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Format: 04/20/2014
Format: 04/20/2014


Pittsburgh Business Times: Few doctors take advantage of reimbursements for drug, alcohol counseling sessions, insurers say

Friday, September 10th, 2010

A visit to the family doctor might be a teaching moment for people with an alcohol problem, but it’s an opportunity that has been largely wasted so far, experts say.
In recent years, local insurers have begun reimbursing primary care doctors for screening people for drug and alcohol problems. The screening is seen as a part of a thorough exam, and reimbursement is available for brief counseling sessions to encourage people with problems to get help.
But even though research has shown the brief intervention approach works, few doctors are doing it.
“The idea was to identify people at the earliest stages of risk, before they get well into addiction,” said Art Kusserow, director of behavioral health at Highmark Inc. “Utilization is not what anybody expected.
“Overall, the program might have lost a little steam nationally.”
Highmark began reimbursing doctors for the screening and brief intervention care two years ago, but has only received about 300 claims since then, Kusserow said. The reimbursement ranges between $30 and $60 for 15- and 30-minutes sessions.
UPMC Health Plan reported a similar anemic response — $52,000 in claims paid during the 18 months the reimbursement has been available, mostly for people with Medicaid coverage, according to Vice President John Lovelace. The insurer received a total of around 1,500 claims.
Lovelace attributed part of the lackluster response to physicians’ lack of training in dealing with substance abuse problems.
“It’s an uncomfortable subject for doctors and patients,” he said. “People don’t do it because they don’t want to deal with the answers.
“I think there’s a sense of ‘why open a can of worms here?’”
A new way of thinking
Dr. William Johnjulio, assistant chair of family medicine at West Penn Allegheny Health System, said substance abuse is part of medical school education, but doctors don’t always make it part of their practice.
Johnjulio is developing residency-level curriculum at Forbes Hospital to drive home the importance of the assessment.
His strategy is to train doctors to think of drug and alcohol screening as a part of a complete physical exam. Blood pressure and glucose levels are among the factors affected by alcohol consumption, he said, and promoting a healthy lifestyle involves addressing substance abuse.
Still, the stigma of the problem may be standing in the way of treatment.
“Drug abuse creates a visceral sensation,” Johnjulio said. “We don’t want to spend money on drug abusers.
“But once doctors see it work, they learn how to provide brief intervention, then you can watch them incorporate it into their practice.”
Primary care doctors are uniquely positioned to provide this kind of care. Between 70 percent and 80 percent of antidepressants, for example, are prescribed by family practice doctors rather than psychiatrists, Kusserow said.
“There’s a huge universe of unscreened, undiagnosed, untreated people who are, every day, going through physicians’ offices,” he said.

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