1680. Screening for Sexually Transmitted Infections in Persons Living with HIV Leads to Significant Financial Losses for a Healthcare System
Session: Oral Abstract Session: Studies that will Impact your Practice
Friday, October 28, 2016: 2:15 PM
Room: 275-277

Background: Sexually transmitted infections (STIs) are common in persons living with HIV (PLWH) and can facilitate the transmission of HIV. The current CDC guidelines recommend annual screening of all PLWH for Neisseria gonorrhea (GC), Chlamydia trachomatis (CT), and Treponema pallidum (Syphilis), and screening for Trichomonas vaginalis (TV) in HIV-positive women. The objective of this study was to understand the financial implications of recommended STI screening in PLWH. 

Methods: We estimated the costs of providing recommended STI screening tests annually to all eligible patients at an academically affiliated HIV clinic in Birmingham, AL from August 2014- August 2015. Expenditures for GC, CT, TV and Syphilis screening were calculated using lab charges (Table 1). Revenue was calculated using reimbursement data for the above tests based on insurer. Commercial insurance reimbursement was based on data from Blue Cross Blue Shield of Alabama, the largest commercial insurer in our population.  Uninsured patients were assumed to have commercial insurance under the provisions of the Affordable Care Act (ACA).

Results: 3,163 patients (27% Medicare, 13% Medicaid, 26% Commercial, 34% Uninsured/ACA) met study inclusion criteria. Net yield, defined as reimbursements minus charges, was calculated for each test. Providing recommended STI screening annually to all eligible patients would result in a clinic net yield of -$783,834.76.

Conclusion: Providing PLWH with recommended annual STI screening tests would potentially result in approximately  $790,000 of uncompensated expenditures for this healthcare system. Policy makers should address this lack of compensation to ensure sustainability and compliance with recommended STI screening in PLWH. Caring for uninsured patients will lead to greater losses.

Table 1. Charges and Reimbursement for Routine STI Screening by Insurer in an Urban HIV Clinic in Birmingham, AL

Screening Tests

Charge ($)

Reimbursement by Insurer ($)

Medicare

Medicaid

Commercial

N=3163

N=854

N=411

N=823

GC NAAT

109.00

30.71

28.00

17.50

CT NAAT

109.00

30.71

28.00

19.08

TV NAAT

84.00

30.71

0

0

Syphilis Antibody

85.00

18.03

19.29

14.88

*NAAT = nucleic acid amplification test; N= number of patients meeting test criteria based on insurance status

Kathryn Hudak, BS1, Christina Muzny, MD2, Jane Schwebke, MD2 and Ellen Eaton, MD2, (1)University of Alabama School of Medicine, Birmingham, AL, (2)Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL

Disclosures:

K. Hudak, None

C. Muzny, None

J. Schwebke, None

E. Eaton, None

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