What is SBIRT?SBIRT (es-bert) is an evidence-based program developed by the World Health Organization as a public health approach to deliver early intervention and treatment services for problem substance users as well as those who are at risk of developing these disorders. The goal of SBIRT is to make substance use screening routine in healthcare. Individuals with non-dependent use are targeted and provided with effective strategies for intervention prior to the need for more extensive treatment. SBIRT is intended to meet the public health goal of reducing harms, healthcare costs and societal risks associated with moderate, heavy and risky use.
What does the acronym ‘SBIRT’ stand for?
- Screening
- Brief Intervention
- Referral to Treatment
What is SBIRT Wyoming’s approach to substance abuse?
- SBIRT Wyoming approaches most substance use as a preventable healthcare issue
- Patients with moderate, risky and binge substance use can be empowered to cut back or stop harmful substance use without the need for extensive treatment
- Screening and brief intervention allows patients to come to their own conclusions about health consequences related to substance use and reinforces responsible lifestyle behaviors
- Healthcare providers are a trusted source of information and SBIRT gives medical professionals tools to open a safe conversation around substance use and abuse
- Through screening pregnant women, the mother and child are both positively affected, resulting in fewer birth-related complications and child health risks
What are the benefits of using the SBIRT program?Patients
- Decrease the severity and frequency of drug and alcohol use
- Reduce the risk of trauma
- Plants seeds for future contemplation of decreasing or stopping use
- Intervene earlier and more effectively in alcohol and drug related problems
- Empower individuals to take better care of their own health
- Heightens awareness of health risks associated with tobacco, alcohol and other drugs
- Provides extra motivation and educational opportunities to help women abstain from substance use during pregnancy and remain abstinent after the baby is born
Providers
- Relieves some of the burden from health care facilities, legal and judiciary systems and mental health and substance use treatment centers
- Individuals at risk for developing substance dependency are identified before they become a burden on the health care system
- Provides clinician with an effective tool to begin a safe conversation about the use of alcohol, tobacco and other drugs
- Helps to give the provider a more comprehensive medical picture of the patient
- Providers can more effectively help patients seek follow-up counseling for tobacco cessation or dependent use of alcohol or illicit drugs
- Emphasis is on harms reduction instead of total abstinence
- Providers using SBIRT services receive reimbursement through Medicaid and/or commercial insurance
Health Care providers have a great influence in helping people make decisions about stopping tobacco and other substance use. However, physicians often do not have the luxury of spending a lot of time with patients, they are not trained to treat substance abuse nor do they want to deal with the resistance involved with asking patients about substance use, especially non-dependent use. Even though many clinicians do ask about alcohol, drug and tobacco use, the SBIRT program offers a safe way to open a conversation with patients that allows them to hear the information in a new and different format.Through SBIRT, resistance is lowered and the responsibility is placed on the patient to cut back or stop substance use so medical professionals do not feel such a burden to ‘fix’ their patients. Motivational interviewing is a process that finds the internal motivation of the patient to help them move toward harms reduction.
What difference can SBIRT make in Wyoming?
- One interaction can make a difference, influencing a person’s substance use and improving their overall mental, emotional, relational, financial and physical health
- A measurable reduction in emergency and in-patient services related to alcohol, tobacco and other drug use, resulting in cost savings for the healthcare system
- Expansion of the continuum of care, focusing on prevention before alcohol and other drug use escalates to addiction
- Reducing the rate of alcohol, tobacco and other drug use
Who is Supporting SBIRT?Coordination and educational support of SBIRT training is being provided by WYhealth…Get Plugged In, a total health management organization for the Wyoming Medicaid population. WYhealth is under the direction of Wyoming Medicaid.Wyoming state endorsements of SBIRT include:
- Medicaid Division
- Prevention Division
- Maternal and Child Health Division
- Public Health Nursing
- Wyoming Health Council
National endorsements include:
- World Health Organization (WHO)
- Substance Abuse and Mental Health Services Association (SAMHSA)
- American Medical Association
- Emergency Nurses Association
- Centers for Medicare and Medicaid Services
- American College of Surgeons Committee on Trauma
- Centers for Disease Control and Prevention
- Office of National Drug Control Policy
- National Institutes on Drug and Alcohol Abuse
What is the SBIRT process?A designated healthcare professional conducts screening of patients for alcohol, tobacco and other drug use by using the ASSIST tool. If a patient screens positive, a brief intervention is conducted to establish an open and trusted dialogue that encourages change. Health education and resource materials are delivered to the patient at the time of the brief intervention. On rare occasions (2-4% of screenings), a patient’s screen may indicate marked alcohol or drug use. In such cases a referral to a more intensive or specialized treatment program may be made if the patient agrees. A referral coordinator or social worker may facilitate placing the patient in the right level and type of treatment option.
