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Screening and brief intervention (SBI) for addictions and other behavioral problems could save billions in healthcare costs if widely implemented as a component of national healthcare reform. But experts say that the programs need to be introduced in a systemic fashion to be effective and avoid overburdening physicians.
Various research studies have shown that SBI can cut hospitalization costs by $1,000 per person screened, save $4 for every $1 invested in trauma-center and emergency-room screening. A study from the state of Washington found that SBI reduced Medicaid costs by $185 per patient per month, according to Richard Brown, M.D., associate professor at the University of Wisconsin School of Medicine and Public Health.
“All three studies showed that the savings occurred over the first 12 months,” noted Brown.
“This has the capacity to save thousands and thousands of lives and billions and billions of dollars,” said John C. Higgins-Biddle, Ph.D., retired assistant professor in the Department of Community Medicine at the University of Connecticut Health Center and a consultant on the Join Together report, Screening and Brief Intervention: Making a Public Health Difference.
The report says that use of SBI programs is growing nationally but still faces some significant hurdles, including lack of funding; reimbursement and cultural issues; and so-called UPPL laws, which allow health insurers in some states to deny payment to individuals injured in alcohol-related incidents, discouraging screening in trauma centers and emergency rooms.
However, the federal government provided $29 million in grants for SBI programs last year and is proposing similar funding in the FY2009 budget. A growing number of insurers have agreed to reimburse for SBI services, including the Federal Health Employees Benefit Plan, which covers 5.6 million federal workers. And in January 2009, Ohio became the 15th state to repeal its UPPL laws.
Advocates say that devoting even a few minutes to screening patients for alcohol and other drug problems in emergency rooms, health clinics, employee-assistance programs, and doctor's offices can identify at-risk patients and steer them into treatment before problematic substance use blossoms into a more serious health crisis.
“Most people don't use at risky levels, so for them the process takes less than a minute,” said Susan Aromaa, co-author of the report and manager of research and communications at Join Together. When a brief intervention is warranted, the 15-20 minutes required can be longer than most physicians allot per patient visit. Therefore, many hospitals and clinics employ specialized screeners to take the burden off of doctors — a setup that has become more common as reimbursement for SBI has been more widely accepted.
Research has shown that many screened patients cut down on their drinking simply because they were asked about their alcohol use; likewise, brief interventions have been shown to effectively reduce alcohol and other drug use. “Some doctors fear not having the treatment space, and that scares them away,” Aromaa said. In primary care settings, however, “Only about 1 percent of patients generally need treatment,” she said. (The rate is higher in emergency-rooms — around 3%.)
Wisconsin has emerged as a national leader in SBI implementation: the latest state budget calls for reimbursement of screening and brief intervention services under the state's Medicaid plan, and Wisconsin insurers have broadly accepted SBI as a part of the treatment continuum, according to Brown, who also serves as the clinical director of the Wisconsin Initiative to Promote Healthy Lifestyles.
Fourteen states currently receive federal funding for SBI projects, but “most [states] only [fund] one organization or hospital,” said Brown. “In Wisconsin, we decided to take on the whole state.” SBI programs are currently operating at 20 sites in the state, and Brown said he is optimistic that the programs will survive beyond the expiration of Wisconsin's federal funding thanks to the support of the state and insurers.
Noting that the U.S. spends at least $200 billion annually treating problems related to alcohol and other drug problems, Brown added that SBI is a natural fit for national healthcare reform. “It's a wonderful way to promote healthy behaviors and reduce healthcare costs,” he said.
The Join Together report spells out a series of recommendations for expanding and implementing SBI programs, including: