TB HEALTH CARD FEE 2.DOCX

Health Cards per year: 1000
TB Skin Test/Health Card: $65
Two-Step Testing: $130
QFT or T-Spot: $110
Current Services Offered:
Clinical Services currently offers a health card to students and employees who are required to
have TB clearance to attend school or to work in certain industries (nursing homes, day cares).
To obtain a health card, a client is required to come into the TB Clinic, have an assessment
completed by a nurse and have a skin test placed. The client then returns to the clinic 48-72
hours later to have the skin test read. If it is determined that the client does not have TB, then
a health card is issued at the second visit. The current cost of a health card is $65. The $65 fee
has been in effect for several years and there is no change being requested to this fee or
service.
The limitations and barriers to the current services being offered are twofold:
 Skin tests cannot be placed on Thursdays. Because of the need to read a skin test in 48-
72 hours, clients are turned away for health card services on Thursdays (requires
reading between Saturday and Sunday). This situation also happens when Monday is a
holiday – clients will be turned away for health card services on Thursday and Friday.
 To obtain a health card, a client is required to make two visits to the clinic; one to have
the skin test placed and one to have the skin test read. The location of the TB Clinic, at
1645 E. Roosevelt, is not always convenient for clients and a second visit to the clinic is
burdensome. Most clients don’t realize what is involved in getting a health card, and
are not prepared to make two trips to the clinic. The fact that skin tests cannot be
placed on Thursday complicates this situation and angers many clients who are seeking
services.
Proposed New Services:
In addition to keeping its current services, Clinical Services is proposing two new services to
better assist clients and meet their needs in obtaining a health card for school or employment.
The first proposed new service is QFT or T-Spot Testing and the second proposed new service is
Two-Step TB Skin Testing.
1. Quantiferon (QFT) or T-Spot Testing.

Both the QFT and the T-Spot are blood tests done for detecting active TB. Either test can be
completed with one visit to the clinic. Although the costs associated with the QFT and T-Spot
are more than a single skin test, the convenience to the client may make the blood test a more
suitable alternative for some clients. The QFT and T-Spot can be done each day of the week,
eliminating the need to turn clients away on Thursdays (and possibly Fridays). The QFT is
submitted to a local lab, while the T-Spot is sent to an out-of-state lab. A specimen for a T-Spot
must be submitted to the Public Health Lab by 1:00 p.m. so it can be prepared for shipment on
the same day (by 3:00 p.m.). The QFT will be used for all clients requesting a blood test for a
health card that arrive after the 1:00 p.m. cutoff time for a T-Spot. Both the QFT and the T-Spot
are used to test for active TB in immunosuppressed individuals as well as individuals who are
medically deemed to be at high risk for active disease. Once the blood test results are received,
(usually within 24 hours), the health card is available to be picked up by the client or mailed to
the client.
The proposed fee for a health card using QFT or T-Spot is $110. Costs associated with the QFT
and T-Spot are as follows:
QFT - $125
Public Health cost for lab testing: $100
Nursing time costs for visit, assessment and specimen collection (30 minutes at a rate of $35
per hour): $17.50
Medical Supplies: $2.50
X-Ray Costs: $5
T-Spot - $95
Public Health cost for lab testing: $70
Nursing time costs for visit, assessment and specimen collection (30 minutes at a rate of $35
per hour): $17.50
Medical Supplies: $2.50
X-Ray Costs: $5
2. Two-Step TB Skin Testing.
Although not determined to be medically necessary or recommended by the Centers for
Disease Control, some schools and employers require individuals to have two-step skin testing
for TB clearance. Two-step skin testing is the placement and reading of two skin tests. Two-

step testing requires four trips to the clinic. As an example, a client who is required to have
two-step testing will come to the clinic on Monday to have a TB skin test placed. The client will
return on Thursday to have the skin test read. The client will then return the following Monday
to have a second skin test placed, and return to the clinic on Thursday to have the second skin
test read. At that time, the client will be issued a health card if both skin tests are negative.
The proposed fee for a health card with two-step skin testing is $130. The costs of two-step
testing are calculated using the cost of one skin test with a health card $65 and another $65 for
the second, identical visit.