Primary care physicians see more patients than any other specialty.
A great deal can be accomplished in 15 minutes.
More could be done in a primary care office to integrate behavioral health, mental health, and physical health support.
These are some considerations before taking that risk.
How to generate revenue, improve patient care
Consider these six tips to ensure a successful integration of behavioral health and primary care:
1. Use a “warm handoff.”
At A Plus Medical, for example, patients complete relevant screenings, then, depending on the results, there’s a “warm handoff” between the physician and CRNP. During these handoffs, Bennett says, physicians tell patients they reviewed the screening and feel the patient could benefit from talking with someone else in the practice to get the help they need. Then they introduce the patient to the CRNP, who schedules the patient to come back for an appointment.
Matthews-Vu follows a similar workflow; however, it also has a process in place for crisis management. If a patient presents in crisis, or a crisis develops during a medical appointment, a behavioral health specialist is always available to speak with that individual.
Practices may want to consider using a daily huddle to identify patients who might benefit from behavioral health services, says Jortberg. For example, have any patients been on depression medication long-term? Do any patients have a history of substance abuse? Flag these patients in the EHR for a warm handoff to the specialist for a brief check-in after meeting with the physician, she adds.
2. Hire a behavioral health specialist with diverse experience.
Depression and anxiety are common; however, behavioral health providers may have varying degrees of experience with trauma, post-traumatic stress disorder, eating disorders, substance abuse, post-partum depression, and pain management, says Chandler. Identify specific needs within the population, and hire someone who can address those needs, she adds.
3. Develop a plan to address coding, billing challenges.
Practices may need more specialized administrative support when hiring a behavioral health specialist, says Chandler. Matthews-Vu, for example, hired a certified medical coder with behavioral health experience to address coding and billing challenges.
Alternatively, a practice could pay for existing staff to obtain training in this field. A Plus Medical trained staff on how to obtain prior authorizations for initial assessments and subsequent visits, though Bennett says there are ongoing challenges. For example, some payers will approve psychotherapy for depression but not for anxiety.
4. Make sure your EHR vendor can accommodate documentation requirements.
The SOAP note works well for primary care; however, behavioral health providers must also perform a mental status examination that should be included in an EHR template, says Bennett. To provide effective care, these providers also need access to comprehensive assessment tools that go beyond the standard Patient Health Questionnaire (PQH)-2 and PQH-9, she adds.
5. Invest in an e-prescribing module.
A module that integrates the state’s Prescription Drug Monitoring Program (PDPM) database into the EHR streamlines the process of prescribing controlled substances, says Bennett. In Maryland, providers prescribing these medications are required to check the state’s PDPM before prescribing because many mental health drugs are controlled substances. Forty-one states have this type of mandate, though the specific requirements vary.
6. Require the specialist to sign a business associate agreement (BAA).
Eramo, L. (2019, December 2). How to generate revenue, improve patient care. Retrieved from https://www.medicaleconomics.com/medical/how-generate-revenue-improve-patient-care.