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Physician Office Resources

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Screening Tools

Here are some examples of standardized screening tools to use in your office.

Audit C—A brief alcohol screen that reliably identifies patients who are hazardous drinkers or have active alcohol use disorders.

CAGE—The substance abuse screening tool prepared by Johns Hopkins Medicine.

SBIRT—The behavioral health assessment prepared by sbirtinaction.org.

Additional resources on screening provided by the Substance Abuse and Mental health Services Administration (SAMHSA).

PHQ–2: Depression Frequency—The Patient Health Questionnaire–2 form assesses the frequency of depressed mood and anhedonia over the past two weeks. This questionnaire screens for depression as a “first-step” approach and does not establish a final diagnosis or monitor depression severity.

PHQ–9: Depression Severity—The Patient Health Questionnaire–9 screens, diagnoses, monitors, and measures the severity of depression that incorporates DSM-IV depression diagnostic criteria with other major depressive symptoms. This tool rates frequency of symptoms. Also available in Spanish.

Other depressing screening tools are available at the Substance Abuse and Mental Health Services Administration (SAMHSA).

For patients with limited cognitive functions, there is a Geriatric Depression Screening Tool from Consultgeri.org.

Reimbursement

Find resources on patient referrals, education, treatment options, as well as HSAG Quality Payment Program (QPP) help.

Medicare Reimbursement Handout—This document provides alcohol and depression screening billing codes, national average reimbursements, coverage and frequency details.

CMS FAQs About Billing Medicare for Behavioral Health Integration Services—The Centers for Medicare & Medicaid Services (CMS) answers common questions related to behavioral health service billing.

Medical Billing for Behavioral Health Screenings Webinar—Health Services Advisory Group (HSAG) presents its Medicare Billing for Behavioral Health Screenings slide deck for download and reference, along with the presentation from Noridian containing the workflows and relevant billing codes. In the presentation, HSAG explains how Arizona- and California-based providers can obtain resources for depression and alcohol screening, along with technical support for Quality Payment Program and Merit-based Incentive Payment System issues. To view the web recording, click here.

Quick Reference Guide for Medicare Preventive and Other Services

Medicare Wellness Visit Office Workflow—This HSAG handout is designed to streamline the integration of alcohol misuse and depression screening into one document. Ideally, this can be used during the annual wellness visit of your Medicare beneficiaries.

CMS Procedure to Procedure Coding Edits—The Centers for Medicare & Medicaid Services (CMS) details procedure to procedure (PTP) coding as part of the National Correct Coding Initiative Edits.

Behavioral Health Billing Quick Reference Sheet—This PDF sheet is intended as a quick reference for billing staff to use when billing Medicare Part B for behavioral health preventive screenings. These codes are intended as a general resource for preventive behavioral health services provided to Medicare Part B beneficiaries only.

Additional Resources

Find more resources on patient referrals, education, treatment options as well as HSAG QPP help.

Arizona Behavioral Health Resources—Health Services Advisory Group (HSAG) has compiled a set of helpful behavioral health resources for Arizona (English/Spanish) and in just Maricopa county (English/Spanish), which include crisis hotlines, legal services, community groups, and facilities with "level of care" assessment.

National Behavioral Health Resources—HSAG has compiled a set of helpful behavioral health resources available across the United States, including crisis lines, benefit guides, and training opportunities (English/Spanish).

Find a Health Center—The Health Resources & Services Administration (HRSA) allows users to find their nearest HRSA-funded health center.

Medicare Physician Compare—The Medicare.gov website provides resources for professionals, including official datasets, answers to common questions about updating Physician Compare information, and Accountable Care Organization performance scores.

Mental Health America—Tools, screening tools, support groups, and treatment resources are featured at the Mental Health America website.

Psychology Today—Locate a therapist by city, Zip code, or name at the Psychology Today website.

Resource Identification Forms—Referring a patient who needs follow-up care for alcohol use or depression is a critical part of their treatment. HSAG recommends that your practice develop a list of community referral resources using the Alcohol and Medication Resources Identification Form and the Mental Health Issues Resources Identification Form.

SAMSHA Behavioral Health Treatment Services Locator—The Substance Abuse and Mental Health Services Administration (SAMSHA) provides an anonymous and confidential source of information for people seeking treatment facilities in the U.S. or its territories for substance abuse/addiction and/or mental health problems.

Mental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, background and identity can make access to mental health treatment much more difficult. National Minority Mental Health Awareness Month was established in 2008 to start changing this.

Take an anonymous health screening online!

Best Depression Apps for Smartphones—Healthline has created a list of the best apps for smartphones in 2018.