What is Motivational Interviewing?
“Motivational interviewing is a guiding, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.” Drs. William Miller and Stephen RollnickMotivational Interviewing (MI) techniques are used throughout the screening and brief intervention process. MI is a respectful manner of speaking with patients which elicits a person’s own arguments for change. The use of MI allows a person to hear their own motivation and it creates a safe place for patients to talk about their substance use.Motivational interviewing is a simple technique to learn and when put into practice can help reduce the strain clinicians encounter when working with patients exhibiting risky substance use.
Where can I download the ASSIST tool?
The ASSIST screening tool, patient response card, alcohol use information card, feedback report card and all health risks cards can be found on the WYhealth website.
What medical entities can bill for SBIRT?
Providers enrolled in Wyoming Medicaid including the following entities can bill Medicaid for SBIRT services:
- Physicians and healthcare professionals working in a physician’s office
- Public Health Clinics
- Family Nurse Practitioners
- Advanced Practice Nurses – specialty in Psych/Mental Health
- Certified Nurse Midwives
- Nurse Anesthetists
Who can perform the SBIRT screenings?Any medical professional working under the physician in a clinic can be trained to use the ASSIST screen. Public Health Nurse clinics can also train staff to administer SBIRT screening.According to the American College of Surgeons, Committee on Trauma:
“Brief intervention does not have to be administered by a state-certified substance abuse counselor or by other clinicians with advanced training in substance abuse treatment. After relatively little training, brief intervention can be performed by anyone capable of showing respect and concern.”
Working within the framework of ‘who you are’ as a medical facility will individualize your program and ease transition.
How can our staff be trained in SBIRT?
Email WYhealth at [email protected] to express interest. Click on the webinar links below to view valuable information about SBIRT.
- Introduction to SBIRT (10 minutes) [link to come]
- Billing SBIRT (10 minutes) [link to come]
- More than the Basics for SBIRT (30 minutes) [link to come]
Will SBIRT screenings assist in reducing the rate of tobacco use in Wyoming?The Wyoming Department of Health specifically chose the ASSIST for SBIRT screenings because it is the most comprehensive screening tool available. Substances covered include all illicit and prescription drug use, alcohol use and abuse, as well as opening a safe conversation to address tobacco use. The Wyoming QuitLine program is closely involved with SBIRT Wyoming in order to synergize the use of both programs. Tobacco users motivated to take steps toward cessation during the brief intervention can be immediately referred to the QuitLine, be given materials from the QuitLine program and they also will have the opportunity to receive a follow-up phone call for accountability and cessation counseling.
Wyoming Quit Tobacco QuitLine or Call 1-800- quitnow
How long does it take to conduct the ASSIST screen?
If a patient screens negative in the pre-screen, the questions take about 1 minute.The full ASSIST screen can be completed in 4-5 minutes.
How long does a brief intervention take to complete?
If a person screens positive, a brief intervention is conducted. The amount of time needed for a brief intervention will vary from patient to patient, however, a BI can most often be completed in 10-15 minutes with some rare and more complicated interventions lasting up to 30 minutes. For billing purposes, any brief intervention over 7 minutes qualifies for billing.
How effective is the SBIRT program?
SBIRT is an evidence-based program that has proven to be effective in clinical settings. The process does not work for everyone all the time but then again neither will any form of substance abuse intervention. According to SAMHSA, on a six month follow-up after a brief intervention:
- rates of illicit drug use dropped by 67.7%
- heavy alcohol use dropped by 38.6%
- no statistics are available for tobacco cessation but certainly the number of patients finding effective cessation methods will be improved
A positive outcome from a brief intervention is qualified by moving a patient one step along in the decision-making process to cut back or stop substance use. These positive outcomes are impossible to capture but motivational interviewing is an evidence-based practice proven to be highly effective in moving people toward making decisions for positive life-style change.
How can our medical facility gain financially from implementing the SBIRT program?
The Wyoming Department of Health, Medicaid Division is providing assistance in the form of training, service payments and help with implementation. WYhealth, the case management organization for the Wyoming Medicaid population, has been contracted to implement SBIRT.
