How physician office lab testing enhances chronic care management
Independent practices are turning to physician office lab testing to better manage their growing patient population with chronic medical conditions. By doing so, practices are also positioning themselves to flourish under value-based care (VBC) programs and quality payment programs (QPPs) that reward practices for keeping patients as healthy as possible and out of costly hospital emergency rooms.
In order to achieve those two objectives, practices should take the necessary steps to ensure they’re offering high-value diagnostic lab testing at the point of care to patients with one or more chronic medical conditions and patients at high risk of lab test nonadherence.
Traditional approach to lab testing creates compliance hurdles
Effectively managing chronic condition populations and positioning for VBC success can be much more difficult when practices use the traditional "send-out" lab testing workflow.
In a send-out workflow, a patient visits the physician, who, based on the initial examination, writes an order for the patient to have a diagnostic lab test done at another site, such as a freestanding clinical laboratory or an affiliated hospital outpatient facility. This workflow creates a number of compliance and adherence challenges:
The patient may not have the lab test done. When the patient leaves the physician with a prescription for a diagnostic laboratory test, the patient may not feel ill and, in turn, skips the test; the patient does not have the time to get to the test at a separate location; or the patient doesn’t take the test because of the cost
It may take as long as a week for the offsite lab to process the specimen and send the results back to the practice, either electronically or by paper, assuming the patient had the clinical diagnostic laboratory test performed
The practice may not be able to contact the patient with the lab test results
Even if the practice gets in touch with the patient, it may be difficult to schedule a follow-up appointment to discuss the test results
At any point along the patient-care workflow, patient adherence with lab test orders can derail, and with it the practice’s ability to properly diagnose and treat a patient for one or more chronic illnesses.
By moving these same diagnostic lab tests in-house and closer to the patient, the practice eliminates the risk of non-compliance entirely. It would have a 100 percent compliance rate from the draw points, or the points from which lab specimens are taken. The practice also doesn’t have to worry about the patient skipping the test for whatever reason.
In many cases, key diagnostic laboratory test results can be available within minutes if conducted at the point of care, allowing the physician to change medication or treatment, or counsel patient behavior during the same visit. This can eliminate the need for a follow-up visit, further mitigating patient compliance issues while creating greater efficiencies for both clinical and administrative staff.
"Having lab results at the point of care enables a physician to initiate or adjust the course of treatment." – Patrick Bowman, Director of Strategic Accounts, Primary Care Lab, McKesson Medical-Surgical
Compliance facilitates clinical benefits for patients with chronic medical conditions
Bringing lab testing to the point of care creates at least five different clinical benefits for patients and practices.
1. Immediate diagnosis: The ability to conduct lab tests on site and have the results available during the same office visit allows the practice to diagnose or monitor a patient’s condition immediately.
2. Enhanced patient engagement: Patients who receive their test results during their primary office visit and see the results firsthand tend to be more engaged with their care as a result. There’s no time lapse between visit and result that could lead to less patient engagement and treatment compliance.
3. Faster treatment decisions: Having lab results at the point of care enables a physician to initiate or adjust the course of treatment for a patient with one or more chronic medical conditions. That new care plan can start right after the patient leaves the physician’s office, rather than delaying treatment—and perhaps exacerbating an illness—until the test results are in from an offsite lab.
4. Quicker medication adjustments: Monitoring the health status of patients who suffer from one or more chronic medical conditions is critically important for physician practices. With lab results available at the point of care, physicians can immediately change or adjust a patient’s medication regimen and head off a deteriorating condition that could result in an emergency room visit or hospitalization.
5. Behavioral counseling opportunities: The engagement that happens when patients see their lab results in their physicians’ office creates an opportunity for physicians to offer behavioral counseling to patients. This could include recommended changes to a patient’s lifestyle, nutrition, diet and exercise that can help them manage their chronic conditions and keep them as healthy as possible.
Clinical benefits for patients translate into financial benefits for practices
As shown time and time again in virtually every aspect of the health care delivery system, better care goes hand in hand with better business. It’s no different for independent practices that provide physician office lab testing for their patients.
In addition to bettering patient outcomes for VBC initiatives and QPP scores, another significant financial benefit to practices that perform diagnostic lab testing closer to the patient is efficiency. Consider the inefficiency of the send-out workflow for lab testing. A practice that eliminates a follow-up patient visit to discuss lab results now has an open slot for a new patient. That’s in addition to eliminating the need for administrative staff to attempt—often unsuccessfully—to re-engage with the patient to schedule the follow up visit. Freeing up new patient appointment times by eliminating unnecessary follow-up visits through a more efficient and thoughtful diagnostic lab program can add new revenue to the practice.
Other new revenue opportunities created by physician office lab testing include:
Billing for reimbursement for diagnostic lab tests performed on patients within the practice
Meeting or exceeding clinical and financial performance benchmarks in VBC and QPP initiatives
Attracting new patients by receiving higher physician ratings due to increased positive patient outcomes and increased patient satisfaction
Three steps to choosing the right tests for patients with chronic medical conditions
It is important that physician office lab testing remains a revenue center for the practice, not a cost center. The best way to ensure this is by choosing the diagnostic tests that make the most sense for the practice’s patient population. I would recommend that practices take the following steps, given that each practice can have a different patient population mix:
1. Analyze patient population: A practice should sort through its patient database to determine how many patients have one or more chronic illnesses and what those illnesses are.
2. Estimate test volume: The practice should then determine what diagnostic lab tests are the most appropriate for those chronic conditions and the volume of tests that would need to be performed.
3. Reconcile test orders: To understand the real impact of moving the lab tests in-house, the practice should look at how many of those tests it ordered for its patients and how many of those tests were actually done by offsite labs, with a goal of measuring total patient adherence rate.
Ultimately, the practice wants to choose the diagnostic lab tests that will have the most clinical impact on its patient population and whose onsite and timely results will allow physicians to change patient treatments, prescriptions, and behaviors at the initial point of care.
For most practices, the “big three” chronic conditions will be diabetes, hypertension and hyperlipidemia. That means most practices should test onsite for blood glucose levels, A1C levels, lipids and PT/INR.
A practice that moves these diagnostic lab tests in-house to better manage their patients with chronic conditions will make them part of its core diagnostic workflow. In doing so, the practice will be serving the clinical needs of its patients and the business needs of the practice itself.