Background: STD clinics must employ systems to bill and be reimbursed for providing STD-related services to ensure access to safety-net services. Clinic-level barriers and facilitators to billing can be understood through theories associated with the organization of health care put forward by Avedis Donabedian – structure, process, outcomes, coupled with emerging concepts associated leadership, organizational culture, and change.
Methods: CAI conducted an assessment of 134 clinics that received 340B discounts to provide STD screening and testing services in NJ and NYS to examine their capacity to bill and be reimbursed for STD-related services via survey monkey. To identify themes and support the design and delivery of TTA, CAI categorized assessment responses into 4 main domains in accordance with public health systems change theory - Policy, Leadership, Resources and Processes. Assessment questions were coded by domains which were used in creating the SPSS syntax to facilitate analysis of assessment.
Results: A 60% (81 clinics) response rate was achieved. No state-level policy barriers for STD-related billing were reported in NYS and NJ. However, 50% of NJ and 42% of NYS STD clinics reported local regulation preventing billing for STD services. As it relates to the domain of leadership, 74% of STD clinics in NJ, and 28% in NYS, reported no steps underway to begin billing for STD-related services. As it relates to resources and processes, 11% of STD clinics in NJ and 65% of STD clinics in NYS currently bill 3rdparty insurance for Immunization or HIV services.
Conclusions: Clustering assessment responses by domain, drawing on prevailing public health systems and change theory, facilitated the identification of key themes from which to design TTA support. Responses indicate planned TTA should support key stakeholders in leveraging existing systems to bill for Immunization and HIV services; and address regulatory barriers at the county-level by building local leadership to mobilize change.