title: Physician "costs" in providing behavioral health in primary care.
abstract: OBJECTIVE
  To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice.
  
  
  METHODS
  Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%.
  
  
  RESULTS
  Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns.
  
  
  CONCLUSIONS
  Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 69198, USA. tmeadows@unmc.edu
authors.forename: Tawnya
authors.initials: T
authors.lastname: Meadows
authors.forename: Rachel
authors.initials: R
authors.lastname: Valleley
authors.forename: Mary Kelly
authors.initials: MK
authors.lastname: Haack
authors.forename: Ryan
authors.initials: R
authors.lastname: Thorson
authors.forename: Joseph
authors.initials: J
authors.lastname: Evans
mesh_terms: D000328:Adult; D002648:Child; D002652:Child Behavior; D002662:Child Health Services / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D009819:Office Visits / Q000191:economics*; D010372:Pediatrics / Q000379:methods; D058007:Physicians, Primary Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D013997:Time Factors