Menu
NRMC lab increases capabilities
Almost a year ago, Nevada Regional Medical Center’s lab director, Bobby Daugherty, announced the installation of new equipment which dramatically dropped the wait time for three tests. Now with the use of new software, he says test results are being transmitted faster and more accurately than ever.
A year ago, results for a respiratory swab, a stool sample or a test for meningitis and encephalitis took three to five days. Once those results were received, they had to be checked by a lab worker and then, using a separate system, each was entered and transmitted to the physician or nurse practitioner who ordered the test.
Now, going from a sample received at the lab to the results showing up on the provider’s computer takes about two hours.
“Because we implemented auto-verification earlier this month (January), that means we can put the sample on the instrument and go and walk away,” began Daugherty in his explanation of the system.
Using software by Cerner, criteria are set by lab technicians for the normal or expected range for the sample.
“I can be down, drawing blood from a patient in the ER [emergency room], and they’re getting results here [in the lab] and if the results are within the criteria we’ve set then I don’t have to be here to review them,” continued Daugherty. “Almost 90 percent of the tests we do are routine and the majority of results are within a normal or expected range.”
With the auto-verification portion of the software, if, as is generally the case, the results are within expected tolerances, “then the software goes ahead and automatically sends the results of the test to whoever ordered it,” said Daugherty.
And if what comes back is not within the programmed range or criteria?
“Then it red flags the result and it immediately shows up on our computer and whoever’s working can evaluate the results,” said Dougherty. “Sometimes a test is rerun but usually we immediately notify the one who ordered the test and make sure it gets their attention.”
Daugherty pointed out how, with so many tests and results being routine, the new software frees up staff from having to read each one so wait times for patients have been reduced, more patients are served and the lab technician can focus on results that need a trained eye and are handled appropriately.
He also shared how this benefits not just employees but patients as well.
Said Daugherty, “Many physicians adjust blood thinner medication, and they want to get it done during the day. This system makes that possible. We also have the patient portal where patients can go online and review their lab results. This means we can get those results to the patient quicker.”
The fundamental update in NRMC’s lab equipment was made almost a year ago and consists of two sample analysis machines connected to a computer loaded with special software and a printer.
“The old way we tested was a microbiological culture, where we literally had to grow out the organism in order to have enough of the organism before we could perform further tests and examine it under a microscope,” explained Daugherty.
What came online last spring is a system which utilizes what is called a polymerase chain reaction technique which duplicates trace amounts of DNA in the sample and compares them with the unique DNA patterns of bacteria, viruses and parasites on file in the computer software.
The respiratory panel can detect three types of bacterial and 17 viral infections. The gastrointestinal panel detects five kinds of viruses, four parasites and 13 types of bacteria. The cerebrospinal panel is set to detect one type of yeast, six types of bacteria and seven varieties of viruses.
When Daugherty first presented the new lab equipment and system in November 2016, NRMC’s board was very uneasy about leasing even one such machine — let alone two — due to cost, until Daugherty shared the Medicare reimbursement rates.
Using 2015 statistics, Daugherty showed the lab had performed 198 tests for Clostridium difficile — commonly called C. diff — which releases toxins producing a form of colitis.
Reimbursement by Medicare for the conventional test method is $47.50 per test while payment under the new system is $567.75.
In 2015, the lab analyzed 238 nasal swabs — testing for influenza — at a conventional method reimbursement rate of $129 versus $711.15 under the new system.
Despite the cost of leasing the machine with a warranty and the steep cost of supplies, the final numbers changed the board’s attitude from “why would we even consider such a purchase” to “why would we not?”
“I explained to the board the high reimbursement rates for PCR test systems is a way for CMS [Center for Medicare and Medicaid Services] to get labs to switch over to this new system,” said Daugherty.
He said that, in a few years, when those rates drop, his lab and NRMC still will be way ahead. For with the new equipment and the Cerner auto-verification software, they can do more, faster and more accurately which will maintain overall cost savings.
The lab director was asked to take a moment and dream. He was asked to name what he would like to add if funds were available.
What he came up with was a bit of a surprise. Instead of addressing a need specific to the lab Daugherty named something which would most benefit patients.
For many years, insurance providers have required patients to obtain a pre-authorization before undergoing certain procedures or receiving specialized care. More recently, there is a new phenomenon for patients who have insurance and seek care at a hospital emergency room. Increasingly, after that visit to the ER, the insurance provider informs the patient it is denying the claim and, in essence, declares such a visit was unnecessary.
Knowing this experience is also on the rise for out-patient procedures as well, Daugherty said, “As healthcare moves towards price transparency and the need to increase point of service collections, the hospital could benefit from software that estimates patient responsibility prior to outpatient services.”
He said many insurance companies already do something like this for in-patient and many specialty services. He thought implementing this type of software for outpatient services would result in a reduction in denied charges and fewer surprises for patients such as uncovered large bills.
Said Daugherty, “It puts the focus more on the front end of a patient’s visit by ensuring proper insurance information, validating co-pay or patient responsibility and significantly reducing the potential for sticker shock for patients and collection troubles for hospitals and clinics.”
While Daugherty is highly trained and can recite a lot of biochemistry, his last thoughts went to patients as people.
He said, “If we help patients with all the insurance and paperwork on the front end, then from then on, the patient can focus on the one thing which is most important of all, which is getting well. And really, that’s what all of us at NRMC are here for.”