Success Stories: The EDOPC Project

The Enhancing Developmentally Oriented Primary Care (EDOPC) Project is a 3–year project that began in 2005 with the goal of improving preventive health and developmental services for children birth to 3 in Illinois. The project involves a collaborative partnership of the Illinois Chapter of the American Academy of Pediatrics, the Advocate Health System’s Healthy Steps for Young Children Program, the Illinois Academy of Family Physicians, and the Ounce of Prevention Fund.

The EDOPC project educates primary care clinicians and staff through training sessions focusing on developmental screening, social–emotional development, and maternal depression screening and referral.

The primary objectives of the EDOPC project include increasing the number of

1. primary care clinicians using validated tools for developmental screening with all children by the 1–year well-child visit
2. primary care clinicians who have established at least three referral relationships with early intervention and family case management services, local public health departments, and other providers of developmental and social–emotional services
3. referrals of children who are identified as at-risk through developmental and social-emotionalscreenings for further evaluation and follow-up
4. parents who report being asked by clinicians about their concerns regarding their child’s development and behavior

In office-based presentations to primary care clinicians, EDOPC trainers provide instruction on using the Ages & Stages Questionnaires® (ASQ) and the Ages & Stages Questionnaires®: Social–Emotional (ASQ:SE).

According to Anita Berry, director of the Healthy Steps for Young Children program, many physicians’ practices find the pictures that illustrate the individual ASQ and ASQ:SE questionnaires to be “really helpful,” making them “easier for parents to understand.”

EDOPC's Strategies to Increase Reimbursement for Screening

EDOPC and the Illinois chapter of the American Academy of Pediatrics (ICAAP) also want to promote the routine use of screening tools by increasing awareness of opportunities for providers to bill for screening services. Here is what the projects has learned about ways physicians can receive reimbursments for screening with ASQ and ASQ:SE in Illinois:

• Physicians can receive enhanced reimbursement for screening by becoming a Maternal and Child Health provider.
• Physicians who implement screening consistently and bill all patients for the service are eligible to receive reimbursement for screening of patients on public aid programs such as Medicaid.
• Physicians are encouraged to inform ICAAP of private insurers that do not reimburse for developmental screening so that the chapter can advocate for coverage.
• Physicians should be aware that the code for developmental screening and social-emotional screening is 96110; the reimbursement amount is $16.10 for each developmental or social-emotional screen.

Go to the ICAAP web site for more reimbursement tips.