We too switched to IGRA’s and the net cost was about the same following the same thought process noted by Jennifer.

Robert A. Marshall, MD, MPH, ABPM, NRCME, CMRO

Medical Director of Occupational Medicine

Mercy Health

1010 N. Washington Street

Janesville, Wi 53548

Office Phone: (608) 741-3800

Office Fax: (608) 741-3808

2400 N. Rockton Ave

Rockford, Il 61103

Office Phone: (815) 971-2256

Office Fax: (815) 971-9574

Email: rmarshall@mhemail.org

Cell Phone: (608) 371-2232

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Carr, Jennifer L.
Sent: Monday, March 18, 2024 6:50 AM
To: 'MCOH-EH'
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

Caution: This email originated from outside the organization. Use caution and DO NOT open attachments or click on links in unexpected email or from unknown senders.

Darryl,

When we transitioned to IGRA, In addition to the cost of the TST, I included the cost of the nurse’s time to place and read as well as the time for the employee to be away from the workplace to complete the TST placement and read. I estimated 10 minutes for each visit for the nurse and employee. This helped to offset the cost and the rest was justified by higher accuracy, industry standard comparison and increased efficiency of the workflow.

Hope this helps you to support the transition.

Jennifer

From: MCOH-EH <mcoh-eh-bounces+jennifer.carr=vandaliahealth.org@mylist.net> On Behalf Of Lesoski, Darryl via MCOH-EH
Sent: Friday, March 15, 2024 9:59 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Lesoski, Darryl <DLESOSKI@mhc.net>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

Yes, I know all this and have this as an option but it is 4x the cost of a TST.  SO I wanted to help our employers / businesses out by being cost minded and the ONLY reason I asked this question was finding out about how you all handle interpretation if you aren’t around to read it.

THANKS for the input

From: MCOH-EH <mcoh-eh-bounces+dlesoski=mhc.net@mylist.net> On Behalf Of Wendy Thanassi
Sent: Thursday, March 14, 2024 4:19 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] TB testing (TST): tuberculin skin testing

You don't often get email from wendy.thanassi@gmail.com. Learn why this is important

Hello Darryl and all,I am potentially no help at all... but all of the logistic and medical (lack of follow-up, documentations and recording challenges, quality challenges) are alleviated by using an IGRA blood test. May I ask why you don't do that and if there is anything I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Hello Darryl and all,

I am potentially no help at all... but all of the logistic and medical (lack of follow-up, documentations and recording challenges, quality challenges) are alleviated by using an IGRA blood test. May I ask why you don't do that and if there is anything I can do to discuss the possibility with you or your clinic?

We eliminated TST testing all together on January 1, 2009 and have never done one since then. PLEASE feel free to contact me if there's room for discussion on use, location, cost, efficiency etcetera!

To answer these below:

1. No

a. No

b. The standard is to use IGRAs: since 2017 when the joint CDC/ ATS/ IDSA /ACOEM guidances were written that say "IGRA is preferred over TST IN ALL SETTINGS" for many reasons, including the ones you raise above. But first and foremost because it is much more reliable, and MMR/VZV titres are usually being drawn anyway.

I suppose it'd be fine to do in separate places if you're still using TST, you'd just need good documentation. 

Or.... do a QFT/TSPOT and then the whole problem goes away?! :)

2. Because of incubation availability, draw IGRA's until 2pm Friday and then we give the lab a few hours to process it.

I don't mean to be a pain, I mean to be helpful. Let me know if there's more I can do to help you get out from under TSTs.

Best always,

Wendy

Wendy Thanassi MD, MA, MRO

VA Palo Alto HCS

On Thu, Mar 14, 2024 at 10:09 AM Lesoski, Darryl via MCOH-EH <mcoh-eh@mylist.net> wrote:

Couple of questions:  THANKS for any input, feedback, suggestions!

1. Does any provider or clinic place TSTs for patients and let them go elsewhere for the read/interpretation?

a. What is our liability if we administer the TST, but allow interpretation elsewhere?

b. What is the current practice standard for administration and interpretation of a TST? They should always be done in the same clinic/practice? Or can they be completed at 2 separate and non-related clinics/practices?

2. Does any provider or clinic NOT place TSTs on THURSDAYs because you are not available on the Saturday or Sunday to provider the interpretation?

We have created some scenarios with the guidance/recommendations at our medical center that hampers our clinical operations to outside clients/businesses and want to know what the rest of you are all doing 😊

Personally, I have no qualms letting my staff administer the TST and allowing the individual to go elsewhere for interpretation (but then again, I may be a little more “liberal” in my practice processes than others).

THANKS for the reply and appreciate your input.   Darryl

Darryl Lesoski, MD, MPH, FACOEM

System Medical Director – Occupational Health and Medicine, Employee Health

Munson Medical Center

Munson Occupational Health and Medicine

Email: dlesoski@mhc.net

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