Miramont Family Medicine Adopted the Patient Centered Medical Home model to provide highest-quality, lowest-cost services to our patients Physician Owned Laboratory (POL) integral to delivery of our health care 4
Miramont Family Medicine POL Test Menu: 5 General Chemistry Hematology Immunochemistry CMP, BMP, Lipid Profile, CPK, Phosphorus, Magnesium, Lipase, Iron Panel, Uric Acid, A1C, Urine Microalbumin CBC, PT/INR, D-dimer, ESR TSH, free T4, PSA, Testosterone, Vitamin D, Troponin, Myoglobin, BNP, RPR, HIV, Hep-C, Urine Drug Screen
6 Miramont Family Medicine
Why a Physician Owned Lab? 7 Increased Efficiencies Immediate Answers and Treatment Decisions Convenience Marketplace Differentiation Competitive Advantage Improved Quality of Care Improved Practice Sustainability
Increased Efficiencies POL testing streamlines result reporting processes Diagnostic information available when the patient and physician are together Teachable moment 8
Centralized Testing: Next Day Results Physician Orders Test Results are sent back to office Doctor interprets results Lab request is prepared Sample is analyzed Office staff calls patient with results, leaves message if unavailable Sample is drawn from patient Sample is transported to reference lab Wait for patient to call the office back 9 Sample is spun through centrifuge Sample is put in drop-box for reference laboratory Doctor provides results to patient
POL Testing: 15-40 Minute Turn-Around Time Physician Orders Test Discuss results with patient on-site Sample is drawn from patient Physician receives and interprets results 10 Sample is spun through centrifuge Sample is analyzed
POL Testing has Half the Steps of Send-Outs Centralized Testing: Next Day Results POL Testing: Results in 15-40 Minutes 11
Time Savings Efficient result reporting saves ~10 minutes of staff time per patient Non-revenue generating time 12
Optimizing Patient Workflow for POL Testing Standing Orders: Routine Physical Exams draw labs for a patient s physical no more than 1 week prior to their appointment If any of these labs have been run within 3 months, draw the blood but do not run unless ordered by provider 13
Optimizing Patient Workflow for POL Testing Standing Orders (cont d) 14 If not performed within the past 3 months, run or send out the following tests (according to the patient s insurance): CBC CMP Lipid panel TSH UA with micro if indicated Hemoccult (over 40 years of age) A1C (if diabetic and has not been run in the past 91 days, or glucose is above 110 on today s testing) Urine microalbumin (if diabetic and not done in the past year) PSA (if male over 45 and not done within one year) Free T4 (if hypothyroid diagnosis in chart or TSH is abnormal on today s testing)
Just-In-Time Lab Results Minimize return visits for medical decision-making Provide attending physician the just-in-time data needed to make important clinical decisions during the same office visit 15
Impact of Just-In-Time Results Real-life Examples: Diagnosing Vitamin D Deficiencies Managing Thyroid Disorders Monitoring Prostate Cancer 16
Is a POL Right for You? Conduct a SWOT Analysis Strengths Weaknesses Opportunities Threats 17
SWOT Analysis 18 Strengths & Weaknesses: Does my office have the resolve to start and maintain a lab? Do we have the room for a lab? Do we order enough tests to warrant the investment? Can we get the financing for new equipment if cash is not on hand?
SWOT Analysis Opportunities & Threats: Do we have favorable contracts that will pay for a POL? Who is the competition? What are the opportunity costs? Who s watching? 19
Myth # 1 The equipment is complicated and requires a laboratory medical technologist on staff to get good results. 20
Fact Newer computer technologies have largely automated modern laboratory equipment to the point that much less technical skill is required to run equipment. 21
22 Tabletop Immuno Analyzer
Myth # 2 The equipment is too expensive I won t be able to afford it. 23
Fact Tabletop equipment prices are generally cost effective for Physician Owned Labs. Good evaluation tools such as Cost Benefit Analyses can limit risk by estimating profitability beforehand. 24
Steps for Cost Benefit Analyses 1. Sort the various costs in the process into fixed costs and variable costs 2.Calculate the unit contribution margin 3.Calculate the break even point 4.Use your clinic s actual volume data to see if running the test in house is viable. 25
26 Federal Trade Commission
FTC Disclaimer The dollar amounts represented on slides in this presentation are fictitious and are provided for sample calculation purposes and illustration only. In no way do they represent actual pricing by the author or an attempt to illegally convey pricing information to marketplace competitors. 27
Steps for Cost Benefit Analyses Fixed Costs: Costs that don t change with volume Equipment Lease $15,000 Annual credentialing 2,000 Total Fixed Costs $17,000 28
Steps for Cost Benefit Analyses Variable Costs: Costs incurred with each test run Reagents/Cassettes (+controls) $10.00 Billing 2.50 Phlebotomy Supplies 2.00 Total Variable Costs $ 14.50 29
Steps for Cost Benefit Analyses Labor: May be viewed as a fixed or variable cost If lab work replaces other duties (filling out forms, ordering online) that are no longer being performed, labor costs do not need to be factored in as they are decision neutral 30
Steps for Cost Benefit Analyses Unit Contribution Margin: The Gross Margin on each test run Revenue $23.00 Total Variable Costs -14.50 Unit Contribution Margin $8.50 31
Steps for Cost Benefit Analyses Break Even Point: The volume needed to incur no loss BE = Fixed Costs / UCM BE = $17,000 / $8.50 = 2,000 Daily Volume 6 tests per day 32
Steps for Cost Benefit Analyses Once equipment is paid for, if still in service, the BE point improves: BE = Fixed Costs / UCM / Daily Volume BE = $17,000 / $8.50 / 6 = 333 days of testing to break even 33
Step-by-Step Guide to Lab Set Up I recommend #1. Go to COLA website (www.cola.org), sign up and attend annual conference with your medical assistant or lab manager. You enroll in lab director courses for credit; they enroll in lab manager courses. 34
But what is COLA? COLA is a certifying body that credentials Physician Owned Labs (POL s) including moderate and high complexity labs. 35
Step-by-Step Guide to Lab Set Up I recommend #2. Price out the equipment you want, meet with vendors. Make a low offer, and let them call you back ( he/she who calls first, loses ). Use a 3-5 year lease to own program with $1 buyout. 36
Step-by-Step Guide to Lab Set Up I recommend #3. Enroll in AAFP s proficiency testing program (http://www.aafp.org/practicemanagement/labs/about.html). Run proficiency testing three times per year (COLA will teach you more about this). 37
Step-by-Step Guide to Lab Set Up I recommend #4. Write your Lab Policy Manual, and have monthly lab meetings with your lab manager (COLA will teach you more about this). 38
Step-by-Step Guide to Lab Set Up I recommend #5. Prepare for and pass your biennial lab inspection with the COLA inspector. 39
Step-by-Step Guide to Lab Set Up I recommend #6. Market in-house lab to your own patients. #7. Track production metrics, including payments, testing volume, labor time. 40
In Summary Miramont s POL has helped to improve patient outcomes while reducing practice costs. Key elements of our success are: Optimizing patient workflow to enable reporting of test results while the physician and patient are together Cost savings achieved through process efficiencies 41
Next Steps Conduct SWOT and Cost/Benefit analyses to see if your office can support the lab. Spend 4 days in Las Vegas at the COLA Resources symposium this April. Plan on significant non-recurring start up time and costs, followed by reasonable maintenance commitments. 42