Harry Jin1, Brandon D L Marshall1, Julia Raifman2, Madeline Montgomery3, Michaela A Maynard4, Philip A Chan. 1. From the Department of Epidemiology, Brown University School of Public Health, Providence, RI. 2. Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA. 3. Department of Behavioral and Social Sciences, Brown University School of Public Health. 4. Department of Medicine, Brown University, Providence, RI.
Abstract
BACKGROUND: Medicaid expansion has led to unique opportunities for sexually transmitted disease (STD) clinics to improve the sustainability of services by billing insurance. We evaluated changes in patient visits after the implementation of insurance billing at a STD clinic in a Medicaid expansion state. METHODS: The Rhode Island STD Clinic offered HIV/STD screening services at no cost to patients until October 2016, when insurance billing was implemented. Care for uninsured patients was still provided for free. We compared the clinic visits in the preinsurance period with the postinsurance period using t-tests, Poisson regressions, and a logistic regression. RESULTS: A total of 5560 patients were seen during the preinsurance (n = 2555) and postinsurance (n = 3005) periods. Compared with the preinsurance period, the postinsurance period had a significantly higher average number of patient visits/month (212.9 vs. 250.4, P = 0.0016), including among patients who were black (36.8 vs. 50.3, P = 0.0029), Hispanic/Latino (50.8 vs. 65.8, P = 0.0018), and insured (106.3 vs. 130.1, P = 0.0025). The growth rate of uninsured (+0.10 vs. +4.11, P = 0.0026) and new patients (-4.28 vs. +1.07, P = 0.0007) also increased between the two periods. New patients whose first visit was before the billing change had greater odds (adjusted odds ratio, 2.68, 95% confidence interval, 2.09-3.44; P < 0.0001) of returning compared with new patients whose first visit was after the billing change. CONCLUSIONS: Implementation of insurance billing at a publicly funded STD clinic, with free services provided to uninsured individuals, was associated with a modest increase in patient visits and a decline in patients returning for second visits.
BACKGROUND: Medicaid expansion has led to unique opportunities for sexually transmitted disease (STD) clinics to improve the sustainability of services by billing insurance. We evaluated changes in patient visits after the implementation of insurance billing at a STD clinic in a Medicaid expansion state. METHODS: The Rhode Island STD Clinic offered HIV/STD screening services at no cost to patients until October 2016, when insurance billing was implemented. Care for uninsured patients was still provided for free. We compared the clinic visits in the preinsurance period with the postinsurance period using t-tests, Poisson regressions, and a logistic regression. RESULTS: A total of 5560 patients were seen during the preinsurance (n = 2555) and postinsurance (n = 3005) periods. Compared with the preinsurance period, the postinsurance period had a significantly higher average number of patient visits/month (212.9 vs. 250.4, P = 0.0016), including among patients who were black (36.8 vs. 50.3, P = 0.0029), Hispanic/Latino (50.8 vs. 65.8, P = 0.0018), and insured (106.3 vs. 130.1, P = 0.0025). The growth rate of uninsured (+0.10 vs. +4.11, P = 0.0026) and new patients (-4.28 vs. +1.07, P = 0.0007) also increased between the two periods. New patients whose first visit was before the billing change had greater odds (adjusted odds ratio, 2.68, 95% confidence interval, 2.09-3.44; P < 0.0001) of returning compared with new patients whose first visit was after the billing change. CONCLUSIONS: Implementation of insurance billing at a publicly funded STD clinic, with free services provided to uninsured individuals, was associated with a modest increase in patient visits and a decline in patients returning for second visits.
Authors: Madeline C Montgomery; Julia Raifman; Amy S Nunn; Thomas Bertrand; A Ziggy Uvin; Theodore Marak; Jaime Comella; Alexi Almonte; Philip A Chan Journal: Sex Transm Dis Date: 2017-05 Impact factor: 2.830
Authors: Preeti Pathela; Ellen J Klingler; Sarah L Guerry; Kyle T Bernstein; Roxanne P Kerani; Lisa Llata; Hayley D Mark; Irina Tabidze; Cornelis A Rietmeijer Journal: Sex Transm Dis Date: 2015-05 Impact factor: 2.830
Authors: Karen W Hoover; Bradley W Parsell; Jami S Leichliter; Melissa A Habel; Guoyu Tao; William S Pearson; Thomas L Gift Journal: Am J Public Health Date: 2015-10-08 Impact factor: 9.308
Authors: Thomas L Gift; Laura T Haderxhanaj; Elizabeth A Torrone; Ajay S Behl; Raul A Romaguera; Jami S Leichliter Journal: Public Health Rep Date: 2015 Nov-Dec Impact factor: 2.792
Authors: Alice J Lee; Madeline C Montgomery; Rupa R Patel; Julia Raifman; Lorraine T Dean; Philip A Chan Journal: Sex Transm Dis Date: 2018-04 Impact factor: 3.868