SBIRT stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is an evidence-based, effective method to intervene in alcohol and drug misuse,1,2 and can successfully reduce healthcare costs.3
The US Preventive Services Task Force (USPSTF), which makes recommendations about preventive care services for patients, has assigned a “B” recommendation for the SBIRT process. They have found adequate evidence that numerous screening instruments can detect alcohol misuse with acceptable sensitivity and specificity.4 They’ve also found evidence that brief counseling interventions effectively reduce heavy drinking episodes in adults engaging in risky or hazardous drinking. Combined study results from the USPSTF review suggest that compared to control groups, implementation of SBIRT among adults resulted in the following:
- A reduction in alcohol consumption by 3.6 drinks per week from baseline,
- Twelve percent fewer adults reported heavy drinking episodes, and
- Eleven percent more adults reported drinking less than the recommended limits over a 12-month period.
SBIRT is endorsed by the National Council for Community Behavioral Health Care, Department of Health & Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).
Also see: AMH Approved Evidence-Based Screening Tools
SBIRT in Oregon
There have been several SBIRT pilot projects implemented in Oregon, the largest and most well-known being the Oregon SBIRT Primary Care Residency Initiative, situated at OHSU Family Medicine and funded by SAMHSA. This initiative focuses on teaching the SBIRT method to primary care physicians. Additional information is available online at http://www.sbirtoregon.org/
As Oregon strives to make a meaningful difference in the health of Oregon communities, SBIRT has been identified as an incentive measure for Oregon’s CCOs, tied to incentive funding. Additional information about the CCO incentive measures is available online at http://www.oregon.gov/oha/Pages/CCO-Baseline-Data.aspx
OHA’s Transformation Center is establishing and coordinating learning collaboratives to create opportunities for peer-to-peer learning and networking, identifying and sharing information on evidence-based best practices and emerging best practices, and helping advance innovative strategies in all areas of health care transformation. The first Statewide CCO Learning Collaborative with the CCO Medical Directors is focusing on SBIRT and the other CCO incentive measures.
Screening for substance use issues is also a core component of Oregon’s Patient-Centered Primary Care Home Program criteria for recognition. To become recognized as a primary care home, clinics must routinely provide assessment of mental health, substance use or developmental conditions and provide appropriate treatment, referral and care coordination for these conditions. SBIRT is a recommended tool for substance use screening, and the Patient-Centered Primary Care Institute has a variety of tools and resources available to help clinics adopt the SBIRT model.
The Oregon Public Health Division (PHD) is also working to develop a practice improvement training to increase utilization of SBIRT within the context of adolescent well care visits.
The Oregon Health Authority is working towards standardizing the billing and payment policies across all payer sources, until that goal is reached, great care must be taken to ensure compliance in service delivery and bill submission to different payer types (e.g. Medicare and Commercial).
Identifying ways to secure payment for providing SBIRT services will be a key strategy to promote widespread implementation of SBIRT services across Oregon. SBIRT coding and billing policies and regulations are a work in progress and coding and coverage policy varies based on payer. SBIRT is a covered benefit for all Oregon Medicaid patients and for a wide-range of provider types. Under the current billing policies and regulations, Oregon providers may be eligible for reimbursement for a majority of their patients.
1 Madras BK, Compton WM, Avula D et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months later. Drug and Alcohol Dependence 2009; 280‐295.
2 Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief intervention for alcohol problems: A review. Addiction, 88, 315–335
3 Quanbeck A, Lang K, Enami K, & Brown RL. (2010). A cost-benefit analysis of Wisconsin's screening, brief intervention, and referral to treatment program: adding the employer's perspective. State Medical Society of Wisconsin, Feb; 109(1):9-14.
4 U.S. Preventive Services Task Force. (September, 2012). Behavioral counseling after screening for alcohol misuse in primary care. Retrieved July 22, 2013 from www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcomisart.htm