PEDIATRICS Vol. 108 No. 4 October 2001, pp. 913-922
Estimating the Cost of Developmental and Behavioral Screening of Preschool Children in General Pediatric Practice
Received Nov 21, 2000; accepted Mar 19, 2001.
,
, and
From the * Institute for Health Services Research and Policy
Studies, Northwestern University, Evanston; Objective. Despite increased
recognition of the importance of development and growth of young
children, formal developmental and behavioral screening often is not
included in general pediatric practice. Barriers to the provision of
developmental and behavioral screening are considerable; among them are
the need for specialized training and uncertain reimbursement. This
article develops a model for estimating the cost of providing pediatric
developmental and behavioral screening that can be scaled to reflect a
pediatric practice's patient population and choice of screening
offered.
Methods. The framework for our scaleable cost model was
drawn from work done in estimating the Resource-Based Relative Value
Scale (RBRVS). RBRVS provides estimates of the work effort involved in
the provision of health care services for individual Current Procedural
Terminology codes. The American Academy of Pediatrics has assigned
descriptions of pediatric services, including developmental and
behavioral screening, to the Current Procedural Terminology codes
originally created for adult health care services. The cost of
conducting a screen was calculated as a function of the time and staff
required and was loaded for practice costs using the RBRVS valuation.
The cost of the follow-up consultation was calculated as a function of
the time and staff required and the number of relative value units
assigned in the RBRVS scale.
Results. The practice cost of providing developmental and
behavioral screening is driven primarily by the time and staff required
to conduct and evaluate the screens. Administration costs are lowest for parent-administered developmental screens ($0 if no assistance is
required) and highest ($67) for lengthy, pediatric
provider-administered screens, such as the Neonatal Behavioral
Assessment Scale. The costs of 3 different groups of developmental and
behavioral screening are estimated. The estimated per-member per-month
cost per 0- to 3-year-old child ranges from $4 to >$7 in our 3 examples.
Conclusions. Cost remains a significant barrier to greater
provision of formal developmental and behavioral screening. Our
scaleable cost model may be adjusted for a given practice to account
for the overall level of developmental risk. The model also provides an estimate of the time and cost of providing new screening services. This
model allows pediatric practices to select the mix of developmental screens most appropriate for their particular patient population at an
acceptable cost.
Children's Memorial
Hospital, Chicago; § Evanston Northwestern Healthcare, Evanston; and
Department of Psychology, Northwestern University, Chicago,
Illinois.
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