HIV testing at the dental office. Podcast interview with Dr. Catrise Austin of VIP Smiles (transcript)

This is the transcript of my recent podcast interview with Dr. Catrise Austin.David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I'm speaking today with Dr. Catrise Austin.  She is CEO of VIP Smiles.  Dr. Austin, thanks for being with me today.Dr. Catrise Austin: Thank you David.  It's such a pleasure to be with you today.Williams: I understand that VIP Smiles is the first private dental practice that's certified and trained to offer oral fluid HIV testing.Austin: Yes.  This year I decided to incorporate a new service for HIV testing in the dental office and this was something that I really didn't know was ground breaking.  I have always been interested in learning about the disease and I felt that it's been 28 years since this first hit the scene.  Yet, we're not getting better with the statistics.  Things seem to be getting worse.  A lot of people are afraid to get tested and I said: “You know what?  If I can do my part by offering the test in the dental office as patients visit us twice a year, why not give them the option to do a pain free test and get the results fairly quickly.”Williams: Now is this something that you would suggest for all of your patients?  Whom would you include or exclude?Austin: I actually offer the test to all of my adult patients and any teenagers who are at the age where they're sexually active.  I don't discriminate because the disease does not discriminate. I've tested people in their 60's because literally infect anyone who doesn't take precautions can be infected, so I don't single out anyone.Williams: Who actually gives the test?Austin: My entire staff is trained to offer the test.  My office manager, my hygienists and I all did the training. Usually we'll leave the testing to the clinical staff, but if we're out doing a health fair in the community, we will gather all of our team members and offer the test to make sure we have enough hands to take care of this.Williams: What would happen if I came in for my regular cleaning? What would be different?  At what point during the exam would the test be offered to me and how would that actually be done?Austin: Here is how it works: you come to our office, at the beginning of your appointment when you check in at the front, the office manager will inform you of our new service and she will ask if you are willing to take the test.  It's completely optional.  At the desk, you will sign a consent form if you are willing to take the test.Then after the patient is escorted back, we conduct the test at the beginning of the treatment.  We offer pretest counseling, explain the test, and then administer the test.  It's very easy. It takes about 20 minutes for the results of your test to be ready, so at the end of your treatment we will offer your results. So far we've been very lucky to not have any positive results.Williams: That's certainly encouraging and I'm sure peace of mind for the folks that have the test. But at some point, especially if you offer this for a long period of time, you will get a positive result. What happens if somebody gets a positive result in your office?Austin: The rapid test that we're using which is called OraSure Advance only offers a preliminary positive result, so the next step would be to give a little bit of counseling, but also refer them to either their primary care physician. If they don't have a primary care physician then we will send them to one of our partner hospitals.  The test that they will get at their primary care physician would be a confirmatory test.Williams: Is the test something that people usually need to pay for out of pocket or is it typically covered by dental insurance or health insurance?Austin: The test is considered a medical procedure so unfortunately in the dental office you're not able to use your insurance.  I currently offer the test at no cost. That is even more of a reason why my patients should be tested in my office, because it doesn't cost anything.  If you decide to utilize the test, unfortunately in the dental office you would have to pay out of pocket for those dentists who are not offering the test at no cost.There is a specific medical code that should be submitted, but again dental providers are not recognized for submitting medical codes. So right now since this is new in the dental practice you cannot utilize your insurance, however my goal in getting out into the public and doing interviews like this is to get more dentists to offer the test. The more the dental community embraces this procedure, the more we can push towards making it a recognizable code and billable code for dental procedures, so the more people who do it the more we'll be able to get it paid for by insurance.Williams: What kind of reaction are you getting from patients when you ask them at the start of their appointment if they'd like to have the screening test?Austin: I am so thrilled because so far the patient response has been amazing.  After testing, most patients have stated that they prefer doing it in the dental office because the test was effortless.  I've had patients say: “Hey, you know what?  You just saved me a trip to the doctor.  It was so convenient to do it here and kill two birds with one stone.”The dental environment makes it a little less threatening. Often people are not getting tested because they're just afraid of going to the doctor because it's such a scary environment.  I think my office is in a position where it's less threatening.  We check for cavities and gum disease, so this is just another service that we're adding that's quick and easy and painless.  It's really just a swab of the mouth.  You put the swab into a developing solution.  I think patients are really enjoying having it done in the dental office.Williams: About how many patients have you tested or about how many do you expect to test in a given year?Austin: We just started actively testing in August and since then we've tested over 100 patients.  Right now about 60 percent of the patients who are offered the test accept the testing in our office.  There is a comfort level that we all have to get used to in terms of offering the patient the test on a routine basis.  We offer the test in just the matter of fact way that we would any other service in our office and I expect to have more and more people test as we continue this journey.It's been really great to know that I am helping people to learn their status in such an easy way because it's so important.  The stats are not getting better over the years so anywhere that I can do my part in making sure that we help people know their status and help prevent the spread of the disease is my goal.Williams: You have a new book out and I understand that you're donating a portion of the proceeds to an HIV organization.  Can you tell me a little bit about that?Austin: Yes, the book is called: Five Steps to the Hollywood 'A' List Smile; How the Stars Get That Perfect Smile and How you Can Too.  I wanted to give back proceeds to an organization called Hope's Voice International.  I found them as I did some research.  They actively do campaigns with MTV.  Their campaign is called: “Does HIV Look Like Me?” and I really like the organization because they're working, not only in the United States but also internationally.  Tomorrow is world AIDS day and finding out that there are over 73 million people right now living with HIV.  So I like the organization because they are working tirelessly across the world to make sure that they get speakers out to tell people about the disease and hopefully prevent the spread of the disease even further.  So I'm giving a portion of the proceeds of the book to Hope’s Voice International and I hope together we can do some great things.Williams: I've been speaking today with Dr. Catrise Austin, CEO of VIP Smiles.  Dr. Austin, thanks so much for your time today.Austin: Thank you so much for having me. Let's keep spreading the word about HIV.