This presentation will describe the model followed by an existing fully-integrated pediatric practice and present research findings from a descriptive study performed at the site. Specific techniques and tools used at the practice will be discussed along with guidance on ways to introduce this model into non-integrated practice.

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Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavior disorder in children. With the frequency of ADHD diagnoses, primary care providers (PCP) are challenged with managing this chronic and complex concern in an efficient yet effective way, both in terms of time and money. Research indicates behavioral diagnoses and management take approximately five minutes longer than medical-only concerns. This can result in a revenue loss for primary care practices. However, an on- site behavioral health consultant (BHC) can help PCPs provide a high standard of care for children presenting with behavioral concerns without compromising cost effectiveness. This study’s aim was to assess the cost per minute in a small rural primary care practice that utilizes an on-site BHC by comparing data between ADHD appointments when the BHC was utilized versus ADHD appointments when the BHC was not utilized. This study used extant data consisting of a sample of 53 children with ICD-9-CM codes 314.00 or 314.01, indicating an ADHD diagnosis. Of the 53 children with these codes, 40 (75.5%) were billed using E/M codes 99213 or 99214. The first of these indicates a regular office visit with an established patient not exceeding 15 minutes while the latter is used if the visit lasts longer than 25 minutes. Both codes were combined and evaluated together. The database was then recoded to indicate whether or not a BHC was utilized. Using descriptive statistics, it was found that children with ADHD spent a max of 69 minutes (20.19 minutes on average) with the PCP when a BHC was not utilized and a max of 22 minutes (13.67 minutes on average) when a BHC was utilized. Furthermore, an average of $82.79 in insurance reimbursement was received by the practice for these types of visits, regardless of up-coding for physician time spent. Using these statistics, it was determined that the practice makes $4.10 per minute when a BHC is not utilized versus $6.06 per minute when a BHC is utilized for ADHD appointments, due to the time savings ratio. The results indicate that utilization of a BHC increases revenue with respect to minutes spent with the child, while still providing behavioral health time and attention to the patient. These findings have practical implications for the treatment and management of ADHD and support the use of BHCs in pediatric primary care settings. Given the nature of pediatric primary care, it would be more cost effective for PCPs to utilize an on-site BHC with all ADHD visits.

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Postpartum depression (PPD) is a prevalent, complex illness impacting 10% to 20% of mothers and their families. Treatments for PPD, such as medication and psychotherapy, are effective at reducing the severity of symptoms and generally improving quality of life for new mothers and their families. Unfortunately, many mothers with PPD go unrecognized due to a lack of standardized screening methods. Further, mothers regularly encounter barriers to accessible, evidence-based follow-up care to treatment even when symptoms of PPD are detected. The use of a stepped care protocol, set in a pediatric primary care clinic, is one proposed strategy to address the insufficient rates of screening, detection, and maternal contact with treatment. This study examines the feasibility of implementing a stepped care protocol to screen and provide brief therapeutic treatment to mothers reporting symptoms of PPD in one pediatric primary care clinic. The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was used to evaluate implementation outcomes. Results suggest this stepped care protocol was feasibly implemented in one pediatric primary care clinic. The protocol was largely successful in screening mothers at a majority of well child checks (83.76%) for PPD and connecting them with resources based on the severity of symptoms reported. Future studies should further evaluate the impact brief onsite mental health treatments have on reports of PPD symptoms, longitudinal maternal and child outcomes as a result of the protocol, as well as the protocol’s replicability to pediatric practices elsewhere.

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