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Urgent cares see a lot of patients with sexual health concerns. Infection rates are at an all-time high and continue rising according to JUCM: Journal of Urgent Care Medicine. With the recent invention of rapid STD/STI testing, we sat down with Alan Ayers, Experity’s President of Strategic Initiatives, to get his insights on how these tests will impact urgent care. Here are his answers to our questions.

What are some of the problems that urgent care has faced in regard to STD/STI testing?

There are a couple of major issues that have been a challenge for urgent cares who provide testing for sexual health concerns.

  1. Turn-around time for send-out labs is generally long — up to a week. This poses a scenario where providers may prescribe presumptive antibiotic treatments until the patient returns to the clinic for results (if they can even get them back.) If the initial treatment is wrong or there was none, there’s a potential for continued spread of the infection. Again, if patients don’t come back in for results/new treatment, the contamination period is indefinite.
  2. High costs make the service cost-prohibitive on a cash basis whether billed to health insurance directly by the reference lab (I’ve seen $900+ EOBs) or for self-pay, billed to the center’s overhead ($350+)

Do the rapid STD/STI tests help solve these issues?

Yes — Visby Medical CLIA-waived 3-panel PCR testing for sexual health. The test is FDA-cleared for chlamydia, gonorrhea, and trichomonas. No “reader” is required — only a power cable to the self-contained test kit—and results are available in 28 minutes.

What limitations, considerations, or concerns do urgent cares need to know about these rapid tests?

Based on what I’m seeing and hearing, there are a few points to make.

  • Currently the lab testing is only available for women (vaginal self-swabbing,) but in early 2023 it will also be approved for men (urethral swab or urine sample). The urgent cares I’ve spoken with don’t see this as a limitation because they say more women than men present for STI evaluations and the send-out tests for men tend to be cheaper, meaning Visby brings pricing parity between men and women.
  • Commercial insurance reimbursement on the test kit and swab is generally equal to their costs, so there’s little to no margin on the test itself, although the center will still get the E/M code. I’m hearing the documentation and time required can generate a Level 4 coding.
  • Medicaid reimbursement may be $20-30 less than the cost of the test kit, but a profit can still be made on the E/M.
  • Payer claim system edits will often bundle the three tests, when billed separately, into one CPT code that may pay 40% less than the sum of the three tests separately.
  • In actuality, strength of the business case will vary by state and payer mix. An “all inclusive” case rate of, say, $114 would likely limit the rapid testing to a cash service.
  • It’s expected the cost of the tests will come down as demand increases (leading to higher volume manufacturing) and/or new competitors entering the market.

Also, I posted about this on my LinkedIn page and received an excellent question: “How do you mitigate the losses when most of our contracts are a case rate and don’t cover these tests?”

The test and swab combined is about $82, so depending on your case rate, you may not be able to do it for those patients.  Clearly if it’s a $165 rate there’s more margin to drive it than if the rate is $114.  But unfortunately until the price of the test comes down, for some payers, those patients would still probably require send-out with the lab billing their insurance for an STD panel.  As this takes off, demand increases, I would expect the price to fall and/or competing options to become available.

So what’s your overall opinion of this development, and where can tests be acquired?

This is huge progress for urgent care. It enables a new service to reach new patients. It enables real-time test-and-treat and expedited partner therapy.

Currently the test kits are available through your Medline Industries, LP or Henry Schein distributor (but not McKesson to my knowledge).

About Alan Ayers

Professional headshot for Alan Ayers.

Alan Ayers has over 15 years’ experience in strategic planning, business development, clinical operations, sales/marketing and customer service for urgent care, occupational medicine, and primary care facilities.

Currently, Ayers serves as President of Experity Networks, responsible for identifying and cultivating new revenue streams and supporting strategic growth initiatives. Ayers has consulted with independent, PE-backed, and hospital-affiliated platforms representing over 1,000 units. He has also served as an expert witness in landlord-tenant litigation involving urgent care.

From 2017 to 2021, while still part of Experity, Ayers also served as Chief Executive Officer of Velocity Urgent Care, a venture of Sentara Healthcare, growing the company from 7 to 17 locations building a complete operating and administrative infrastructure, assembling leadership and management teams, migrating systems, optimizing the staffing model, acquiring the hospital’s occ med practice, and implementing a values-based culture. In 2020, Velocity Urgent Care became the leading provider of COVID19 test services in its markets.

 

 

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