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Chapter 42 : Outreach Implementation Requirements: A Case Study

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Abstract:

A variety of methods have been designed to reduce cost per procedure, which include increased test volume through hospital laboratory mergers, consolidation, and integration and/or development of an outreach program that markets laboratory services to physician offices, nursing homes, and other hospitals. An intrapreneur must convert the illusion of revenue consisting of clad coinage created by delusional, magical thinking to a coherent outreach program generating genuine profits. Numerous potential barriers may be encountered during a change process, including myths, active inertia, lack of incentive, insufficient support from financial analysis and other groups, a slow approval process, conflicting visions, and others. This chapter describes the implementation of a hospital-based clinical laboratory outreach program, Beaumont Reference Laboratory (BRL), and its affiliation with a regional hospital laboratory network, Joint Venture Hospital Laboratories (JVHL), to secure provider status with major local and regional insurance carriers. A section of the chapter reviews the development of the sales and marketing department, as well as courier services for BRL. The chapter shows how BRL built success through affiliation with JVHL. The key factor to success in this network affiliation is the ability of the laboratory network to win provider status for its members with the major managed-care organizations. The implementation of the outreach program led to many benefits, including using spare capacity and thus achieving economies of scale, generating a new revenue stream, lowering unit costs, enhancing the test menu, and creating a new avenue for customer (physician) bonding.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42

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Figures

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Figure 42.1

BRL organization chart. doi:10.1128/9781555817282.ch42.f1

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Image of Figure 42.2
Figure 42.2

Courier management, client services, and client interaction with software for courier routing, specimen counts, STAT pickups, client supplies inventory, specimen tracking, and client service problem logs. Note: Client numbers and procedures continue to increase by 10 ± 5% annually. doi:10.1128/9781555817282.ch42.f2

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Figure 42.3

Annual volume of tests, including total tests and five different methods, performed from 1992 to 2002 in the molecular pathology laboratory at William Beaumont Hospital. Note: The test menu increased from 33 tests in 2006 to over 45 tests in 2011. doi:10.1128/9781555817282.ch42.f3

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Figure 42.4

The daily requisitions for tests at BRL received by physician offices (♦) and nursing homes (♦), and totals (▪), in January 2002. doi:10.1128/9781555817282.ch42.f4

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Tables

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Table 42.1

2002 BRL outreach laboratory utilization analyzed by specialty

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.2

Beaumont Reference Laboratory’s annual client numbers and clinical pathology procedures

Total clinical pathology procedures include inpatients, hospital-registered outpatients, and BRL clients.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.3

Courier routing optimization results: the BRL experience

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.4

Route-optimization results: rerouting for cold weather

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.5

Route optimization results: reoptimization of Monday p.m. routes

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.6

Annual volume of tests of cervical cytology at BRL

Data collected by Jennifer Shimoura.

Liquid-based cytology specimens continued to be greater than 95% of GYN specimens annually from 2005 to 2011.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.7

Tests performed in 2002 in the molecular pathology laboratory at William Beaumont Hospital

RT-PCR, reverse transcriptase PCR; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HBV, hepatitis B virus; CMV, cytomegalovirus; ACE, angiotensin-converting enzyme; TMA, transcription-mediated amplification; MTHFR, methylene tetrahydrofolate reductase; HPV, human papillomavirus.

The test menu had increased to more than 45 billable procedures in 2011.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
Generic image for table
Table 42.8

Summary of tests performed by BRL in 2002 according to specialty

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.9a

Breakdown of tests performed by BRL in 2002 according to specialty

CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
Generic image for table
Table 42.9b

Breakdown of tests performed by BRL in 2002 according to specialty

CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.10

Frequently ordered tests performed by BRL in 2002 listed in rank order according to specialty

E2, estradiol; U/A, urinalysis; ESR, erythrocyte sedimentation analysis; Ab, antibody; Ag, antigen; E3, estriol; Prel, preliminary; Def, definitive; HS, high sensitivity; HH, hemochromatosis gene mutation; ID, identification; cul, culture.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.11

Send-out test volumes at William Beaumont Hospital

The distribution in percentage for BRL vs. non-BRL send-out specimens remains approximately the same. The total volume exceeded 100,000 in 2011.

Non-BRL represents inpatient, emergency center, and registered outpatient send-out procedures.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.12

Review of send-out tests by telephone at William Beaumont Hospital

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.13

Potential areas to monitor to track financial outcome in an outreach program

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.14

Annual revenue at BRL

From 2003 to 2011 the gross and net revenues generally increased in proportion with the total procedure count. At the specific procedure level there are exceptions based on Centers for Medicare and Medicaid Services changes in billing policies.

Total procedures performed by BRL in anatomic and clinical pathology.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
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Table 42.15

Payor mix for four years at BRL

The payor mix has fluctuated with the local economy and changes in unemployment in the state of Michigan.

Comprises capitated and fee-for-service contracts.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
Generic image for table
Table 42.16

Annual statistics relating to procedures performed by BRL

Total procedures performed by BRL in anatomic and clinical pathology.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42
Generic image for table
Table 42.17

Comparison of procedures and revenue for BRL and JVHL business

Refers to all BRL business and all payors (Medicare, Blue Cross, JVHL, etc.).

Refers to the total revenue for clients with JVHL activity and includes JVHL-only gross revenue column.

Refers to JVHL capitated contracts (payments) only and excludes pull-through business.

NA, not applicable.

Citation: Kiechle F, Shaw J, Skrisson J. 2014. Outreach Implementation Requirements: A Case Study, p 740-758. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch42

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