Missed Opportunities in STI Test Bundling

An analysis of 70,915,524 visits logged across ~3,600 urgent care centers in the Experity EMR from January 1, 2024, through November 22, 2025, reveals a critical disconnect between testing realities and Centers for Disease Control and Prevention guidelines advising concurrent screening for HIV and syphilis when testing for chlamydia and gonorrhea (CT/NG).

The most glaring omission is syphilis. As the table illustrates, fewer than 45% of patients tested for CT/NG who used health insurance—which paid reimbursement to the urgent care center—also receive a concurrent syphilis screen. We separated the data by payer status to highlight a critical operational failure: financial friction. For self-pay patients, syphilis co-testing drops to just 23.1%. This suggests that itemized pricing scares away cash patients from medically necessary testing,¹ even as syphilis cases continue to surge in locations like Chicago and New Jersey.^2,3

To close these gaps and capture missed revenue, operators can implement 3 concrete fixes:

1. Decision-support-driven co-testing: Configure your systems to automatically prompt for HIV and syphilis whenever a CT/NG test is ordered. This makes best practice the default, ensuring consistent testing without relying on provider memory
2. Flat-rate “Express STI Panel” for self-pay: The 23.1% co-testing rate proves itemized fees are a barrier. Replace á la carte pricing with a single, transparent self-pay bundle. This helps anxious cash buyers choose comprehensive screening without “sticker shock.”