Re: in office lab tests, clia waived and what not--whats most helpful?

[Guest guest]

If you are at a small group I would strongly urge you to consider setting up a moderate complexity lab.  We have had one for two years now in our small family medicine and psychiatry group and it's been great.

Clinically, I love having CBCs, sed rates, glycohemoglobins and INRs instantly available.  Since we're small, we have an outside lab technician come twice weekly to run other tests.  We often schedule patients who need routine labs on those days for quick turnaround on the results.  

We have an ABX machine for CBCs, a miniVidas runs TSHs , a Siemans machine for waived glycohemoglobins,  and our primary tool is a Cobas Miras chemistry analyzer that does BMPs, CMPs, lipids, etc.  

Financially,  a small, efficient lab is very helpful for our bottom line.   It also helps our cash patients since our lab prices are lower than the local hospitals'.  We're considering adding moderate complexity creatinine/microalbumin ratios on the Siemans machine and ferritins and PSAs on the miniVidas,   We're also looking into Ddimers since our local hospital is too slow getting the results back to us in time to order an ultrasound before radiology goes home at 430 pm unless we see our rule out DVT patients at 0800.

Pierce

 

For those of you that don't know, I have a new job as med director of

a small new clinic in seattle. We are part of a larger system of

smaller clinics around the portland area, but the first in Seattle.

Hopefully we will have more!

We do draw blood in our office which we send out to lab corp for

processing. But the higher-ups have asked me lately about anything

that would be helpful to do in the office for quicker results.

This had lead to my prior question about d-dimer tests--which sadly

are not clia-waved--they are moderate complexity so it might not be

cheap to add the infrastructure to be able to do those tests.

But if you could have a few machines handy, what would be most helpful?

I would like an automatic urine analyzer since it would be faster and

more reliable than having our front desk people do the urine dips.

And that does not appear to be expensive at all. But certain reviews

have turned up some other equipment--a cbc machine that does a wbc

with a 3 part diff is cheaper than a 5 part diff.

The 3 part " t is inferior because it lumps together neutrophils,

eosinophils, and basophils " Obviously you would want

neutrophils....but when getting a wbc there can be so much variation I

would think there would be plenty of false positives anyway.

Does anyone have any experience in this and if so, what tests were helpful?

Given our patient population strongly considering rapid chlyamdia

tests or the like, since STD testing is very common. I try to refer

most to lower cost health department options but many would prefer

getting it done asap.