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SAMHSA News - March/April 2008, Volume 16, Number 2

Screening Works: Update from the Field

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

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.

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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 (GWU) Department of Health Policy in Washington, D.C. 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

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