Developmental and Autism Screening Best Practices
In September 2021, MVP spoke with Daren Wu, MD, Chief Medical Officer at Open Door Family Medical Center to discuss best practices for implementing a process for Developmental and Autism screening as well as the tools and resources used. Also discussed were some of the challenges that the practice faced, lessons learned, and best practices for streamlining the coding process.
Dr. Wu, to help providers understand the importance of standardized tools to screen for developmental delay, can you advise how using the tools have supported you in your practice to help ensure you are meeting standards in care?
While developmental screening began many years ago at Open Door, it took a two-year organizational conversation to improve upon our practice’s screening process. Open Door looked to its Pediatric team as they are the leaders in children’s health care, and everyone agreed a better system was needed. Having the Pediatric team lead this effort showed other clinicians the gravity and importance to adequately detect developmental delay in children. The decision was made to use the ASQ and MCHAT as the preferred tools for developmental and Autism screening within the practice.
Did you experience any barriers when implementing the tools?
Our biggest barrier was the amount of time it took to go through all the questions during the visit. During the height of the COVID-19 pandemic, Behavioral Health providers helped to conduct the ASQ and MCHAT. To ensure enough visit time, Open Door began booking longer appointments if the child was due for a developmental screening. The screening is not meant to be walked through by the clinician; it is supposed to be done by a parent with the child. However, there are times when they need to be assisted because they may not be able to read or cannot interpret the questions. Extending appointment times from 15 to 30 minutes helped Open Door improve their rates from 25% to 50% for children that had an MCHAT or ASQ by nine months.
Did you experience any barriers in adapting to coding changes when billing for use of the standardized tools?
Open Door has not experienced any barriers in adapting coding changes because the practice utilizes templates, and we were able to add the CPT and ICD-10 codes for these screenings. Our practice does not bill modifiers, so we use ICD-10 Z13.41 instead of a CG Modifier to identify usage of the MCHAT when performing Autism screening.
It is commonly expressed that use of these tools can be extremely time-consuming for the provider and the patient. Can you share best practices used to ensure these tests are completed during a busy, time-constrained wellness visit?
It is important that parents do not rush through and are allowed more time to ask other questions. To overcome the time barrier, Open Door went from 15-minute appointments to 30-minutes to allow for more time. Behavioral Health providers are brought in when there is a screening fail and that is done virtually. It is the Provider’s discretion to plan for upcoming appointments. For example, some will print out the ASQ and give to the parents for the next appointment. Another option would be to have the receptionist hand it to the parent.
Does your practice have any plans for continuous improvement that have been informed by the various barriers you faced, and lessons learned?
Open Door will continue with 30-minute appointments to allow more time to complete the screening and ask appropriate questions. Many times, children seem fine, and then parents fill out the ASQ tool and it indicates they are borderline and may have delay issues. The MCHAT has been useful in validated or confirmed Autism findings. The practice also plans to streamline its process by utilizing the office staff. Continuous quality improvement is being discussed as everyone agrees we need to do better. Utilizing data dashboards, the practice can analyze quality performance and determine which measures they are doing well on and those that need improvement. They will work closely with the medical team and continue another round of brainstorming for barrier solutions.
Have you received any patient feedback regarding their experience with the tools?
There is a small percentage of parents who require assistance with the screening tools. However, most parents complete the entire screening process without any assistance.
The COVID-19 pandemic presented unique barriers and challenges, not only for routine wellness care but implementing new initiatives during such a rapidly changing time. Was there anything learned from this experience, challenges experienced, and what did you do to overcome those challenges?
Behavioral Health providers cannot complete screening tools virtually and many parents weren’t comfortable with in-person visits. Open Door had to pivot priorities and for some time, had to prioritize COVID-19, which reinforced how important primary care is and the role it plays in outpatient care. As Primary Care providers, they often wonder if they really make a difference. But it was clear, when primary care was not utilized during COVID-19, measures went down. Once patients started going back, measures went up. This confirmed the importance of what primary care providers do. Developmental and Autism screenings were a priority once patients started coming back into the offices and continues to be a goal of the practice to become more efficient with these screenings.