Thursday, March 13, 2008

Screening in Month 3: How's it going?

This came across my e-mail today, and seemed relevant:
"3. MANUAL PROVIDES GUIDANCE IN CHOOSING PEDIATRIC DEVELOPMENTAL SCREENING INSTRUMENTS:  Pediatric Developmental Screening: Understanding and Selecting Screening Instruments informs practitioners' selection and application of screening instruments in a range of practice settings. The Web-based manual, developed by the Commonwealth Fund, is based on a review of the scientific research on available developmental screening instruments.  Part 1 is designed to facilitate the selection of screening instruments by helping practitioners define their practice needs. Part 2 presents guides designed to facilitate practitioners' abilities to compare developmental screening instruments with respect to clinical utility in practice settings and validity, or sensitivity and specificity, in
different populations and at various ages. An interactive Web feature (flow chart) is also available to answer questions about screening needs and make instrument recommendations. The manual is available through the Commonwealth Fund"
Sat with a few providers the other day, pondering the current screening program and speculating about what to do next.  Only a few glitches identified:
1)  Screening kids under two years of age for behavioral problems makes no sense:  The parents understand the need to screen development, but find the behavioral questions irrelevant, especially at two weeks of age.  It would be better if Masshealth were to require fewer screens early in childhood for behavioral health problems, and let us focus on developmental issues at that time.  Also, the major behavioral health issue that affects the behavioral health of 2 week olds is maternal depression;  we need to be developing a system to deal with that.
2)  Billing remains complex:  Since most of us treat all of our patients the same, using the screening code and the modifiers has resulted in a some of our patients with "out of state" insurances getting billed for the screening, to their dismay.  Makes me long for the days of a single payer system (wait, we haven't had those days yet).
3)  U1 and U2 mean what?:  We all have found that the PSC doesn't identify a number of kids that we think have fairly significant problems, some of which are on-going and some of which are new, and think that the "yes/no" coding is too simplistic (don't capture the richness of what is actually going on.
4)  Teens and confidentiality:  We've had a couple cases now where parents looked at their kids PSC before it was collected, and argued with their kid about his "self-report".  Not sure that we have helped parent-child interaction in those cases.

Still, most folks were feeling pretty good about how things were going.  

I'm running a meeting in a faraway place this week, which is why the postings have been sparse.  More next week.

FEEDJIT Live Traffic Map