The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

Abstract

Introduction Sexually transmitted diseases continue to increase in the U.S. There is a growing need for financially viable models to ensure the longevity of safety-net sexually transmitted disease clinics, which provide testing and treatment to high-risk populations. This micro-costing analysis estimated the number of visits required to balance cost and revenue of a sexually transmitted disease clinic in a Medicaid expansion state. Methods In 2017, actual and projected cost and revenues were estimated from the Rhode Island sexually transmitted disease clinic in 2015. Projected revenues for a hypothetical clinic offering a standard set of sexually transmitted disease services were based on Medicaid, private (“commercial”) insurance, and institutional (“list price”) reimbursement rates. The number of visits needed to cover clinic costs at each rate was assessed. Results Total operating cost for 2,153 clinic visits was estimated at $255,769, or $119 per visit. Laboratory testing and salaries each accounted for 44% of operating costs, medications for treatment 7%, and supplies 5%; 28% of visits used insurance. For a standard clinic offering a basic set of sexually transmitted disease services to break even, a projected 73% of visits need to be covered at the Medicaid rate, 38% at private rate, or 11% at institutional rate. Conclusions Sexually transmitted disease clinics may be financially viable when a majority of visits are billed at a Medicaid rate; however, mixed private/public models may be needed if not all visits are billed. In this manner, sexually transmitted disease clinics can be solvent even if not all visits are billed to insurance, thus ensuring access to uninsured or underinsured patients.

Medicaid Coverage of Sexually Transmitted Disease Service Visits

“…Even so, as mentioned previously, STD clinics are beginning to bill for Medicaid services in order to cover their costs. 14 Because of this, researchers may wish to investigate whether patients seeking care in STD clinics receive comparable care to those who seek STD care in community-based physician offices. Stake-holders should monitor U.S. healthcare system reforms, including amendments to the eligibility standards of Medicaid (or other public programs), in a way that broadens the program to additional populations, for how they affect the rate of people being uninsured, and ultimately, access to STD services.…”

“…10–12 It is possible that recent healthcare system changes have affected the financing and delivery of STD care, particularly in public clinics and among populations at increased risk for STDs. 13,14…”

Sexually transmitted disease services and third‐party payer reimbursement: Attitudes, knowledge, and current practices among 60 health departments/districts. Why does this matter to public health nurses?

“…Nearly 11 million Americans have insurance coverage as of February 2018 through the exchange programs (Henry J. Kaiser Family Foundation, ). Through these insurance programs access to preventive health care and the requirement for insurance plans to cover, in some populations, with no co‐pays for HIV, syphilis, gonorrhea, and chlamydia testing are all provisions in the ACA (Dean et al, ). While these reforms increase insurance availability, they also offer significant opportunities for public health agencies to bill for STD services that have previously been billed to Medicaid only or provided for free.…”

“…While these reforms increase insurance availability, they also offer significant opportunities for public health agencies to bill for STD services that have previously been billed to Medicaid only or provided for free. One study suggested publicly funded STD clinics might not be fiscally sound when billing Medicaid only but could be financially viable if other types of private insurance reimbursement were available (Dean et al, ). Public health agencies face the constant challenges of decreasing budgets and mounting service needs which escalates the importance of developing a billing strategy to sustain services (McCullough, ).…”

“…A recent study of health departments/districts found health departments routinely billed Medicaid for STD services, but their experience with private insurance was limited, both in familiarity and fewer insurance contracts (Kovar & Carter, ). While utilization of STD clinic services has remained nearly constant following ACA implementation, maintaining financial solvency should be a priority (Dean et al, ; Mehtani et al, ).…”