HeadsUpGuys.org is a website featuring health strategies for managing and preventing depression among men.

Helping Your Patients Understand the Alcohol and Depression Screening—This Patient & Family Advisory Council Poster helps introduce your patients to the screenings and their value.

Medicare Wellness Visit flyer—This flyer will help walk your patients through their "Welcome to Medicare" or "Annual Wellness Visit" so they know what to expect and can work with you to get their health on the right track. (English/Spanish).

New Clinician Screening Tool Available for Substance Use—The National Institute on Drug Abuse (NIDA) Clinical Trials Network has released a new scientifically validated online screening tool that assesses a patient’s risk for substance misuse and substance use disorder, and helps healthcare providers with prevention and treatment interventions. Read the NIDA press release for background.

Physician Tip Sheet to Introducing Behavior Health Screening

Screening For The Best Possible You—This Patient & Family Advisory Council Poster explains why you as a provider are screening for alcohol use and depression. Also available in Arabic, Armenian, Korean, Navajo, Spanish, Simplified Chinese (Mandarin), Tagalog, and Traditional Chinese (Cantonese). Watch a video version in your preferred language: English, Spanish, or Navajo.

Social Media May Reduce Depression Risk for Older People with Pain (Psych Congress Network) — Socializing online may lower the relationship between pain and depression for older adults, according to a study from the University of Michigan in Ann Arbor. Researchers studies 3,401 human subjects who were all older than age 67, of whom approximately one-third lived alone, and more than half the subjects experienced pain in the last month. Among people with pain, their rate of depression was lower if they used social media. Among 6 percent of subjects who used social media also reported depressive symptoms as compared with 15 percent of subjects who did not use social media. Read more at the Psych Congress Network article.

Are You Missing the Signs of Anxiety or Depression? (Harvard Medical School article)—This article summarizes the top symptoms of depression and anxiety in easy-to-understand language, accompanied by treatment intervention suggestions.

Core Resources

Addressing Alcohol Use Practice Manual—This guide was developed by the American Academy of Family Physicians (AAFP), to assist healthcare providers to regularly screen for alcohol misuse and to apply brief behavioral interventions when risky alcohol use is identified.

Alcohol Screening Is Good Medicine—HSAG provides this flyer to assist physicians in understanding why alcohol screening helps their patients, while also identifying three screening instruments to use. Brief recommendations for varying patient types is also featured.

Behavioral Integration Fact Sheet—The Centers for Medicare & Medicaid Services (CMS) has created this fact sheet, describing the new CPT codes for integrated behavioral health services.

Best Practice Intervention Package (BPIP) on Depression—This BPIP is designed to provide evidence-based information, tools, and resources related to depression for community-based settings such as home health.

CMS Roadmap to Behavioral Health—CMS describes behavioral health information, including how to find a behavioral health provider, defining behavioral health terms, receiving services, and following up on care. It also links to other Health and Human Services Administration (HHS) resources.

HealthyPeople.gov—The Office of Disease prevention and Health Promotion features an overview on substance abuse, objectives for prevention and intervention, along with national snapshots.

Improving Identification of Depression and Alcohol Use Disorder in Seniors—HSAG has created a flyer explaining its no-cost technical assistance available to providers to help your practice integrate depression and alcohol screening into your current workflow.

Racial and Ethnic Disparities in Mental Health Among Diverse Groups of Medicare Advantage Beneficiaries (PDF)—The CMS Office of Minority Health (OMH) released a data highlight examining the mental health outcomes of Medicare Advantage beneficiaries by race and ethnicity. This highlight is one of the few analyses that (1) compares granular racial and ethnic groups in the same study, (2) is based on a nationally representative sample, and (3) focuses on mental health in older adults. Download the full report to better understand mental and health outcomes in various racial and ethnic groups.

MentalHealth.gov—The U.S. Department of Health and Human Services (HHS) developed an online hub for mental health information, including consumer guides, conversation aids on mental illness, veterans' assistance, and ways to get immediate help.

National Alliance on Mental Illness (NAMI)—Read about support options for patients and family members who are living with a mental health condition and access information about NAMI's programs and discussion groups.

National Institute on Mental Health—Find free, easy-to-read publications about various mental disorders under the Health & Education section and information and resources on healthcare providers, treatment options, and mental health.

Primary Care Guide for Implementing Evidence-Based Screening/Counseling for Unhealthy Alcohol Use with Epic-Based EHR Tools—This report is from the Agency for Healthcare Research and Quality’s (AHRQ's) series on Health Systems Partnership Pilot Project Reports. These reports describe the efforts of Evidence-based Practice Centers (EPCs) to work with health care decisionmakers and facilitate the use of information from AHRQ EPC evidence reports.

