Implications of SBIRT for early identification of substance use disorder

Everyone in the addiction treatment recovery industry knows that too many Americans never receive addiction treatment because their disorders go completely undiagnosed. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that has been clinically shown to identify, reduce and prevent substance misuse and the disease of addiction and ultimately reduce healthcare costs. While implementation barriers still exist, the Affordable Care Act has created valuable opportunities for the expansion of SBIRT utilization across various healthcare settings.

SBIRT is an early intervention approach that can be used in primary care settings to identify individuals at risk for substance use disorder. This approach targets individuals with non-dependent substance use to provide intervention prior to the need for more extensive treatment. Healthcare practitioners are encouraged to utilize SBIRT for patients who may not be actively seeking treatment for substance abuse, but who are at risk for developing medical complications or whose substance use may interfere with other responsibilities such as work and family matters.

Early intervention for patients with the potential for being diagnosed with substance use disorder is a priority for federal and commercial health plans. While there are obviously benefits of early treatment for the patient, utilizing SBIRT has the potential to lower costs to healthcare programs by shortening the time needed for treatment by identifying the issue at a less severe stage and reducing the likelihood of the patient developing costly comorbidities as the result of long-term substance abuse.

SBIRT consists of three major components:

• Structured Assessment or Screening – Identifying risky substance use behaviors using standardized assessment tools.
• Brief Intervention – Engaging the patient in a short conversation, providing feedback and guidance.
• Referral to Treatment – Providing a referral to brief therapy or additional treatment to patients whose assessment or screening shows a need for such additional services.

Who can administer and bill for SBIRT?

SBIRT can be administered in a primary healthcare setting, such as a physician’s office or outpatient hospital by a physician, physician assistant, nurse practitioner, clinical nurse specialist, clinical psychologist, clinical social worker, or a certified nurse-midwife. Reimbursement for SBIRT is available through commercial insurance, Medicare and Medicaid.[1] The Centers for Medicare & Medicaid Services (CMS) published guidance for Medicare and Medicaid providers utilizing SBIRT services, including documentation standards.[2] While Medicare currently pays for screening and brief intervention as a preventive service in the primary care setting, some states are working to “activate” Medicaid codes for SBIRT reimbursement.

According to the most recent information from the Substance Abuse and Mental Health Services Administration (SAMHSA), 16 states have approved SBIRT codes in their respective Medicaid plans; of these, five states have activated codes that allow providers to bill and receive payment for the services, four have activated SBIRT codes to allow for reimbursement of non-physician professionals (including Alaska, Tennessee, Colorado, and Virginia) and two states (Indiana and Oklahoma) have activated SBIRT codes to allow for reimbursement of physicians only.[3]

Implementing SBIRT

Following the backlash by commercial insurers who have been inundated with claims for substance abuse treatment, CMS has released more information about Medicare and Medicaid coverage for substance abuse services. Untreated substance abuse issues will only cost commercial insurers and federal programs more money in the long run, so it is in the interest of all healthcare programs to publicize approaches targeting early intervention.[4]

In 2013, an estimated 2.8 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to about 7,800 new users per day.[5] Ignoring the increasing number of individuals with substance use disorders is not an option.

However, implementation of SBIRT will require overcoming operational barriers. For many healthcare providers, especially those considering implementing this process in the emergency department of a hospital, the added time required to administer SBIRT is a significant barrier to implementation. The intervention requires a time commitment of at least 15 minutes, which for some providers would nearly double the time of visits, which are already tightly scheduled. Incorporating the SBIRT into electronic health record could minimize some of the use barriers, but on the front end this integration will cost time and money.

The final obstacle for consideration are the training needs of staff. Licensed and certified addiction treatment professionals can serve as an important resource for  providers with little or no exposure in this area of healthcare, thus enabling these  providers to be more effective when discussing interventions and treatment options. The partnership between treatment facilities and providers who can administer SBIRT is integral to increasing the incidences of early intervention for individuals at risk and the  development of a network to improve the continuum of care for those individuals assessed to need a referral for treatment at either residential or outpatient programs.

For more information on SBIRT assessment and screening tools, as well as examples of tools, click here. 

Paige Pennington is the Chief Operating Officer for Compliagent, and is responsible for the oversight of regulatory content development for the American Addiction Treatment Association.