Health insurance companies should reimburse emergency departments that provide HIV tests so that the tests become a routine part of medical care as recommended by CDC, Jeremy Brown, research director at George Washington University Medical Center's Department of Emergency Medicine, writes in a New York Times opinion piece (Brown, New York Times, 9/22).

CDC last year released revised recommendations on HIV testing in the U.S. that say HIV tests should become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling should be dropped. CDC estimates that about 25% of HIV-positive people in the U.S. do not know their status. Many physicians believe that routine testing could lead to earlier diagnosis and earlier treatment. The recommendations, published in the Sept. 22, 2006, edition of CDC's Morbidity and Mortality Weekly Report, were designed to "simplify the HIV testing process" and "overcome several barriers that hindered implementation" of the agency's previous guidelines -- released in 1993 -- calling for tests to be given to "high-risk individuals" and to all patients "in health care settings" with HIV prevalence of more than 1% (Kaiser Daily HIV/AIDS Report, 9/22/06).

According to Brown, there are about 115 million visits to EDs in the U.S. annually, and such visits "often serve as the only medical point of contact for those most at risk from the HIV epidemic." Routine HIV testing could help medical professionals identify people who are unaware they are HIV-positive, Brown adds.

Because of a lack of funding, almost no hospitals offer routine HIV testing in EDs, Brown writes. According to Brown, insurers typically reimburse ED care based on the final diagnosis. For example, if a patient had a sprained ankle, the insurer will cover a fixed amount, but that amount typically does not cover unrelated services, such as an HIV test.

Brown says, "If health insurers reimbursed emergency rooms a mere $40 in addition to the usual medical charges for every patient tested, HIV screening programs ... would be self-sufficient." He concludes, "Unless we compel insurance companies to pay for these simple, proven, relatively inexpensive tests, ... [CDC's] major public health initiative will amount to nothing" (New York Times, 9/22).

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