Ask the Expert with Barry Craig

Each month, BarryCraig, POR's expert on Physician Office Labs, answers questions submitted by POR Magazine and blog readers.  You can ask Barry a question here.

Where can I get references for chemistrytests I run in my lab? I would like to get a wall chart that explains each tests, drug interactions, etc.  I get questions all the time from patients about what certain tests results mean and I would like to be more knowledgeable.

It is great that you want to be able to answer patient's questions, but it is better to let the physician explain any results or give any recommendations to the patients. However, most companies that sell instrumentation will provide you with a reference chart or booklet explaining the test menu and will give you information on each test. Contact your rep that sold the equipment to you and they should be able to get you something. You can also check with American Association for Clinical Chemistry (www.aacc.org) to see if they have any resources available.


We test for drugs of abuse using an analyzer in our office. Our reagents come from a different manufacturer than the manufacturer of our analyzer. Does this change our testing category? Someone told me this made us High Complexity for testing, even though the machine is classified as Moderate Complexity.

The classification of the instrument is irrelevant. The type testing you perform is how you determine your billing and inspection classification.

If you use reagents that have not been cleared by the FDA for use with your analyzer, then the testing is High Complexity. These reagents are FDA cleared for use, and are not experimental, etc. but are not approved for your analyzer which defaults them to High Complexity. There is also different CPT coding for billing as High Complexity.CLIA, COLA, and state inspection agencies are clear that if you perform testing with reagents not approved for your analyzer, your testing category is High Complexity.

When running High Complexity testing, you are required to meet all of the High Complexity CLIA standards. This includes higher personnel standards, validation protocols, etc. Also, it does not matter if the testing is qualitative or quantitative in nature, the higher standards still apply.


I am at the end of my rope! I have two medical assistants who will not wear their gloves consistently while in the lab. I have told the doctor/owner and he just tells me to handle it. I am very frustrated at this point. What can I do to gain compliance?

The first thing you should do is remind the doctor that any OSHA violations come back to rest at his feet, not yours. If a formal complaint is made to OSHA's hotline by a patient, OSHA will come in unannounced and throw the book at him. If they are investigating a complaint, they will look for every violation they can find. BIG fines and BIG problems.

Your doctor needs to realize he is the one at risk as well as his patients by non-compliance with the glove rule. He needs to implement a non-tolerance policy and fire employees if they cannot comply.

Sounds harsh, but do you really want to go into an office where the staff does not wear gloves? I will not eat at buffet restaurants for the same reason. I have no idea where all those hands have been. (Except for the kid wiping his nose with the back of his hand)

As a family practice physician, I run both hematology and chemistry tests in my office. I want to use a MLT (Medical Lab Technician) to run my lab and the testing. I am having a difficult time finding a qualified candidate to fill this role? I am in the Southwest part of the US. Is this a problem everywhere or am I just not offering enough compensation?

There is a nationwide shortage of MLTs (two year degree) and MTs (four year degree). Nursing degrees pay more money and the lab programs are shutting down right and left. As the shortage increases, the effect will be the same as when there was a nursing shortage. Salaries will go up, and people will begin to choose this as a career field again. I would personally offer them more money. As part of their curriculum, an MLT has training for not only lab work but usually some X-ray, ECGs, and other office procedures. An MLT can be utilized for all kinds of additional duties in addition to lab.

Barry Craig

 

Expert on physician office laboratories and diagnostic equipment

Barry works almost exclusively with POLs and understands the needs and challenges they face. With more than 20 years of lab consulting experience, his company works with office lab start-ups, inspection follow-ups, and help with the CLIA, COLA and JCAHO regulatory issues offices face daily. He offers a unique insight and customer focused approach to the lab and its solutions. In his current role as President of Laboratory Consulting, LLC, Barry is leading the way for physician's offices to develop their in-house labs as a place to obtain fast, accurate results and maintain a healthy profit using the latest technology available.

Being in touch with the POL community nationwide his company has a unique insight into the problems and questions that arise from the operation of a POL.

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