Ask The Expert

 We are thinking of adding some different tests to our menu of what we do at our office. What is the best way to go about it?

Adding test in-house is a great way to improve patient care and increase revenue. This is a process that needs to be looked at from several angles, since it involves many things to consider.

First, look at the tests you are currently sending out to a reference lab on a regular basis. If any of those tests are ones that are sent out in volume, chances are you could bring that testing in-house and get results much quicker.

Second, look at the total cost of running the test in-house. The analyzer and consumables are just the start. Look at the costs for calibration, controls, linearity studies, etc. Also consider the cost for collecting the specimen such as alcohol preps, gauze, bandages, lancet devices, etc. An often overlooked cost is the time usage of the person performing the test. If each test takes 10 minutes to perform and your LPN earns $20.00 an hour, then the test cost an additional $3.33 in employee time.

Third, look at the complexity of the test under consideration, If you are a waived lab, then a CBC is not feasible for your site. Consider upgrading your lab to Non-waived status (Certificate of Compliance) to access the higher level of tests.

Fourth, is the test under consideration appropriate for your patient base? If you’re a pediatric office, do you really need and analyzer that performs chemistry panels? Make sure your testing is of value for the time and expense invovled.

With this in mind, I am going to give some specific recommendations for testing options.

Lipid Panels – Cholestech LDX®  and CardioChek® make excellent waived analyzers for performing lipid panels and other tests. They are simple to operate, and with the proper volumes, cost effective.

PT/INR – This is one test that has real advantages for your patients if done in-house. Coumadin levels can be adjusted while the patient is still in the office.

CoaguChek® S or CoaguChek® XS, Protime® System and Hemochron® systems all measure the PT and INR ratio. Some are waived systems, but all provide quick accurate results

Metabolic Panels, Renal Panels, etc. -  The Piccolo Express® , the Abbott iStat®, and the BioSite Triage® are three excellent systems for performing chemistry panels in-house with quick turnaround times. The Piccolo is a waived instrument system

CBC (Complete Blood Count) – This is one of the most comprehensive tests that can help diagnose problems like anemia, infection, inflammation, and bleeding disorders.

The BeckmanCoulter AcT Diff or AcT Diff2, the Abbott Cell-Dyn 1800, and the Sysmex KX-21N are all excellent contenders for office lab testing. All provide a three part differential and quick turnaround times.

Help! We need to save money! My doctors are talking lay offs if we can’t cut cost. Do you have any suggestions?

I have addressed different aspects of cost cutting over the last few months, but here are a few more tips.

1. READ this magazine! This magazine has ads from many manufacturers, some that list promotions or discounts.
2. If your office needs to purchase a large ticket item such as an analyzer, contact other office in your field and see if you can negotiate a better deal if two or three are willing to purchase.
3. Consider leasing analyzers and equipment to lower upfront out-of-pocket cost.
4. Look into government healthcare grants. If your practice is in a rural area or sees primarily Medicaid patients, you may qualify for federal grant money.
5. Shop, shop, shop your order list! Get quotes from every medical supplier in your area using a list of your 50 most frequently ordered items. Sales rep loyalty is one thing, but cutting cost to save your job is another.
6. Look for seasonal savings. Buying Flu kits preseason usually nets you promotions of buy 3 get one free, etc.
7. You will not like this one. Several physician office practices have saved a ton of money by deleting the cleaning service and rotating the cleaning of the office among the employees. To me, it would be preferable to stay late and clean the office one week a month than to lose my employment altogether.
8. Go Green Use compact fluorescent lights (CFLs), use programmable thermostats so you don’t heat and cool the office as much when you are not there, turn out lights when not in use, curtail any, and I mean any, drips in your faucets or running toilets. I perdonally know of one office that embraced a green initiative and saves over $1500.00/month.