Physician "costs" in providing behavioral health in primary care

Tawnya Meadows, Rachel Valleley, Mary Kelly Haack, Ryan Thorson, Joseph Evans

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)447-455
Number of pages9
JournalClinical pediatrics
Issue number5
StatePublished - May 2011


  • behavioral health
  • insurance reimbursement
  • pediatrics
  • primary care
  • psychosocial concerns

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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