Talking Points on Early Detection of Developmental-Behavioral Problems

Current Detection Rates

70% - 80% of children with disabilities and mental health disorders are not detected in primary care or referred for needed services.
Nationally, only 2 1/2 % of children between 0 – 5 are served in early intervention. The Center for Disease Control contends the prevalence is 12% in the 0 – 5 year age range, and 16% -18% in the 0 – 18 year age range. Recent studies have shown higher rates (e.g., 13% in the 0 – 2 year age range).
Informal detection methods are the major cause of under-detection (e.g., checklists, ad hoc questions to parents, partial test administrations, observation, etc.).

Why Low Detection Rates are a Major Problem

Early intervention is effective and saves society $17 for each $1 spent.
Some children, if detected and enrolled early, may have problems that can be successfully treated before school entrance (and onset of secondary mental health problems often born from school failure).
All children, even if their problems cannot be cured, have major improvements in outcome and are far more likely to complete high school, become employed, avoid criminality and teen pregnancy.

Time and Expense

Informal detection methods such as eliciting milestones take time, at least 2 – 3 minutes per visit.
Eliciting milestones does not deter time-consuming “oh by the way concerns” so disruptive to visit length and patient flow.
Reducing “door-knob” concerns and the time devoted to eliciting milestones, frees time for the far better endeavor of advising parents and making referrals.
Use of quality measures save time and improve reimbursement and help clinics generate needed revenues that more than cover the cost of good tools.

What is Early Detection Policy?

The American Academy of Pediatrics (AAP) recommends surveillance and periodic screening. The same evidence-based tools can be used to perform all the following:

Eliciting and addressing parents’ concerns at each visit
Viewing milestones at each visit
Identifying and addressing psychosocial risk and resilience factors
Using a general screen that is validated and accurate at 9, 18, 24 – 30 months and.... at each subsequent well visit
Using an autism-specific screen at 18 and 24 months

Reimbursement

The Center for Medicaid and Medicare guarantees reimbursement for screening offering an average of $10 per screen administered.
In most states, only standardized and validated screens qualify for reimbursement. A review of milestones even if drawn from measures such as the Denver-II do not qualify for reimbursement.
States are required to implement the CMS policy by December 2005.
Private payers are following suit, often paying far more than Medicaid does.
Each payer (private or Medicaid) may require different billing procedures.
For basics on coding and reimbursement, please click here.
Appeal all denied claims. If unsuccessful, go to the AAP Coding site, http://coding.aap.org. The AAP is actively working with payers to ensure reimbursement.
Quality developmental-behavioral screening should become a profit center for practices and more than offset the costs of screening.

Implementation

Use of quality tools actually saves time at visits. Figuring out the best work flow process for your setting is the challenge.
Because there are no RVU’s for provider time, staff need to take responsibility for administering and scoring screens, leaving clinicians to interpret and explain results.
Actively engaging staff is essential to figuring out an optimal work flow.
Electronic applications of quality tools exist and can save time because they provide ICD-9/procedure codes, eliminate hand-scoring (and its errors), generate summary reports for parents and referral letters when needed.
See www.developmentalscreening.org and www.pedstest.com for implementation and training suggestions, case examples, slide shows, videos, etc.
Staff and providers will need to be familiar with referral and parenting information resources.