Diagnostic Testing, Cost Considerations, and Management Approaches for a Patient with IBS

QUESTION

K.F. is a 45 y/o female that presents with a 10-year history of intermittent chronic lower cramping like abdominal
pain that is relieved when she has a bowel movement. She endorses episodes of diarrhea, constipation, and mucus
in her stool. She states she works long hours at her job and most days skips meals. She denies any chest pain,
worsening of pain with her periods, BRBPR, hematuria, abdominal trauma or increased pain when lifting. PE
reveals positive findings of hyperactive bowel sounds and mild tenderness with deep palpation of the lower
abdomen on both sides. Rectal exam was unremarkable.

Following tests have been ordered:

1 Tissue glutaminase antibody (IgA-tTG) Negative
2 C Reactive Protein Normal
3 Capsule endoscopy Normal
4 Colon biopsy Normal
5 Colonoscopy Normal
6 Complete blood count Normal
7 CMP Normal
8 CT abdomen Normal
9 CTA, abdomen Normal
10 ESR Normal
11 Sigmoidoscopy Normal
12 Vitamin B12 Normal

Pt’s DX is IBS

QUESTION:

Which diagnostic tests did you select for this client? Using the estimated national average cost for each diagnostic test from a website such as MD saveLinks to an external site. calculate the total cost for diagnostic testing for this client if she was uninsured. How might this information change your decision to order diagnostic tests for the client? Would lack of insurance change your management plan? Why or why not?

How would you alter your management plan for this client if she was experiencing food insecurity or lack of housing?

ANSWER

Diagnostic Testing, Cost Considerations, and Management Approaches for a Patient with IBS

Introduction

K.F., a 45-year-old female, presents with a history of chronic lower abdominal pain, intermittent diarrhea and constipation, and mucus in her stool. After conducting a physical examination, multiple diagnostic tests were ordered to determine the underlying cause of her symptoms. This article will discuss the selected diagnostic tests, estimate the total cost for an uninsured patient based on national average costs, and explore the impact of lack of insurance on the management plan. Additionally, considerations for managing the patient’s condition in the presence of food insecurity or lack of housing will be addressed.

Diagnostic Tests Selected

Based on K.F.’s symptoms and physical examination findings, several diagnostic tests were ordered to rule out other potential causes and establish a diagnosis of irritable bowel syndrome (IBS). The selected tests included:

1. Tissue glutaminase antibody (IgA-tTG)
2. C Reactive Protein
3. Capsule endoscopy
4. Colon biopsy
5. Colonoscopy
6. Complete blood count
7. Comprehensive metabolic panel
8. CT abdomen
9. CT angiography (CTA), abdomen
10. Erythrocyte sedimentation rate (ESR)
11. Sigmoidoscopy
12. Vitamin B12 level

Total Cost of Diagnostic Testing for an Uninsured Patient

To estimate the total cost of diagnostic testing for an uninsured patient, the national average costs of each test can be considered. Based on available data from websites such as MDsave, the costs for these tests may vary. However, for the purpose of this discussion, let’s estimate the total cost based on hypothetical average costs:

1. Tissue glutaminase antibody (IgA-tTG): $200
2. C Reactive Protein: $100
3. Capsule endoscopy: $2,500
4. Colon biopsy: $1,000
5. Colonoscopy: $2,000
6. Complete blood count: $50
7. Comprehensive metabolic panel: $150
8. CT abdomen: $1,500
9. CT angiography (CTA), abdomen: $2,000
10. Erythrocyte sedimentation rate (ESR): $100
11. Sigmoidoscopy: $500
12. Vitamin B12 level: $50

Estimated Total Cost: $10,050

Impact of Lack of Insurance on Diagnostic Testing and Management Plan

The lack of insurance coverage can significantly impact the decision to order diagnostic tests due to the high costs involved. Without insurance, patients may face financial barriers and be unable to afford the necessary tests. As a healthcare provider, this information would prompt a reassessment of the diagnostic approach. It would be essential to prioritize cost-effective tests that provide the most diagnostic value while minimizing financial burden for the patient.

The lack of insurance coverage should not change the management plan for a patient with a confirmed diagnosis of IBS. However, the financial constraints may impact the feasibility of certain treatment options or medications. Healthcare providers must consider alternative strategies, such as prescribing generic medications, exploring patient assistance programs, or referring the patient to low-cost or free clinics to ensure access to necessary treatments and support services.

Management Considerations for Food Insecurity or Lack of Housing

If K.F. was experiencing food insecurity or lack of housing, additional considerations would be necessary to address these social determinants of health. Collaborating with social workers, community organizations, and local resources would be crucial in connecting the patient with food assistance programs, affordable housing options, and other support services. Healthcare providers should also prioritize patient education on nutrition, healthy food choices on a limited budget, and stress reduction techniques to manage the impact of external stressors on her IBS symptoms.

Conclusion

In the case of K.F., multiple diagnostic tests were selected to evaluate her symptoms and establish a diagnosis of IBS. Estimating the total cost of diagnostic testing for an uninsured patient indicates a significant financial burden. Lack of insurance coverage may necessitate a reassessment of the diagnostic approach and consideration of cost-effective alternatives. While lack of insurance may impact affordability of certain treatments, it should not alter the management plan for a confirmed diagnosis of IBS. However, if the patient is experiencing food insecurity or lack of housing, additional support services and resources should be integrated into the management plan to address these social determinants of health.