SAMHSA Suicide Prevention Application—Download this free Suicide Safe suicide prevention application from the Substance Abuse and Mental Health Services Administration (SAMHSA) that helps providers integrate suicide prevention strategies into their practice and address suicide risk among their patients. Also, check out SAMHSA’s Suicide Assessment Five-Step Evaluation and Treatment (SAFE-T) card.

The Integrated Edge—This is a new resource from the SAMHSA-Health Resources Services Administration (SAMHSA-HRSA) Center for Integrated Health Solutions (CIHS) that outlines practical tips and examples from organizations that have been working to integrate primary and behavioral healthcare.

USPSTF Advises Primary Care Doctors to Screen for Unhealthy Alcohol Use—The U.S. Preventive Services Task Force (USPSTF) announced in its June 5, 2018 draft recommendation statement that primary care providers should screen adults for alcohol misuse, along with offering brief behavioral counseling interventions. Review the draft recommendation statement from the USPSTF website. Read more at the Psychiatry Advisor article.

ZEROSuicide—This is a website with resources and toolkits to aid in suicide prevention.

Articles

Cardiovascular Disease Patients Need Depression Screening and Management (Psychiatry & Behavioral Health Learning Network article)—

According to the most recent Journal of the American College of Cardiology (ACC) State-of-the-Art Review, patients with cardiovascular disease should undergo screening to identify and manage depression. The risk of depression among those with cardiovascular disease numbers 1 in 5. The statement recommends that cardiologists inform their patients about the importance of depression screening and then administer the screen among patients who agree. Read more at the JACC article or the review of the statement at the Psychiatry & Behavioral Health Learning Network article.

Consuming One Drink of Alcohol Per Day Raises Risk of Stroke (CNN article)—According to a research study published in The Lancet, drinking one serving of alcohol per day raises the risk of a stroke by 10 to 15 percent. Consuming four drinks per day raises the risk of stroke to 35 percent. A single serving was defined as a small glass of wine, a bottle of beer, or a single measure of spirits. Researchers conducted the study on more than 500,000 Chinese people for a decade. Read more from the CNN news article.

Depression on the Rise in Middle-Age Americans (Economist article)—Vanderbilt University research has discovered that unhappiness is widespread among those in the middle age range in America across all races and ethnicities. Depression, suicide, and heavy drinking and marijuana use were tracked among study subjects. Heavy drinking was highest among whites, as were acts of suicide with the highest toll of suicide among older men. Depressive symptoms were highest among blacks and Hispanics. Read more at The Economist article.

Geriatrician Offers Tips for Those Who Imbibe Over 65 (Forbes article)—According to the latest research, elderly Americans are drinking alcohol more than ever before. The National Institute on Alcohol Abuse and Alcoholism confirmed this trend in its 2017 report. In this Forbes article, geriatrician and chief scientific officer at Clover Health, Kumar Dharmatajan, MD, sets forth concrete recommendations to older adults who drink. Read the article at Forbes for details.

How Much Alcohol Can You Drink Safely? (New York Times article)—According to a Lancet study, researchers found that the safest drinking level is none. The findings suggest that several health conditions are at increasing risk if a person imbibes one drink per day, including diabetes, eight cancer types, accidents, and self-harm. However, for older adults who reach the age of 80, when heart disease becomes a major cause of death, the study found that a serving a day of alcohol reduces cardiac health risks. Read more at the New York Times article or read the Lancet journal article.

Seniors With Hearing Loss Have High Risk of Depression Study Says (UPI article)—Older adults who suffer from hearing loss face a higher risk of depression, and that the greater the hearing loss, the greater the risk, according to Columbia University researchers who studied more than 5,200 adults over the age of 50 who participated in the Hispanic Community Health Study/Study of Latinos. Individuals with mild hearing loss encountered roughly twice the risk of depression than people with normal hearing. People with significant hearing loss were four times as likely to have depression than people with normal hearing.  Read more about the study at the UPI article. The study may be found in the January 2, 2019 Journal of the American Medical Association (JAMA) Otolaryngology-Head & Neck Surgery.

Behavioral Health Improvement Activities and Quality Measures handout—For the 2018 reporting year, the Improvement Activity (IA) Performance Category measures specific to Alcohol and Depression are available in this handout, along with the Quality Performance Category measures specific to alcohol and depression.

HSAG Quality Payment Program Service Center—Visit HSAG's online hub for information on how to receive our no-cost technical assistance, download helpful resources, and submit questions for rapid response.