Physician Office Labs
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I work for a health care system that supports 14 (for now!) off-campus POC labs. At the moment, the individual offices all order their own test supplies - kits, strips, reagents, controls, etc. I think it would be advantageous, not to mention improving quality control and compliance.
Has anyone gone through the process of drawing the supply flow back through the primary lab, or through the point of care department after offices such as these have been in charge of their own supplies?
Were you able to make this bring revenue to the primary lab?
How much push-back did you get?
Where did you even begin?
What were the pros/cons of the decision?
Was it worth it?
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Our main hospital lab now purchases and distributes all specimen collection and testing supplies.
Advantages include:
We QC all test kits upon receipt prior to distribution to clinics to insure compliance with QC requirements.
All supply transfers are tallied and the expenses transferred to the receiving cost centers so that the expense is applied to the cost center receiving the revenue.
We had support from our CNE and Administration, so clinics were actually receptive to the process. It also gave the clinics access to supplies on an urgent basis. Since I also have oversight for the courier department, coordination of supply distribution was easy.
Other than manpower to manage the supply program, tally transfers once a month and submit paperwork to Accounting for the journal transfers, I cannot identify any other cons worth mentioning.
Our first year following implementation, we reduced outdating approximately $10,000. Through better compliance with GPO contracts, we estimate we are saving another $2-3,000 annually with locked in multi-year pricing. Lastly our accreditation inspectors have been complementary to our process.
Thank you, Gregory. How long ago was this implemented? Are you seeing consistent improvement?
I'm not sure how to even start the process of making the change. Do I gather purchasing records for each office for the last year/two years/longer? I'm not sure how to measure the amount of waste due to outdating, as stock merely gets disposed of when it goes out of date. Do I need to start monitoring this for a certain amount of time before I take the proposal to my lab director and the director of Physician Services?
We began our journey 8 years ago.
Getting a handle on out dating is difficult. We required all expired product to be returned to our lab under the guise of it being used for training purposes.
I am a very data driven person. The more data you can gather the better, since some out dating will be seasonal.
Sounds like your best angle/argument will be to tackle this from a regulatory and standardization process in regard to supplies and compliance with GPO contracts. Focus on the potential positive patient, financial and regulatory outcomes.
Best wishes.
Greg
Our clinics are managed by a physician group separate from the hospital.
Each clinic has each own CLIA certificate.
My job was to make sure they are in compliance with regulations.
The Core lab has nothing to do with their operation, or ordering kits or billing.
They are TJC or CLIA inspected. So far they passed inspection.
They used to have different kits and there is no compliance monitoring.
We made sure they are using the same kits. They order from the same company.
They are not to use new test without telling me first.
I standardized their procedure, QC forms, made sure those with PPM has
Proficiency subscription, training and Competency forms are the same.
I visit once a month. They get their Skills checked the same time every year.
There is always a lead person in each clinic who is my contact to make sure all QC are done.
I make a tracer of 5 patients each month. So far compliance is good.
There seem to always be a problem child in a group. Still working on that one.
I report any problems to the Physician group manager.
.
Pet, when you say you report problems to the physician group manager, do you mean problems that aren't resolved by communicating with staff, or do you mean any time there's a deficiency?
Shannon,
I try everything I can to communicate to the staff and my contact person and the practice manager in the clinic to resolve any problem.
If after all my effort to get them to comply and nothing is done, I talk to the group manager .
He is the guy who is on top of the food chain in the clinics.
Shannon,
My suggestion is supporting Pet's. I want to enphasize that 'before going to the top of the heap' (for us that's a 'Director' level which is one step up from Practice Managers and one step down from the Executive Director of Clinics Administration for Hospitals & Clinics) you do cross check with the Practice Manager that 'they heard you' - even if they did not take action and/or you did not see the correction/outcome you needed/requested/required. In our system, the Practice Manager is told 'you own the clinic/practice' and to go to the next level above them with 'I'm not getting satisfaction' is well-received by Director level when substantiated/documented but can get pretty nasty for the person who 'reported them' if they have not given due deligence 'to the process'. I'm not saying 'don't go above them!'...I'm saying 'be sure you have exhausted what you are able 'to do/to impact' at your level and Practice Manager level (eg you've tried several tactics in case they didn't receive the information - avoid assuming they understood you and your message). Before escalating. Because in their world, there is no going back.
In the long run, what helps tremendously is building trust with 'all' the practice managements/all the different levels of management. If you need to escalate related to a certain Practice Manager, there are most likely other areas where that Practice Manager is 'deficient/lacking/failing' and it's likely your 'evidence' will be added to the pile. The other Practice Managers will appreciate your willingness to help 'clean up that act'. Hopefully you do have some star performers in that Practice Manager group.
Just a thought from 10 years working in the environment you are delveing into- all my best! Peggy Mann in Houston-Galveston and up to 400 miles!
On this same subject:
My director is not prepared to move complete control (purchasing/storing) over POCT supplies to the POCC office. However, I do have the go-ahead to reduce waste by shuffling inventory from one office to another as low-volume facilities reach near-expiration date. I hope that made sense - sometimes I feel like I'm speaking a foreign language!
I'd like some feedback on how I plan to manage this. For example:
Facility A has HCG tests that will expire next month.
I have a queston, that kinda off th is topic, but maybe you can help. What kind of QA program are you guys using for your Physician Office Labs??
I perform monthly checks in each of our 13 POLs. I make sure that all documentation for testing and temperature is filled out completely, and that QC is being performed as prescribed by our Procedure Manual. I compare RALS with charted results monthly, and I compare hand-written waived testing results with charted results, checking 5 tests, at least one from each month, and 5 different tests if the office performs that many or more, otherwise, at least one of each test. I'm in the process of performing linearity testing on all glucometers in our enterprise.
I'm attaching my basic checklist. There are a few items missing, but you'll get the idea.
POC Duties Checklist.xlsx
Hope this helps!
Darlene, we maintain same QC Program in practices/clinics that we run for inpatient and on-campus clinics.