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Background: The District of Columbia, sexually transmitted diseases (STD) clinic operates free of charge. To determine if billing for services would be feasible we estimated the total insurance and self-pay reimbursement the clinic could collect. We distributed two surveys to identify insurance coverage, clinic usage patterns, and the need for expanded services.
Methods: Reimbursement estimates were calculated based on patient-reported insurance coverage, DC Medicaid and federal Medicare reimbursement amounts and fee-for-service payments. In 2013 we distributed a survey to female patients to determine unmet health needs. In 2014 we distributed a survey to patients to determine patient insurance coverage and clinic usage.
Results: The clinic could bill $817,498.41 based on current clinical practice and $1,778,192.93 if all patients were offered an expanded assessment and physical exam. The women’s health survey supported integrating emergency contraceptives, Pap tests, and the HPV vaccine into clinic; 22% of patients considered the clinic their medical home. For the STD clinic health insurance survey, 62.7% (95% CI: 58.9%—66.4%) of patients reported having insurance. Medicaid was the largest insurer. Sixty percent of respondents were willing to use insurance for future visits. Reasons for unwillingness to use insurance included: not wanting insurance provider (29.3%) or significant, other (20.5%) to know and unable to afford co-pay (29.3%).
Conclusions: The DC STD clinic’s plan to begin billing for services could potentially provide revenue of between $817, 498.41 to $1,778,192.93 if current usage patterns and insurance coverage remain unchanged. This also assumes that all patients with health insurance are willing to use it. Most of the clinic’s patients have health insurance and are willing to use it for services. Many STD patients regard the clinic as their medical home and prefer the expansion of routine preventive care services.