of Health
Policy in Washington, D.C.
Dr. Goplerud worked closely
with SAMHSA and key stakeholders
to help get the codes established.
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.