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Response to CDC's New Standards for HIV Testing

May 23, 2011
by James L. Holly, M.D.
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Adding HIV screening to a prevention screening tool

The Texas Department of State Health Services created an HIV/ASTD Prevention and Care Branch which manages a grant program Promoting Annual HIV Screening for ages 13-64. This is in response to the 2006 CDC Recommendation for HIV Testing. SETMA’s first interest in this issue came from meeting with the staff of this program. Immediately, SETMA understood the value of this initiative, but as we proceeded, the application requirements were so complex SETMA decided to do the project without participating in the government funded program.

As a result SETMA has set aside $60,000 to fund the program over the first three months, beginning July 1, 2010. The funding will be for the screening of those patients whose health insurance does not pay for HIV testing.

The biggest question in this project is, “How do you get this done by providers who are already screening numerous diseases, giving extensive preventive care and processing multiple disease management tools at every visit? How will providers remember to do it and how will they have the time to do it? One of the principles of SETMA’s deployment of electronic patient records is that we want to make it easier to do “it” right than not to do “it” at all. “It” is excellent healthcare and new initiatives which improve the quality of care the patients we care for receives.

As a result, SETMA took the Pre-visit/Preventing Screening tool which is already completed at every visit on every patient and added HIV screening. When the provider opens the template, if the patient is between the ages of 13 and 64, and if the patient has not had an HIV screening test in the past year, the screening question will be in red. In that case, all the healthcare provider has to do is to click the “order HIV” button and the following things happen:

    1. The test is ordered and sent to SETMA’s laboratory.
    2. The test is documented on the patient’s chart
    3. The charge for the test is sent to the patient’s insurance company.
    4. If the company refuses payment, SETMA will pay the charge.
    5. At the same time, a document is created where the patient can sign for permission for the test to be done.

    All of this is done with one click on one button – what could be easier? The provider or nurse can also document two exceptions:

    1. The patient refuses the test. If the patient refuses the test, a pop-up appears where it is possible to document why the patient refuses.
    2. The patient has a known HIV positive test in the past.

    If the HIV Screening question is “black,” it means that the test has been done. If it is “grey,” it means that the test does not apply.

    Monthly, quarterly and annually, SETMA will report the following internally and to the Texas State Health Department:

    1. How many patients between 13-64 years of age were seen?
    2. How many patients were screened for HIV?
    3. How many patients refused and why?
    4. How many patients have a prior diagnosis of HIV or HIV/AIDS?
    5. How many patients were positive for the first time?

    At the end of three months and at the end of six months, SETMA will determine the uncompensated cost to the practice of continuing this program. If it is manageable, we will continue it. If it is not, we will contact the major insurance carriers who are declining payment and see if they will change their policy. If we prove that this program is sustainable in a private setting without government, grant or other funding, then we will have performed a significant service to the community.

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    James Holly

    CEO, managing partner of the Southeast Texas Medical Associates (SETMA) in Beaumont

    James L. (Larry) Holly, M.D., After completing his medical education, James L. (Larry) Holly, M....