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Category: Clinical Microbiology
Outreach Implementation Requirements: A Case Study, Page 1 of 2
< Previous page | Next page > /docserver/preview/fulltext/10.1128/9781555817282/9781555817275_Chap42-1.gif /docserver/preview/fulltext/10.1128/9781555817282/9781555817275_Chap42-2.gifAbstract:
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.
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BRL organization chart. doi:10.1128/9781555817282.ch42.f1
BRL organization chart. doi:10.1128/9781555817282.ch42.f1
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
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
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
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
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
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
2002 BRL outreach laboratory utilization analyzed by specialty
2002 BRL outreach laboratory utilization analyzed by specialty
Beaumont Reference Laboratory’s annual client numbers and clinical pathology procedures
a Total clinical pathology procedures include inpatients, hospital-registered outpatients, and BRL clients.
Beaumont Reference Laboratory’s annual client numbers and clinical pathology procedures
a Total clinical pathology procedures include inpatients, hospital-registered outpatients, and BRL clients.
Courier routing optimization results: the BRL experience
Courier routing optimization results: the BRL experience
Route-optimization results: rerouting for cold weather
Route-optimization results: rerouting for cold weather
Route optimization results: reoptimization of Monday p.m. routes
Route optimization results: reoptimization of Monday p.m. routes
Annual volume of tests of cervical cytology at BRL a
a Data collected by Jennifer Shimoura.
b Liquid-based cytology specimens continued to be greater than 95% of GYN specimens annually from 2005 to 2011.
Annual volume of tests of cervical cytology at BRL a
a Data collected by Jennifer Shimoura.
b Liquid-based cytology specimens continued to be greater than 95% of GYN specimens annually from 2005 to 2011.
Tests performed in 2002 in the molecular pathology laboratory at William Beaumont Hospital
a 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.
b The test menu had increased to more than 45 billable procedures in 2011.
Tests performed in 2002 in the molecular pathology laboratory at William Beaumont Hospital
a 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.
b The test menu had increased to more than 45 billable procedures in 2011.
Summary of tests performed by BRL in 2002 according to specialty
Summary of tests performed by BRL in 2002 according to specialty
Breakdown of tests performed by BRL in 2002 according to specialty
a CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.
Breakdown of tests performed by BRL in 2002 according to specialty
a CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.
Breakdown of tests performed by BRL in 2002 according to specialty
a CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.
Breakdown of tests performed by BRL in 2002 according to specialty
a CHE, chemistry; HEM, hematology/coagulation; IMM, immunology; MIC, microbiology; MOL, molecular pathology; FLO, flow cytometry; BLB, blood bank; CYT, cytology.
Frequently ordered tests performed by BRL in 2002 listed in rank order according to specialty
a 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.
Frequently ordered tests performed by BRL in 2002 listed in rank order according to specialty
a 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.
Send-out test volumes at William Beaumont Hospital a
a The distribution in percentage for BRL vs. non-BRL send-out specimens remains approximately the same. The total volume exceeded 100,000 in 2011.
b Non-BRL represents inpatient, emergency center, and registered outpatient send-out procedures.
Send-out test volumes at William Beaumont Hospital a
a The distribution in percentage for BRL vs. non-BRL send-out specimens remains approximately the same. The total volume exceeded 100,000 in 2011.
b Non-BRL represents inpatient, emergency center, and registered outpatient send-out procedures.
Review of send-out tests by telephone at William Beaumont Hospital
Review of send-out tests by telephone at William Beaumont Hospital
Potential areas to monitor to track financial outcome in an outreach program
Potential areas to monitor to track financial outcome in an outreach program
Annual revenue at BRL a
a 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.
b Total procedures performed by BRL in anatomic and clinical pathology.
Annual revenue at BRL a
a 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.
b Total procedures performed by BRL in anatomic and clinical pathology.
Payor mix for four years at BRL a
a The payor mix has fluctuated with the local economy and changes in unemployment in the state of Michigan.
b Comprises capitated and fee-for-service contracts.
Payor mix for four years at BRL a
a The payor mix has fluctuated with the local economy and changes in unemployment in the state of Michigan.
b Comprises capitated and fee-for-service contracts.
Annual statistics relating to procedures performed by BRL
a Total procedures performed by BRL in anatomic and clinical pathology.
Annual statistics relating to procedures performed by BRL
a Total procedures performed by BRL in anatomic and clinical pathology.
Comparison of procedures and revenue for BRL and JVHL business
a Refers to all BRL business and all payors (Medicare, Blue Cross, JVHL, etc.).
b Refers to the total revenue for clients with JVHL activity and includes JVHL-only gross revenue column.
c Refers to JVHL capitated contracts (payments) only and excludes pull-through business.
d NA, not applicable.
Comparison of procedures and revenue for BRL and JVHL business
a Refers to all BRL business and all payors (Medicare, Blue Cross, JVHL, etc.).
b Refers to the total revenue for clients with JVHL activity and includes JVHL-only gross revenue column.
c Refers to JVHL capitated contracts (payments) only and excludes pull-through business.
d NA, not applicable.