Home Forums Discussions General Discussion CLIA waived lab testing equipment

Having been hit by declining reimbursements, I have been looking into in office CLIA waived testing equipment for CBC, comprehensive med panel, lipids, A1c, etc. I have discovered that the cost of running these test varies widely. I am curious what the other small practices are using. Any suggestions?

We do A1C using the DCA machine.
PT/INR using the INRatio machine.
And U/A, I forget the model we use.

These tests are not big money makers in our geographic area. Considering the cost of the kits, and the poor reimbursement from medicare, we do about 15-20% over the the break even mark overall. We would certainly not do these at all if they lost money. But they are not contributing enough to the bottom line that I feel these are critical to our practice. We do them not for the added reimbursement, rather for the added CONVENIENCE to our patients and to me.

It's nice to have an A1C at every diabetic visit, and I never have to listen to a patient say at the diabetic followup visit "sorry doc, I forget to get my labs done." Well that's the whole point of the diabetic visit is to have the A1C value, so we run it right then and their. It's a 6 minute run time.

PT/INR is decreasingly important with products like Pradaxa and Xarelto on the market. We've switched 75% of our coumadin patients to these products. But we still have a few that can't get insurance coverage for these or have mechanical valvular disease, or other non-indications for these drugs. And the convenience of knowing their PT/INR within 3 minutes, having the patient right their when we tell them what their coumadin dose will be is MUCH safer than going to a lab, awaiting chasing down lab results, calling patients back, maybe leaving a message on a voicemail..... not safe.

Keep in mind one thing with DCA and INRatio, sometimes the kits are faulty or a staff member screws one up and has to scrap the kit. For example the INRatio kit costs us about $10-12 per test. In our geographic area, we make about $32 from medicare on a 99211 and $7 or $8 for the PT/INR test, totalling about $40. Minus $10 for the kit we net $30. If my staff screws one up, we net only $20. If they screw up another...well that's when I get PI$$ED OFF. The DCA kits cost us nearly $30 per kit and we clear about $30 from medicare. One screwed up kit and I'm PI$$ED.

U/A is convenient for the UTI patient.

As far as CBC, LFT, Lipids: I've looked into those devices. In my practice the times when I order those tests is mostly in the context of an annual physical. At which time I usually also want a full CMP, PSA, TSH, U/A, and vit D level. So I don't see much point in sending these patients to the lab for part of their workup, and coming to our lab for another part of the work up. They would obviously want to know why they can't just get it all done at once. one final consideration for us is we make our patients get their labs drawn several days PRIOR to the office visit so I have results to review at the time of their face to face eval. It's always been more convenient to send to the lab for these scenarios.

another consideration is your staff time. Of course you realize that you are paying your staff to run these tests. Time is money. The more lab draws you do, the more you will distract them from other duties like phones, referrals, putting patients in rooms, etc.

So my advice would be to consider doing whichever tests help your office from a standpoint of CONVENIENCE rather than motivation by financial concerns. But take into account your local medicare reimbursement, your local suppliers costs, your staff time involved. I hope in your practice you can make it profitable, but at least in our geographic area and with a solo office of 2,300 active patients I don't have the volume to make more advanced lab draws in our office financially sound.

We do other diagnostic testing in our office however that pays better than these labs. We do full PFT (not just spirometry), radial arterial elasticity/compliance testing with the CardioVascular Profiler, and autonomic nervous system testing with the Ansar ANX 3.0. These tests make a $hit load of money. I'd be happy to discuss, but in a new thread since these are not CLIA-waived lab tests. These are procedural tests (but don't require any special certifications to own).

Thanks Adam....Helpful. Over the years, Doc's have let dollars slip away and most of these have been gathered up by the hospital. Appreciate your thoughtful and practical comments.

No problem Tom.
I hope that helps you make an informed choice that suits your individual needs. Happy New Year

Adam,
Can you tell more about radial artery elasticity and autonomic nervous system testing ?
Thanks

Yes no problem,
Please just view my profile and send me an email stating your question above.

I want to make sure I answer your question, but it's a lengthy reply and I'll forget this question if it's sitting on the message board. Send me an email and that will guarantee that I reply to this question. thanks Dariusz

Copy that email response to me at todd@drtoddleslie.com I need it too...thanks Adam

will do

Hey guys, check your email. it's lengthy. feel free to email me any questions. Don't post them here b/c I may not return to this thread.

as far as clia waived we also do lipid panel, AST,ALT on cholestech and do microalb/creat ratios on seimens. Tried thyrochek it but preformed not as well as would like. They pay not bad and save staff time and make adjustments while patients are in office.

We have a CBC machine (Abbott) and a Dimension Chem Analyzer (Siemens) running CMP, lipid, TSH, PSA, HbA1C, tied together by lab software (Antek LabDAQ). With two of us in the office and our Medicare-heavy practice, we clear about $4-6,000/month over expenses. Not a fortune. So as Adam says, we continue to offer these to our patients because the commercial labs are so overcrowded and impersonal, and are constantly a headache for patients by screwing up billing. Plus we just plain do a better job getting the reports and acting on them promptly. As PSA indications decline, we are interested in doing Vitamin D, but will need to upgrade to a newer Siemens Analyzer, so we'll have to do some homework to stay ahead of the pinheads at CMS who are trying to close Physician's Office Labs down. My advice is to never sign a contract for lease-purchase of any of these units without a 90-day out clause. That way you have less risk when the screw-ups in Washington drop their next bombshell on us.

I do several clia wavied tests, mainly as a convenience for patient:
DCA A1c
Cholestech Lipid
Cholestech Ast/ALT
Bayer UA tests
INR's
Hemocue Hgb
Hemocue Glucose

I have a mostly medicare practice, so after the staff wastes a few cartridges I doubt I make much on these.

I had thyrotests for a while, but they make you order so many , I found they expired before I used them all.

in fact, this has been a problem with many other clia waived tests like mono's. I don't have a adolescent population, so I would find my box of 25 mono's expiring before I used them all. Course we all know the tests are probably still good, but with the legal climate, well you know...

I used to draw venous tests in my office and had a lab courier pick them up, but I have found more and more insurances refuse to pay much of anything for this. So I just send the patient down one block to Quest Labs. they don't mind too much. Also before at the end of the month I would get my Quest bill and the staff would mess up and charge the wrong entity (they had to choose Client (MD), Insurance, or patient,) then I would have to submit a form to clean it up. Wasn't worth the time.

Ken I definitely agree it is NOT worth your money to draw blood for a local lab.
They make the money from the test, not the lab draw fee.
They hire the fulltime phlebotomists, not me. I don't want to do their work for them at my expense with my MA's that I"m paying their salaries when I can't even get decent reimbursement for the lab draw.

I appreciate your responses. Thanks again.

No problem Tom.

We do some of these CLIA waived tests in the office. Tried to enter CPT codes in the Quick code section of AC. It is not allowing to add QW modifier.Need help to solve this problem.
Thanks

Our lab gives us a reduced price to use their service. I get a little profit on several common labs and I get a lab draw fee. My MA is good at drawing the blood. How much is a typical INR machine? This is CLIA waved?

We use the INRatio device.
Our supplier gave it to us for ordering the test strips from them
I don't know what they cost exactly. I would not be willing to spend much on one since its not a huge money maker.

Since pradaxa and xarelto hit the market, 75% of our coumadin patients are switched over and we are not using the test as often. But we test about 2-3 pts per day.
In-office INR is CLIA waived. I do it for convenience not as a big income producer.