Monday, April 5, 2010

Melissa Young, MD: In house or not, that is the question

As an endocrinologist, I do fingerstick blood glucose readings in the office. I use the same glucometer a patient might use at home, courtesy of one of the companies that leaves me sample meters and strips. I charge for the service, and am paid anywhere from nothing to about $10. Not a substantial amount, won’t change my bank account by much, and I’d probably do it even if wasn’t reimbursed since it takes a couple of seconds and it doesn’t cost me anything.

Enter medical supply company reps hawking their Hba1c machines. They are fairly easy to use, they don’t take up a lot of staff or physician time, and allegedly they are decently reimbursed by most albeit not all payers. The machine is free, but the consumables are not. So after expenses, net reimbursement is about $5.

So the question is, is it worth it?
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Yes, I need the Hba1c in my clinical decision making, and yes, having the result in front of me while the patient is in the exam room sure beats calling them back with lab results. But I have a pretty good system in place, and although it doesn’t always work, the majority of the time, it does.

I have patients get their labs done before their visit. Like I said, not all of them do (“Really? Was I supposed to go to the lab?”, “Oh, yeah, I think you did tell me that.”), but most of them do. Besides, I have them get other labs, too – lipids, met panels, urine microalbumins – so if they come without an a1c I’d need to call them with their other labs anyway.

The rep’s argument was that I could order all those other labs to be done prior to the appointments, but plan on doing the Hba1c in the office, as an income generator. Really? For $5 a pop?

And just when he was beginning to sway me, he brought up other tests I could do, now or in the future. It started to feel too much like “business” than service, and that me uneasy.

In the end, I figured I’d give it a shot on a trial basis. I’ll have to see a) what it does to our work flow, b) whether or not it will actually get reimbursed as he claims, and c) how my patients feel about it.

1 comment:

  1. It's a lot more complex than that. You need to look at what your lab charges you to do the test (if you are doing pass-thru billing) and what the reimbursement by insurer. For Medicare, Cigna and UHC (and a few other small players), you are always ahead as you cannot pass-thru bill. But if LabCorp charges you $3 and the supplies cost $5, you are giving away $2 by running it yourself. You also have to factor in the lancet cost and remember to bill for a capillary blood draw 36416. And of course it is worthwhile to run a few patients both ways- capillary and venipuncture (with supplies furnished free by the machine company of course) to check accuracy of the capillary test. Or you could just start doing Botox and forget about the little $5 profit here and there ;-)