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How to run a laboratory: Getting ready to implement physician office laboratory testing

As a physician, you're probably looking for ways to create efficiencies in your practice while improving the quality of care you provide for your patients.

Point-of-care (POC) testing can help you address both of these issues. But, before implementing a new laboratory, ask yourself these four questions:

  • What is the mission of my practice's new laboratory?
  • Is my practice willing to implement a new lab?
  • Is my practice able to implement a new lab?
  • Is my practice ready to implement a new lab?

What is the mission of my practice's new laboratory?

As your practice's chief decision-maker, your job is to set the new lab's defining mission. Equally, you must communicate clearly and confidently with both staff and patients about the new lab and why it will benefit them.

Consider this possible lab mission:

"Our in-office laboratory will provide high-quality, routine point-of- care (POC) testing to help guide our patients' treatment plans as we deliver the best possible care within our practice."

The mission statement establishes the importance of lab testing in the patient care mission overall. It also helps set general expectations about which tests you will perform in-house and which you will send out to a hospital or reference laboratory.

The mission statement is an important step in realizing your new lab, so you'll want to get the word out. Display the mission statement prominently in the office for both staff and patients to see and include it in your employee handbook.

Is my practice willing to implement a new lab?

Once the new lab's mission is clear in your mind, it's time to address staff and patient willingness. You need to convey your confidence in the testing mission and commitment to overcoming obstacles along the way toward implementing your new lab.

  • Address any staff concerns to earn their buy-in and generate excitement
  • Communicate confidently with patients about the new lab, knowing that most patients will appreciate this improved level of service
  • Be prepared to address and overcome common obstacles, including construction challenges as you modify your facility, the need to adapt and modify staff training plans and the possibility of lab supply backorders or other supply chain issues
  • Commit to continual evaluation of in-office test selection and protocols, as well as the lab's impact on staff workflow and patient satisfaction

These challenges are part of establishing a new level of service and addressing them will become routine over time.

Is my practice able to implement a new lab?

Implementing a new lab requires careful planning and a significant commitment of resources. Here are some top factors to consider as you move through the process. Be prepared to address:

  • Physical space. You'll need some dedicated physical space for sample collection and your facility may need electrical updates or new storage space
  • Licensing and staffing issues. Don't take any shortcuts here. Your distributor and lab equipment supplier can help you identify cost-effective sources of information
  • Initial training for all staff involved in lab testing. Remember that continuing education is an essential element of an efficient, modern lab, too
  • Staffing plan before initiating testing. Make sure that at least two staff members are ready, willing and able to perform tests to avoid service interruptions
  • Answering patient questions. They may want to know why your practice performs some tests and not others, for example.

Is my practice ready to implement a new lab?

Getting test-ready

Start with the critical task of determining which tests your lab will perform. All other considerations will flow from this decision. Consider these best practices:

  • Focus on tests that you can perform and discuss during the patient visit (15 minutes or less), most of which will be CLIA-waived procedures, including:
    • Lipids
    • Urinalysis
    • Rapid pregnancy
    • Respiratory and some cardiac markers
    • Hemoglobin A1C
  • Evaluate your send-out testing patterns from the previous several months and select those you send out most frequently
  • Request that your distributor provide you with product literature and product demonstrations to help you select appropriate tests and technology for your practice
  • Seek input from your staff and colleagues about patient testing needs
  • Start with core tests and add more tests as your experience grows

Getting your facility ready for an in-office lab

Once you've identified the physical space you think will work well for your new laboratory, you can move on to executing your vision. Here are some things to consider:

  • Evaluate whether you will need to upgrade your plumbing or electrical service for the equipment you plan to use
  • Determine how much space you can dedicate to the testing area, allowing some room for expansion — lab space will depend on the size and the number of instruments in your lab, and defining this is just as important as choosing your instrumentation and setting your test menu
  • Consider ways to ensure patient privacy and comfort during sample collection
  • Create a well-organized space to store lab records, package inserts and operator manuals
  • Purchase a dedicated laboratory refrigerator and enforce a strict no-food storage policy
  • Obtain needed ancillary supplies from your distributor before you begin testing, including:
    • Centrifuges
    • Rocker
    • Phlebotomy consumables
    • Cups for urine collection

Getting your staff ready for an in-office lab

Secure your staff's support for the new venture. Their commitment to success is critical, so address any concerns and earn their buy-in before the lab becomes operational. Enlist their support for providing this important service while increasing quality of care.

Establish roles and responsibilities for testing. Seek out staff members who want to perform testing, considering:

  • Who will draw blood if needed
  • Who will be the backup person when your primary lab expert is out of the office

Above all, assure your team that they will be fully trained before testing begins.

Getting your patients ready for an in-office lab

Once word gets out, your patients are bound to have questions.

First, send out notices via social media, patient portals, invoice stuffers, practice newsletters and appointment reminders to announce your new lab's debut once you are fully prepared to implement the lab services. Don't announce it too early in case preparations get delayed.

Be sure to inform patients in advance how they will receive their test results — both normal and abnormal — from your in-house lab. If necessary, use the opportunity to streamline and refine the way your practice communicates with patients.

Emphasize to your patients that implementing a new laboratory will facilitate and refine your treatment recommendations.

Getting your insurance and billing office ready

Make sure your staff is prepared to bill payers for the tests you will perform by verifying that the relevant ICD-10 and CPT codes are readily available.

You'll want to contact the key private insurance providers for your practice well before testing begins. Ensure that they know which plans you accept and will cover the testing from your new lab. You may need to go through the provider credentialing process with private insurers as well as Medicare and Medicaid, keeping in mind that negotiating contracts for reimbursement may take some time.

Expect payers to challenge your first claims even when the coding is appropriate. Don't hesitate to contact the payers and be prepared to resubmit some of your first claims as needed. Note that commercial payors may only allow a few months to resubmit claims while Medicare and Medicaid may allow for a longer turnaround when resubmitting a claim.

Getting your electronic medical record (EMR) ready

Consult your EMR vendor about your interoperability options in terms of direct interface with your new lab instruments. Direct interface to the EMR fosters practice efficiency, ensures that results reach the patient's chart correctly and helps improve billing speed.

Before you launch your lab, you should also ensure that your patient portal is set up to report lab tests online — and make a plan for communicating to your patients how to retrieve them.

Your readiness to implement a new laboratory has many dimensions. You'll need to base some of the exact steps on your test selections, which in turn should stem from the clinical needs of your patient population. In any event, rely on your lab equipment supplier and distributor as experts in your quest to streamline and help improve your practice's clinical care.

For more tips and guidance, continue reading McKesson's six-part series, The primary care physician's guide to expanding your practice with point-of-care testing.

Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information. 

© 2021 McKesson Medical-Surgical Inc.