Ask the Expert with Barry Craig | August 2013

Each month, Barry Craig, POR's expert on Physician Office Labs, posts answers to some of the questions submitted by POR Magazine and blog readers during the past month. You can ask your question at the blog & experts portion of our website.

We have two medical assistants that run our hematology machine. We would like to have a nurse practitioner learn to use the analyzer as well. What are the lab regulations regarding who can train someone in our office to do the lab testing?

If the medical assistants have documented training for the analyzer and have had their competency evaluated, they can train the other employee to use the analyzer. They will need to document the training and assess their competency before allowing them to test patients. They also would need to add that person to the proficiency testing rotation.

We have a practice with approximately 6000 active patients and are thinking of putting a POL. Is that a good idea at this time of significant change in the medical field?
The answer is yes. Even in the current medical environment, it is still worthwhile to have a POL. I am going to give you three reasons why:

First and foremost, it benefits your patients. By performing testing in house, the doctors receive the results while the patient is still there. They can make a clinical decision on the patient's care, write prescriptions on the spot, and explain the results to the patient. Sending out all of your testing, delays the treatment of your patient. Also, when you send all of your lab testing out, someone has to deal with the results when they come in. The patient has to be called, prescriptions phoned in, etc. This is a drain on your office and clinical staff. You are paying someone to do all of this. Your staff would be better utilized for patient care.

Second, although reimbursement for everything connected to patient care has dropped, it is still profitable to run an in-house lab if you have the patient volume to support it. You can simply look at the volume of tests that are sent out to determine how many tests would be performed in-house. For instance, most hematology analyzers have a break even cost of about four patients per day. If you are sending out more then four CBCs a day, then it would probably be a profitable do the tests in your own lab. Many tests are simple kit tests that are easy to perform and require minimal training.

Third, you can utilize an onsite physician as your lab director. They can take a 20 CME online course to qualify as lab director. You will need to have an outside technical consultant check on your lab routinely the first year of operation. This is a CLIA requirement unless the physician acting as lab director has years of laboratory training and experience. Also, you do not necessarily need a degreed lab tech to run your lab. You may be able to utilize a medical assistant or LPN to run your lab testing. For Moderate Complexity testing, the person performing testing must have, at minimum, a high school diploma and documentation of training. You do need to be careful in your selection of who will run your lab testing as they will be responsible for the results that are used in the treatment of your patients.

My urine dipsticks are turning positive for everything, even on normal patients. What can I do to fix this?

Urine dipsticks are sensitive to heat and moisture.

First, make sure you are storing them properly. Do not store them on the bottom shelf of overhead cabinets if the cabinets have fluorescent lights mounted on the underside. The ballast in these lights heat up the bottom shelf of the cabinet. Also, do not store them near a sink or water/moisture source.

Second, make sure you always place the lid back on tightly as soon as you remove a dipstick. Do not wait to place the cap back on until after the tests. Those dipsticks absorb moisture and it is cumulative. You can also purchase additional desiccant packs to add to the dipstick vial. Remember, if your dog is caught outside in a sprinkle or a downpour, you still get a wet, stinky dog! A little moisture on the dipsticks is just as bad as a lot of moisture.


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.