Does 'lab' issue INFORM II (or any gluc meter) to your clinics?
Hello,
Picture a health system where the POC Program is given responsibility from the getgo to 'run'/manage all POCT across the health system (includes 4 campus hospitals, campus clinics and ambulatories (clinics off site). The POC Director's approved POC formulary only lists the INFORM II, connected.
The health system keeps expanding and opening new or acquired clinics. In the last year, 3 clinics opened services that required putting in a glucose meter. The POC lab stopped supplying the INFORM IIs. The clinic practice manager was notified 'you have to buy your own'.
About $1200 for meter, base, tote I think the last invoice came to. And also pay for whatever data drop/data plug activation the health system IT dept charges per testing location.
What are your thoughts? should the lab 'always' have to supply the INFORM II? since it's the university's mission to expand, all depts. are expected to support the continued expansion, and it's also our accreditation standard to keep standardized programs and processes the same across the entire health system.
How do others in POC programs in large health systems accommodate continued (nonstop) expansion?
Thanks much,
Peggy
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When depts. want to add addtitional POC equipment like Inform II they buy their own.
Do the necessary steps needed for the installation. We are then notified to come and install.
Thanks,
Cindy
We have EXACTLY the same problem. We have opened 12 NEW clinics in the last 18 months. CURRENTLY, the clinics are paying for equipment, reagents,QC, Interface with EMR, etc. Point of Care (LAB) pays for CLIA License, any accreditation needed (for moderately complex) and proficiency testing.
Our current discussion is, who gets the revenue - LAB or CLINIC.
We have these discussions EVERY time a new clinic comes on board
Bob Newberry
Thanks Bob! At least "I am not alone here"...although I noticed you don't offer the perfect solution ;-))...which I guess goes to show 'there is no perfect solution'.
I get the clinic paying for all the reagents and labor and then taking the reimbursement - which let's face it, reagents and labor exceeds the reimbursement these days.
But it's the cost/outlay for the instrument/device which one would hope was part of the calculated agreement when the agreement/contract is struck. The problem is I guess the health system does not worry about 'the details' of expansion...and the expansion comes 3 years after the agreement signed so...expansion just not accounted for in the initial agreement so no goods on the shelf when 20 more clinics open.
Great to see your name, Bob!
Peggy
I agree with you Peggy. The cost for POCT has to be shared. Lab budgets just can’t absorb the cost. Future forward, users are going to have to purchase the test platforms. It will take some very organized management with a lot of communication.
Unfortunately, test expansion does not equal additional POCCs. And then there is the same ole story of users not recognizing the regulatory requirements for a POCT. Example: the ole doc, who hides their own personal set of FOBT cards and developer in their
lab coat pocket.
In utopia, The SYSTEM, whether it be hospital or outpatient clinics, would provide the entire test platform (reagents and the meters/analyzers.) The caveat is that bulk purchase drives better pricing. Clinics creating individual contracts
for goods drives the price up. Connectivity to a software is one license. It would take some fancy budgeting to peel out connectivity individual costs if the POCC is using a single middle ware platform to manage quality. So the SYSTEM needs to create the
one contract which includes all pieces with the POCC driving the test method/system.
For the time being, the easiest way that I see to spread cost is in the reagents. The supply house purchases the reagents and charges the cost to the individual consumer (clinic or hospital unit). The POCC works in conjunction with the
Supply house and manages the test validations, users, quality, etc.
I do think its time for POC to start having the discussion of creating its own department. Pull it out from the main lab, give it a budget and a staff and its own CLIA.
Our practice is the same as Cindy’s. New locations are required to pay for the equipment and any new “wires”. POCT handles equipment set-up, installation, and education.
We make the new clinic or unit buy their meters and accessories. even the ones inside the hospital.
Nursing units have bigger budget than the lab. So far we have not heard any complaints.
Our glucoses at the hospital are charged by DRG so there is no revenue generated for the lab.
The glucoses done at the clinics are charged by the clinic to the patients.
No charge is generated for the lab so, I am a freebie when they look closely.
The lab monitors their compliance and I am paid by the lab not nursing service.
Our clinics belong to a different administrative and financial entity. They are for profit.
They have different CLIA. They are not under the hospital CLIA.
The lab helps with getting them set up for CLIA, instruments, training, compliance but they put out all the money.
No money goes to the lab. But since they are from the same organization we have to assist them.
I always find these topics interesting to learn from - everyone is different and it's hard to know the "best" way to move forward.
The POC program here buys everything - equipment , IT costs, reagents, etc. We also get all the reimbursement. I think this is ok to a certain extent but I have a couple endo/gyn clinics that I have 1 instrument in so the whole clinic somehow has migrated to "under point of care's management". Example, I recently had to buy 2 clinics a new centrifuge because our main hospital labs act as their reference lab. That, I did not agree with as these clinics just popped up out of nowhere years ago without lab input and now the expense is ours??
Our system works very similar to what Penny described. I work in a level two trauma center with ~300 beds. I have ~75 Abbott glucometers spread throughout the main hospital and in our hospital system’s EMS vehicles. I also have 10 remote clinics with the same meters in use. We have a contract with Abbott to provide strips and meters to the system as a whole. This way we receive bulk orders of strips to our bulk stores and they are distributed to the hospital units, EMS, and remote clinics from there. We have lot sequesters set up twice per year, so I only do a new lot evaluation every 6 months.
Each clinic purchases their own POC supplies, whether it is strep screen kits through Henry Schein or glucose strips through bulk stores. Each clinic also maintains and pays for their own CLIA certificates. Each clinic receives their own reimbursement. As for requesting meter I am in a unique situation. I currently have an excess of meters. Our system’s home health care program originally was using the meters for home visits but has since transitioned to using the patient’s personal meters instead. This left me with an excess of 30 meters until our contract expires. This allows me to “issue” a meter to requesting clinics on an as needed basis.
We use Pweb for connectivity. When a clinic requests a meter I just create a new location in Pweb. I imagine I will hit a point when I no longer have extra meters to issue and I’m not sure what I would do in that situation. I’m not sure what will happen when our contract is up for renewal.
Ruth Harmala
ruth.harmala@mghs.org
When we have a request for new POCT the lab buys the equipment and pays any charge for interfacing. Atleast with Telcor we don't have to pay for interfacing each instrument so it could be worse.
If it's an inpatient unit the lab collects the revenue (if there is any lol) but if it's a satellite then the site gets the revenue. I think they do this because it's easier to keep "rogue" equipment out of the sites and everyone is standardized. If a satellite wants to start a new test they have to send a POCT request form to us and we pick the instrument they need for the testing.
The off sites do pay for their CLIA certification, reagents and any network/electrical drops that are required. We install and train the staff when they are ready to go live. We also supply the procedures and any other support they need for POCT. Currently we have 31 satellites and we never know when they are planning on adding more.
Adonica