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Chapter 40 : Outreach Implementation Requirements: a Case Study

Authors: Frederick L. Kiechle, Joseph E. Skrisson
Content Type: Reference
Publication Year: 2004

Category: Clinical Microbiology

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Abstract:

This chapter describes the planning process to implement an outreach program, identifies potential barriers to acceptance of the implementation plan for an outreach program, discusses the impact of a successful outreach program on various laboratory sections, discusses the advantages of computer-assisted routing for couriers, describes methods for monitoring the financial success of an outreach program, and discusses the advantages of initiating a joint venture with affiliating hospital based outreach laboratories to obtain contracts with managed-care organizations. It reviews the development of the sales and marketing department, as well as courier services. Send-out tests represent procedures that are not performed in any of the laboratory sections and must be sent to an accredited laboratory. The total revenue for all beaumont reference laboratory (BRL) business compared with the total revenue gained through joint venture hospital laboratory (JVHL) highlights the contribution of JVHL and JVHL pull-through test volume to BRL’s overall business growth. In conclusion, laboratory networks appear to provide an advantage in increasing pull-through in laboratory volume due to the network’s extensive coverage of basic managed-care organizations, thereby providing one-stop shopping for laboratory services.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40

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Outreach Implementation Requirements: a Case Study
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Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.fig40-1
Figure 40.1

BRL organization chart.

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Figure 40.1

BRL organization chart.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
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Figure 40.2

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.

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Image of Figure 40.2
Figure 40.2

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.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
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Figure 40.3

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.

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Figure 40.3

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.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
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Figure 40.4

The daily requisitions for tests at BRL received by physician offices (▲) and nursing homes (♦), and totals (■), in January 2002.

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Image of Figure 40.4
Figure 40.4

The daily requisitions for tests at BRL received by physician offices (▲) and nursing homes (♦), and totals (■), in January 2002.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
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Tables

Outreach Implementation Requirements: a Case Study
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Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-1
Table 40.1

2002 BRL outreach laboratory utilization analyzed by specialty

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Table 40.1

2002 BRL outreach laboratory utilization analyzed by specialty

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-2
Table 40.2

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

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Table 40.2

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

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-3
Table 40.3

Courier routing-optimization results: the BRL experience

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Table 40.3

Courier routing-optimization results: the BRL experience

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-4
Table 40.4

Route-optimization results: rerouting for cold weather

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Table 40.4

Route-optimization results: rerouting for cold weather

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-5
Table 40.5

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

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Table 40.5

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

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-6
Table 40.6

Annual volume of tests of cervical cytology at BRL

Data collected by Jennifer Shimoura.

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Table 40.6

Annual volume of tests of cervical cytology at BRL

Data collected by Jennifer Shimoura.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-7
Table 40.7

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.

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Table 40.7

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.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-8
Table 40.8

Summary of tests performed by BRL in 2002 according to specialty

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Table 40.8

Summary of tests performed by BRL in 2002 according to specialty

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-9
Table 40.9

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.

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Table 40.9

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, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-10
Table 40.10

2002 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.

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Table 40.10

2002 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, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-11
Table 40.11

Send-out test volumes at William Beaumont Hospital

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

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Table 40.11

Send-out test volumes at William Beaumont Hospital

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

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-12
Table 40.12

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

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Table 40.12

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

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-13
Table 40.13

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

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Table 40.13

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

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-14
Table 40.14

Annual revenue at BRL

Total procedures performed by BRL in Anatomic and Clinical Pathology.

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Table 40.14

Annual revenue at BRL

Total procedures performed by BRL in Anatomic and Clinical Pathology.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-15
Table 40.15

Payor mix for three years at BRL

Payor mix for three years at BRL

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Generic image for table
Table 40.15

Payor mix for three years at BRL

Payor mix for three years at BRL

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-16
Table 40.16

Annual statistics relating to procedures performed by BRL

Total procedures performed by BRL in Anatomic and Clinical Pathology.

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10.1128/9781555817695/tab40-16.gif
Generic image for table
Table 40.16

Annual statistics relating to procedures performed by BRL

Total procedures performed by BRL in Anatomic and Clinical Pathology.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40
/content/10.1128/9781555817695.chap40.tab40-17
Table 40.17

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.

In conclusion, laboratory networks appear to provide an advantage in increasing pull-through in laboratory volume due to the network's extensive coverage of basic managed- care organizations, thereby providing one-stop shopping for laboratory services.

10.1128/9781555817695/tab40-17_thmb.gif
10.1128/9781555817695/tab40-17.gif
Generic image for table
Table 40.17

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.

In conclusion, laboratory networks appear to provide an advantage in increasing pull-through in laboratory volume due to the network's extensive coverage of basic managed- care organizations, thereby providing one-stop shopping for laboratory services.

Citation: Kiechle F, Skrisson J. 2004. Outreach Implementation Requirements: a Case Study, p 654-671. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch40

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