Assisting Primary Care Practices with Implementation of Depression and Alcohol Screenings

By Archie Hamilton, Qsource Behavioral Health Manager

Depression and alcohol use disorders are common behavioral health conditions in adults, yet they are often under-identified in primary care settings. Challenges in effective care coordination for these and other behavioral health conditions contribute to high hospital readmission rates and problems with treatment adherence.

Qsource provides technical assistance to over 1,200 primary care practices in the five-state region of Alabama, Indiana, Kentucky, Mississippi and Tennessee. Primary care practices are the gateway into the healthcare system and preventative screenings are a core component of quality patient care.

Medicare reimburses providers for a number of preventative screenings, including depression and alcohol misuse, on an annual basis. Using an evidence-based depression screener like the PHQ-9 (Patient Health Questionnaire 9) and the AUDIT-C (Alcohol Use Disorders Identification Test) for alcohol misuse enables practices to effectively identify those patients experiencing symptoms of depression or alcohol misuse. Medicare also provides reimbursement for brief counseling related to alcohol misuse up to four times per year.

The need for effective screening, referral and treatment of depression and alcohol misuse disorders could not be greater at this juncture in our nation’s history. Approximately 6.7 percent of American adults, or 14.8 million people, live with major depression. Approximately 9.2 million adults have co-occurring mental health and addiction disorders. Fewer than half of those patients suffering from depression are identified in the primary care setting and roughly two-thirds of those with a behavioral health disorder do not receive treatment.

This gap in identification, referral and treatment within our healthcare system leads to significant human and economic costs. It is estimated that Major Depressive Disorder alone costs our nation’s economy approximately $210 billion in lost productivity per year and is the leading cause of disability claims. The emotional and physical strain on the millions of Americans not receiving any treatment is tremendous and difficult to fully quantify. All of this leads to additional strain on our healthcare system- high ED visit rates, high hospital readmissions and poor overall treatment adherence to co-morbid physical health conditions like diabetes, chronic heart failure and hypertension.

In addition to being the gateway into our nation’s healthcare system, primary care practices provide the majority of depression care to patients, serving approximately 60 percent of patients with depression and prescribing approximately 79 percent of antidepressants. Only 40 percent of those receiving behavioral health treatment are receiving it in specialty settings like psychiatry office and out-patient therapy. As the de facto behavioral health treatment setting, utilization of robust clinical workflows and practice guidelines is critical to quality patient care in the primary care setting.

Qsource Advisors can assist your practice with the implementation of depression and alcohol misuse screening interventions. From assessing clinical workflow to finding the best spot for screening to providing billing and coding guidance, Qsource is here to assist your practice. Primary care has many priorities competing for time and considering the addition of any other service, workflow or billing process can feel daunting and unwelcome. Qsource works to customize all assistance to the needs of the individual practice, aiming to minimize, or ideally, to reduce provider burden.

Here are a few areas that Qsource can assist primary care practices with:

  • Billing and coding guidance related to depression and alcohol misuse screening
  • Assess clinical workflow for implementation of efficient screening protocols
  • Clinical practice guidelines for addressing depression and alcohol misuse in the primary care
  • Guidance related to the Quality Payment Program and associated quality reporting options related to mental health and substance misuse
  • Identifying treatment and referral options


Improvement Activities Relating to Behavioral Health

Diabetes screening IA_BMH_1 Medium
Tobacco use IA_BMH_2 Medium
Unhealthy alcohol   use IA_BMH_3 Medium
Depression screening IA_BMH_4 Medium
MDD prevention and treatment interventions IA_BMH_5 Medium
Implementation of co-location PCP and MH services IA_BMH_6 High
Implementation of Integrated Patient Centered Behavioral Health Model IA_BMH_7 High
Electronic Health Record Enhancements for BH data capture IA_BMH_8 Medium
Unhealthy Alcohol Use for Patients with Co-occurring Conditions of Mental Health and Substance Abuse and Ambulatory Care Patients IA_BMH_9 High


Quality Measure Data Relating to Behavioral Health

Step 1: Select At Least 1 Outcome Measure

For the MIPS Quality Performance Category, you must report at least one outcome measure. If no outcome measures are applicable to your patient population, then you must select at least one high-priority measure (see Step 2). The outcome measures you report do count towards the six measure requirement for the Quality Performance Category. Reporting additional outcome measures beyond the required one will award two (2) bonus points to your Quality Performance Category Score.

Step 2: Select Applicable High-Priority Measures

If you were able to select an outcome measure in Step 1, this step is optional. Non-outcome high-priority measures are worth one (1) bonus point for the Quality Performance Category. This makes it a smart idea to include as many outcome and/or high-priority measures as possible in your six Quality Performance Category Measures.

Step 3: Make Sure You Have 6 Measures Selected

If you have not yet selected six measures and are aiming for a positive MIPS Payment Adjustment, select from the other recommended measures. If you report over six measures, CMS will calculate your MIPS Quality Performance Score using your top performing quality measures

Quality Id Measure Name High Priority MeasureType
047 Care Plan Yes Process
128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan No Process
130 Documentation of Current Medications in the Medical Record Yes Process
134 Preventive Care and Screening: Screening for Depression and Follow-Up Plan No Process
181 Elder Maltreatment Screen and Follow-Up Plan Yes Process
226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention No Process
282 Dementia: Functional Status Assessment No Process
283 Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management No Process
286 Dementia: Safety Concerns Screening and Mitigation Recommendations or Referral for Patients with Dementia Yes Process
288 Dementia: Caregiver Education and Support Yes Process
317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented No Process
325 Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions Yes Process
370 Depression Remission at Twelve Months Yes Outcome
383 Adherence to Antipsychotic Medications For Individuals with Schizophrenia Yes Intermediate Outcome
391 Follow-Up After Hospitalization for Mental Illness (FUH) Yes Process
402 Tobacco Use and Help with Quitting Among Adolescents No Process
411 Depression Remission at Six Months Yes Outcome
431 Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling No Process