August 17, 2007

Initiative on identifying addiction outlined

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Peter Martin, M.D., with Bertha Madras, Ph.D., of the White House Office of National Drug Control Policy, before her talk Tuesday afternoon in Light Hall. (photo by Dana Johnson)

Initiative on identifying addiction outlined

New federal guidelines are allowing medical centers in 17 states to collect payment for treatment when a patient is identified and counseled for addictions during their medical visit.

Bertha Madras, Ph.D., deputy director for Demand Reduction in the White House Office of National Drug Control Policy, explained the Federal Government's demonstration program, “Screening, Brief Intervention, Referral and Treatment” (SBIRT), to Vanderbilt faculty, staff and students, Tuesday in 202 Light Hall.

The program provides screening and brief interventions in hospitals, primary care settings, colleges and one tribal council by allowing doctors to bill Medicaid for drug and alcohol abuse screening using "CMS codes” approved by the Centers for Medicare and Medicaid Services.

Madras urged Vanderbilt to institute screening and brief intervention in its clinics, to become a training center for the program in Tennessee and to implement the procedures within the ED so residents can have the knowledge as part of their educational backgrounds.

“There are other universities doing this on the West Coast, in Massachusetts, in New York, across the country,” Madras said.

“And the feedback we are getting is they are shocked at the high numbers, 40-50 percent, that are screening positive. And the students who have gone through the interventions are very grateful because they never quite connected their patients' problems with their substance abuse behavior.”

Changes in coding policies feature a medicalization of these disorders to facilitate collaborations among physicians called upon in management of substance-abusing individuals — from trauma physicians in the ED to the inpatient medical, surgical and psychiatry services.

“Dr. Madras has done some very impressive work by implementing a strategy whereby doctors will be compensated for inquiring about whether an individual has addiction or not, and I think that is a great accomplishment with benefits for the entire health care system,” said Peter Martin, M.D., professor of Psychiatry and Pharmacology and director of the Vanderbilt Addiction Center.

“I think the vast majority of people who are in our hospitals are there because of the behavioral consequences associated with their addictive life behaviors. The coronary care unit and medical units are full of people who smoke cigarettes or overeat and hence are obese. The majority of those who have automobile accidents or various other forms of trauma are in the emergency room because of their addiction-related problems.”

Madras said 19.7 million Americans are current users of illicit drugs and the vast majority of those persons are unaware of the problem or do not feel they need help.

She said studies indicate that intervention for an alcoholic can save $2-$4 in health care costs for each $1 expended.

As of January, more than 460,000 patients have been screened through the program, with 14.9 percent receiving a brief intervention, 2.6 percent receiving brief drug treatment and 3.2 percent were referred to specialized drug treatment programs.

A six-month follow-up review of patients showed significant declines in substance abuse after the brief interventions.

“If we don't recognize that patients have addiction problems then we can't treat them appropriately. If you do not help people obtain treatment for their addiction they are going to continue with the behavior. Ultimately, society is going to have to deal with the medical costs associated with this,” Martin said.

“The financial benefits of dealing with addiction as a primary medical problem instead of focusing on its protean consequences are overwhelming.”