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Re: Triple screening in CaliforniaFrom: James Smeltzer (James.Smeltzer@wellstar.org)Tue Jun 14 10:45:43 2005
Hi! We take care of a large cash-paying population, certified as medically indigent by the health department, and given a price break under a special contract. (BTW for those with the same population, needs and problems, this screening and pre-qualification for discounts based on need, preferentially by an outside party is your best way to avoid illegal pricing problems & still offer affordable care to the working poor). Because of our volume and the population we serve, we get them an incredible price break from Labcorp for the screening. Nonetheless, the value per dollar of serum screening is hard to calculate. They have definitely identified a group needing redating who were due for sonograms anyway. So far we have two infants with DS not identified on basic US screening (one with both 12 - 14 week and 20 week normal scans, but picked up by the quad and confirmed sonographically by targeted US and by amnio. One of these had a termination after a targeted showed an AV canal after normal basic US. Assuming a "cost" of DS avoided for this outcome of $.5 Million (& probably a lot more with that heart), it is about a wash between screening with US alone and added value of serum in our population. We are a select population and it still makes dollars and $ense (I take back my old opinion that it was a waste of cash - it takes very few miss avoidances to make the numbers work, in our case one). I prefer finding these cases to prepare the family and providers for special outcomes before they arrive. We go out of our way not to scare everyone to death, but women are still freaked by abnormal screens (a hidden cost as big as the dollar cost of the test). My positive amnio rate still hovers at 30 percent because we can reassure most of them with normal targeted scans. I no longer believe that serum screening is a net loss to the patient. I can not remember a baby saved by extra surveillance because of a high AFP, but it is certainly possible that there have been some. Conflict of interest disclosure: Dr. Smeltzer is virtually guaranteed a living wage for the rest of his life because of the work generated by serum screening.;^) Jim
>>> gormanm@fcm.ucsf.edu 6/12/2005 3:47:35 AM >>> It is my understanding that California law states that the tripple screen must be offered to each women with appropriate counseling so as to allow her to make upher own informed mind. There is quite alot misunderstanding about it here. Many in the field think the women "has to get it done"., but this is is just not true.On the other hand I must offer the tripple screen, with infrormed consent, to her. Many of my patients decline the test after I explain the pros and cons. Including many of my closest friends and family. Michael R. Gorman, MD UCSF
At Wed, 12 Aug 1998, Joseph A Worrall wrote:
>
phenylketoneuria, and
>we have laws that require treatment of newborns eyes to prevent
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