IOM panel: Domestic violence screening should be routine

A panel of experts says the federal health law should waive co-pays for domestic violence screening and other preventive health services.

The recommendation comes from experts gathered by the Institute of Medicine, and will help federal officials craft rules under the Affordable Care Act.

Social worker Marcy Witherspoon says it takes training to get young doctors comfortable enough to ask about domestic violence.

“A lot of providers are concerned about what the response will be and what they might have to do if they get a response that’s positive. It’s sort of like opening up of a Pandora’s box,” she said.

Witherspoon works with the Institute for Safe Families in Philadelphia and trains workers at city health clinics. She said providers who ask about violence consistently create a place for patients to bring their concerns.

Dr. Ana Nunez directs the Women’s Health Education Program at Drexel University College of Medicine. She likes the set-up at St. Christopher’s Hospital for Children, which has an in-house counselor.

“If somebody gets screened, they actually have a human being who’s there that can get them into care quickly. Just like I’m going to refer to a physical therapist, I can refer to the DV counselor,” she said. “It makes it a lot easier.”

She says the new IOM recommendations highlight the need to address a woman’s health and well-being comprehensively. She said persistent physical health problems, such as high blood pressure and backaches, are sometimes linked to the stress of abuse and control in the home.

“So if I’m treating someone for migraines and they are not getting any better, maybe you need to dig a little bit deeper into those other issues,” Nunez said.

Dr. Jeffrey Jaeger, of the University of Pennsylvania School of Medicine, said several health organizations already encourage doctors to make domestic violence a part of routine preventive care, but not enough physicians follow through.

Jaeger said doctors should be able to bill health payers when they screen for domestic violence, similar to the other care they offer.

“We as doctors, of course, are looking to do what’s best four our patients,” he said. “But often changes in behavior follow changes in reimbursement.”