- SBIRT training is provided by WYhealth at no cost to the medical facility. These training’s include informational meetings, basic ASSIST and BI training, help with billing questions, training in motivational interviewing skills and assistance during implementation
- Medicaid codes are available for billing SBIRT services
H0049 Alcohol and/or drug screening $24.00
H0050 Alcohol and/or drug service, brief intervention, per 15 min $48.00
99406 Smoking and tobacco use cessation counseling (3-10 min) $13.53
99407 Smoking and tobacco use cessation counseling (over 10 min) $25.95
- Commercial insurance (CPT) codes are also available for billing SBIRT services. Check with individual companies for their billing requirements.
- Over time, the rate of recidivism should decrease resulting in less expenditures for medical facilities.
An SBIRT billing flowsheet can be downloaded www.wyhealth.net/uploads/SBIRT_Billing_Flowchart_9_2_14.pdf
What are the requirements for billing SBIRT services?
- Patient must be 18 or over
- The ASSIST screening tool must be used for the screen
- The patient’s screening report card must be kept in the patient chart (paper or EMR) as documentation of the screen
- Any brief intervention over 7 minutes is billed as one unit of code H0050
- Time of the brief intervention must be clearly documented in the patient record
- If the screen is positive for alcohol or drugs and a brief intervention is completed, bill the screening code (H0049) and the BI code (H0050). If the screen is positive for tobacco, use H0049 on the first visit and then use the tobacco cessation codes on subsequent visits.
- SBIRT codes and tobacco cessation codes cannot be billed on the same date of service.
- Refer to the SBIRT billing flowchart for examples of how to properly bill for SBIRT services. www.wyhealth.net/uploads/SBIRT_Billing_Flowchart_9_2_14.pdf
How often can SBIRT screens be conducted?
- Medicaid will pay for the ASSIST screen once annually per provider type
- Four, 15 minute units of the brief intervention can be billed per patient, per provider type annually. Example: A patient screens positive on the initial ASSIST and a brief intervention of 15 minutes or less is conducted during that visit. Three additional brief intervention sessions can occur on subsequent visits in that calendar year.
- Any intervention over 7 minutes is considered a 15 minute unit.
What is the best way to implement SBIRT in our community?The initial rollout of SBIRT Wyoming will be focused on maternal healthcare providers. Initial outreach, training and implementation help is directed toward OB/Gyn clinics, Public Health Nursing and other medical facilities managing the maternal Medicaid population.Though the basic principles will remain the same, implementation may look a bit different for each clinic. To meet the unique needs of patients and staff, the SBIRT process (i.e. patient flow, screeners, charting) can be adapted to meet individual clinic situations. The SBIRT coordinator can offer help through implementation by brainstorming through the screening process, patient flow, charting and billing. Each clinic has the freedom to implement a strategy that works best for them. Implementation help is offered by the WYhealth at no charge to the clinic or other healthcare facility.
Who needs to be involved in implementation?
It would be ideal if everyone working in the medical facility has at least a basic knowledge of SBIRT. Even though a small percentage of employees (maybe only 1) will actually perform the SBIRT screens, other staff will be involved in patient care, charting, compliance, billing and follow-up. Many people in your institution can contribute to successful SBIRT implementation because they have the talent, experience, and related work responsibilities.
- SBIRT is a clinical service. All staff should understand the screening process.
- Decide who is most likely to perform the Screening and deliver the Brief Interventions.
- Decide how will SBIRT services be charted.
- Decide who from your institution should be involved in the proper documentation and billing of the program.
- Decide how job descriptions may be changed or work flow affected.
A team healthcare approach where all providers and employees are at least familiar with the SBIRT process is recommended.
Will SBIRT screenings assist in reducing the rate of tobacco use in Wyoming?
The Wyoming Department of Health specifically chose the ASSIST for SBIRT screenings because it is the most comprehensive screening tool available. Substances covered include all illicit and prescription drug use, alcohol use and abuse, as well as opening a safe conversation to address tobacco use. The Wyoming QuitLine program is closely involved with SBIRT Wyoming in order to synergize the use of both programs. Tobacco users motivated to take steps toward cessation during the brief intervention can be immediately referred to the QuitLine, be given materials from the QuitLine program and they also will have the opportunity to receive a follow-up phone call for accountability and cessation counseling.
Wyoming Quit Tobacco QuitLine or Call 1-800- quitnow
Who can I contact for more information about SBIRT Wyoming?
WYhealth Care Management Line: 1-888-545-1710
WYhealth Email: [email protected]