An Economic Evaluation of Primary Care Behavioral Health in Pediatrics: A Case Study

A barrier cited by primary care administrators in integrating behavioral health is financial risk. Fee-for-service billing mechanisms remain complex and there is little empirical guidance on cost-effective models. This study was an economic evaluation of an integrated care model in a pediatric private practice clinic. The study evaluated cost benefits by examining specific delivery indices such as concerns presented, time spent, billing codes used, and reimbursement received in regards to pediatric primary care visits by comparing days when an on-site Behavioral Health Consultant (BHC) was available versus Non-BHC Days. All 3 hypotheses were supported: 1) more patients were seen in clinic on BHC Days; 2) more revenue was generated on BHC Days; and 3) incorporation of the BHC was cost-effective. Findings showed that time saved by having a BHC onsite increased provider productivity, resulting in an additional $1,142 in revenue generated on a BHC Day when compared to a Non-BHC Day

Temperament-Language Relationships during the First Formal Year of School.

The purpose of the current study was to investigate temperament-language relationships among school-age children and across a wider variety of SES. Head Start, Pre-K, and Kindergarten classes of 10 elementary schools located in rural Appalachia were sent information about the study and 35 children were consented to participate. Parents completed a short demographic survey and the Child Behavior Questionnaire Very Short Form (CBQ-VSF). Children were administered the Preschool Language Scale-4 (PLS-4). Participants were split into low and high SES groups so associations between the CBQ and PLS-4 scores could be compared at each SES strata. Both reactivity and self-regulation were associated with language outcomes, consistent with prior research. Importantly, socioeconomic status was not found to moderate observed temperament-language relationships, so prior temperament-language research findings do not seem to be an artifact of high SES samples

“Powerful Tools for Caregivers”: Teaching Skills That Reduce Stress and Increase Self-Confidence

Educational Objectives 1. Describe caregiving stress and burnout symptoms and effects experienced by older caregivers. 2. Report implementation and evaluation of the “Powerful Tools for Caregivers” workshop, which is designed to increase knowledge and skills in caring for elders and reduce caregiver stress. 3. Suggest ways to alleviate caregiver burden at both micro and macro levels

Bringing a Behavioral Health Consultant to Residency: Implications for Practice and Training

This study examined pediatric residents’ responsiveness and experiences in the context of a new pilot program, building an on-site Behavioral Health Consultant (BHC) into their primary care training site. Fifteen pediatric residents were divided so that 9 had access to an on-site BHC and 6 did not. Over the first year of the program, research assistants observed 322 patient visits to record concerns raised, residents’ responses, and visit length. Data regarding BHC activity and residents’ subjective impressions of the program were also collected. Results showed that at least one BH concern was raised in 24% of observed visits. Residents with access to the BHC initiated 89 on-the-spot referrals, resulting in 127 BHC-to-patient interactions. On average, residents spent 10 additional min/visit when BH concerns were raised but those with access to the BHC saved 8 min/visit when BH concerns were raised. Overall, residents utilized the service, particularly first and second year residents. Those with BHC access managed BH concerns in less time than those in the control group. Residents who utilized the BHC were very satisfied, perceived a better quality of care and patient outcomes, and desired future BHC collaboration. Implications for training residents in the area of pediatric behavioral health by using an on-site provider are discussed

Integration Can Work! Demonstrating Cost Effectiveness and Marketing It in the Real World

But how do you pay for it? Sigh no more! The indirect benefits of hiring a Behavioral Health Consultant have been demonstrated in large health care industry but not in small, stand-alone practices. Until now! In this session, we will tell you how we answered this worn-out question with a short study comparing productivity and income in one small rural pediatric practice on days with a BHC and days without. Come find out how we showed the providers and staff how this practice saved over $1,000 per day when the BHC was present. We\u27ll also talk about how we\u27ve marketed this data to other practices and third party payers

Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost

Objectives Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Methods Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers\u27 direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. Results On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. Conclusions The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued

The Cost Effectiveness of Behavioral Health Consultant Utilization for Attention-Deficit Hyperactivity Disorder Cases in Rural Pediatric Primary Care

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavior disorder in children. With the frequency of ADHD diagnoses, primary care providers (PCP) are challenged with managing this chronic and complex concern in an efficient yet effective way, both in terms of time and money. Research indicates behavioral diagnoses and management take approximately five minutes longer than medical-only concerns. This can result in a revenue loss for primary care practices. However, an on- site behavioral health consultant (BHC) can help PCPs provide a high standard of care for children presenting with behavioral concerns without compromising cost effectiveness. This study’s aim was to assess the cost per minute in a small rural primary care practice that utilizes an on-site BHC by comparing data between ADHD appointments when the BHC was utilized versus ADHD appointments when the BHC was not utilized. This study used extant data consisting of a sample of 53 children with ICD-9-CM codes 314.00 or 314.01, indicating an ADHD diagnosis. Of the 53 children with these codes, 40 (75.5%) were billed using E/M codes 99213 or 99214. The first of these indicates a regular office visit with an established patient not exceeding 15 minutes while the latter is used if the visit lasts longer than 25 minutes. Both codes were combined and evaluated together. The database was then recoded to indicate whether or not a BHC was utilized. Using descriptive statistics, it was found that children with ADHD spent a max of 69 minutes (20.19 minutes on average) with the PCP when a BHC was not utilized and a max of 22 minutes (13.67 minutes on average) when a BHC was utilized. Furthermore, an average of $82.79 in insurance reimbursement was received by the practice for these types of visits, regardless of up-coding for physician time spent. Using these statistics, it was determined that the practice makes$4.10 per minute when a BHC is not utilized versus $6.06 per minute when a BHC is utilized for ADHD appointments, due to the time savings ratio. The results indicate that utilization of a BHC increases revenue with respect to minutes spent with the child, while still providing behavioral health time and attention to the patient. These findings have practical implications for the treatment and management of ADHD and support the use of BHCs in pediatric primary care settings. Given the nature of pediatric primary care, it would be more cost effective for PCPs to utilize an on-site BHC with all ADHD visits

Cumulative Sociodemographic Risk Indicators for Difficult Child Temperament

Cumulative risk models provide a convenient, parsimonious way to identify outcomes associated with multiple, highly correlated risk factors. In this paper, we explored linkages between a cumulative sociodemographic risk index, which included rurality status, and aspects of temperamental difficulty in an early school age sample of 53 school-aged children from Southcentral Appalachia. Cumulative risk was significantly predictive of temperamental difficulty, as defined by high negative affectivity and low effortful control, but post-hoc analyses revealed this association to be driven primarily by two of the eight risk indicators: rural status and income-to-needs risk. Although rurality status was highly correlated with income-to-needs risk, rurality predicted negative affectivity over and above income-to-needs risk and income-to-needs risk predicted effortful control over and above rurality status. Future models of cumulative risk may benefit from including rurality status as a risk indicator, despite high collinearity with income-to-needs risk