Data-Driven Management: Sharing Laboratory Cost Data to Improve Clinics' Adherence to Selective Screening Criteria

Background:
Most state STD programs do not have sufficient resources to fund CT testing for all women seen at clinics outside the STD program. Selective screening criteria (SSC) have been established in the Region X IPP to give priority to highest risk populations. SSC specify testing all women <25 years; for those 25+, testing is based on behavioral and clinical risk factors. In 1999 and 2002, the WA STD program implemented a management intervention to notify and bill IPP clinics using SSC for tests that did not meet criteria.

Objective:
Assess management intervention effects on IPP clinic compliance with SSC between 1998 and 2006.

Method:
SSC adherence was calculated, stratified by age (<25 vs. 25+ years), for 431,182 tests among women seen at IPP clinics implementing SSC in Washington State, 1998-2006.

Result:
In 1998, 15% (8,646/58,739) of female tests did not meet SSC. Upon notifying clinics of testing costs related to SSC non-compliance in 1999, the proportion of ineligible tests decreased to 7% (3,262/45,812) in 2000. After billing was implemented, non-compliant testing fell to 6% (2,724/47,598) in 2003. Very high (95%) SSC compliance has continued through 2006. Of the 5% of tests performed that did not meet SSC, clinics reimbursed 50% of these test costs to the IPP.

Conclusion:
Clinics will modify procedures when informed of the cost of non-compliance (data driven management). SSC compliance improved and IPP recouped a significant proportion of misallocated test costs. Billing clinics for tests on low-risk patients is an effective way to assure public health funds are efficiently allocated.

Implications:
Monitoring and communicating costs associated with screening outside program guidelines provides incentive for clinics to adhere to SSC. Requiring reimbursement for tests performed outside IPP guidelines can improve program outcomes.