ED medical director institutes new screening program

April 28, 2017
Greg Hall speaks in a conference room
Dr. Greg Hall leads a meeting of the ED screening team. Photos by J. Ryne Danielson

Infectious diseases caused by viruses, bacteria or other microorganisms are one of the leading threats to public health in the United States and around the world. They attack indiscriminately and recognize no state or national borders. While doctors have made tremendous headway in treating the hepatitis C virus (HCV), HIV and AIDS over the past few decades, the interconnectedness of modern society, coupled with access to care issues, have complicated the fight against them.

Routine screenings are one of the most effective tactics available to doctors and other health care professionals. But all too often, those who would benefit most do not have access to primary care where those screenings might be available.

Greg Hall, M.D., medical director of the Adult Emergency Department, is working with a team to change that. As the recipient of a new grant from Gilead Sciences, a biopharmaceutical company, they have developed a program to integrate routine HIV and HCV screenings into MUSC’s Emergency Department and hopefully reach patients who might otherwise slip through the cracks. 

“Gilead has partnered with a number of organizations throughout the country to integrate HIV and HCV testing into clinics and hospitals to catch undiagnosed infections and get individuals into treatment,” Hall said. “Historically, these screenings have been feared because we didn’t have any effective treatments. But, as new treatments become available, if we can see these patients, we can do something to help them. We can now cure HCV, and HIV has become more of a disease patients live with instead of die from.”

One in eight Americans with HIV does not know he or she is infected, and approximately half of HCV cases go undiagnosed, according to Gilead. Its FOCUS program aims to change those statistics by making screenings more routine and changing public attitudes that discourage testing. FOCUS stands for Frontlines of Communities in the United States, and according to Hall, the Emergency Department is the tip of the spear.

“Many of our population in the Emergency Department don’t have adequate access to care so we are the default primary care for a lot of folks. There are a lot of people who get screened when they come through the ED who wouldn’t be screened otherwise.”

South Carolina is one of 19 states that chose not to expand Medicaid coverage under the Affordable Care Act, also called Obamacare. Almost 650,000 South Carolinians remain without health insurance, according the Centers for Disease Control and Prevention, one of the highest rates in the country. And of those, half earn too much to be eligible for Medicaid but too little to qualify for subsidies on the federal exchange.

“One of the challenges is meeting the needs of this population with limited resources,” Hall said. “We provide a lot of primary care to the general population, both because patients don’t always have funding, and because there is a shortage of primary care providers. Even in states that expanded Medicaid, that doesn’t mean they expanded the primary care options that they have available.”

The Emergency Department is a safety net for a lot of people, Hall said, but it also provides an opportunity to provide a valuable public health service. “We’re seeing a lot of the public, so it makes sense to put this sort of screening program on the front lines.”

The grant from Gilead funds both screenings and case management services to get patients into treatment if they test positive.

“Though the pharmaceutical industry gets a bad name sometimes,” Hall said, “a lot of times they want to do something to give back. In addition to the philanthropic benefit, Gilead also makes medications to treat these diseases. By investing in these programs, they can find additional patients. So it’s a win-win for both patients and the company.”

Historically, Hall noted, the ED has been a place reserved for acute care. “As we move forward into patient-centered, value-based care, the ED will provide patients a valuable resource they may not have access to anyplace else and hopefully provide that link to further care.”