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hrsa

participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Definition of HIV Expert

The DHHS guidelines and the IAS-USA guidelines state that IV care should be provided by an "expert," and multiple studies support this concept by showing that experienced providers have superior outcomes in terms of patient survival, use of guidelines from authoritative sources to guide medical decisions, and cost of care. The problem is that the definition of an "expert" is arbitrary. The following definitions from "official sources" are provided by Christine Lubinski, CEO of the "HIV Quality Care Network," a HRSA-funded agency that deals with issues of managed care in HIV:

  • Medicaid definition: Rachel Block, Deputy Administrator, Center for Medicaid State Operations, sent a HCFA letter to state Medicaid directors on October 6, 1999 that defines an HIV expert as a provider with ¡§an active ongoing caseload of at least 25 patients with HIV/AIDS over the preceding 24 months, either in regular practice or as part of a supervised postgraduate training program. In urban areas with high incidence this should be a minimum of 50 patients over the preceding 24 months.
  • New York State AIDS Institute: The 2/2000 revised definition defines the HIV expert as having "experience equal to 20 patient-years." Twenty patient-years could represent 40 unique patients followed over six months or 10 unique patients over a course of two years. An additional requirement is six hours of HIV-related CME/year.
  • MOORE Options Program: The Johns Hopkins Moore Options Program has a Medicaid contract that defines the qualifications for primary HIV care to be a physician with 50 active HIV patients/year, 50 HIV-related CME credits/year, and concent to chart audits.
  • Tennessee Medicaid Program: Tenn Care defines the criteria for HIV physicians as those who are part of an AIDS Center of Excellence, who maintain an active roster of 50 HIV-infected patients who are seen at least two times/year, and who acquire at least 20 CME category I credits/year.
  • American Board of Internal Medicine: The organization of the American Board for Medical Specialties that certifies for internal medicine and its specialties defines an HIV expert as anyone certified in the discipline of infectious diseases. posted JGB, 5/3/2000




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