Ask The Expert: Falling Lab Reimbursements

I am a primary care physician with a small in house lab. My reimbursements continue to fall and it is getting harder to perform testing and stay "in the black." Do you have any recommendations?

I hear this lot. With the added burdens and decline in payments related to ObamaCare, the laboratory is suffering.

One thing you can do is look at alternative testing.

As an example, most offices check blood sugar levels on a Waived meter approved for home use. This type of glucose testing does not reimburse much at all.

However, this is one meter out there that uses a different methodology and is more accurate so it is allotted a different billing code that reimburses much better. The same is true for occult blood testing. The standard guaiac fecal occult blood test pays a very minimal $3.50 to $4.50. However the iFOB occult blood test reimburses around $21.58. This higher specificity methodology is different from the old methods, and hence, it pays more. This technology is available from several manufacturers.

These are only two examples and there are many more. Lab testing today has evolved, so you may not only see the benefit of higher reimbursements for some tests but also more accurate results as well.

Does the lab inspection include fire and electrical hazard checks? I think our lab may have too many devices plugged into one outlet, etc.

This answer is.........maybe. (I should be in politics) The CLIA lab inspection only checks for the items listed in the Federal Register as it relates to CLIA. Items that are OSHA related, such as what you mentioned, do not fall under your inspector's jurisdiction. That being said, if a CLIA inspector finds evidence of ANYTHING they believe compromises a patient or employees health or safety, they can notify the proper government agency. For instance, if they observed that safety needles were not being utilized, they could notify OSHA which would result in an unannounced inspection.

And now, the top three funniest, craziest, and weirdest things I have ever witnessed or heard of at a lab inspection.....................

  1. I attended an inspection of a lab that stored their reagents, calibrators, etc. in a dedicated refrigerator in the lab. They did not utilize the upper freezer unit, just the refrigerator. They had signage indicating "for lab use only", "biohazard" and "keep out".

    I checked the refrigerator and freezer prior to the inspection, to make sure everything was dated, etc. The inspector arrived, greeted everyone, and proceeded to the lab. She immediately opened the freezer and there sat an ice cream cake labeled "Happy Birthday, Dr. XXXXX". In the 30 minutes since I had checked the freezer, someone had entered the lab and stored the cake there. I was both horrified and hungry at the same time.

  2. At a different inspection, I saw a series of quartz crystals, different sizes rocks and stones, lining a countertop in the lab. The inspector asked what was the purpose of these items? The lab tech answered that they were healing crystals and they aided in the recovery of the patients. She was dead serious. The inspector said they could stay as long as they were cleaned routinely on the same schedule as the rest of the lab.
  3. One inspector I know showed up for a new inspection on a physician's office lab. The practice was located in a residential neighborhood and was actually a house, not an office. He knocked on the door and was greeted by the physician himself. He explained why he was there and asked to see the lab. He was led to the back porch (which was screened in). There was a cat resting on top of the hematology analyzer and flies swarming the blood tubes on the folding table. Did I mention it was around 100 degrees? Lab shut down, end of story.
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.