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Office testing in group practice.

Office testing in group practices

A recent survey of its members by the Medical Group Management Association sheds new light on the scope and direction of laboratory testing in group practices. Two highlights: 70 per cent of the groups perform in-house lab procedures, and 85 per cent of these groups plan to expand their laboratory services within the next three years.

The study surveyed 3,200 MGMA members about their current laboratory services and volume, instrumentation, personnel, and determination of lab charges. The 733 respondents were divided about equally among single- and multispecialty groups. The average number of FTE physicians in the typical responding group was 18.9, although the groups ranged in size from 3 to 810 physicians.

Here are some of the findings of the survey as reported in the September/October 1985 issue of Medical Group Management:

Why they have labs. The groups that have laboratories were asked to rank the main reasons why they offer this service. The three most important reasons cited were patient convenience, physician convenience, and turnaround time of test results.

Services and volume. Ninety-five per cent of the respondents offer hematology, including urinalysis, and 88 per cent have chemistry services. About 60 per cent also offer microbiology, coagulation, and serology.

In terms of volume, the average group practice lab performs 717 CBCs per month, 449 differentials, 441 chemistry panels, 291 glucoses, 209 potassiums, 196 platelets, and 176 urine cultures. Most respondents (61.5 per cent) anticipate that their total lab volume either will not be affected by Government regulations or will increase.

Instrumentation. Of the respondents with labs, all said they have a microscope, and 94 per cent have a centrifuge-microhematocrit. About 40 per cent have a dedicated single-chemistry analyzer, a semiautomated hematology system, and/or a multitest semiautomated chemistry analyzer. In contrast, only 15 per cent have laboratory computerization that includes a microcomputer.

Personnel. An average of five certified medical technologists are employed in group practice labs. This figure may be somewhat misleading, however, due to variances in the size of the responding groups.

Group practice labs are usually headed by a nonpathologist as laboratory manager/administrator (46.5 per cent). A significant minority, though, does not have a laboratory manager/administrator (32.6 per cent).

Only 31.5 per cent of the respondents have a pathologist associated with the group. If the pathologists are on premises, most are on a part-time basis, are often connected with another group or hospital that contracts with the office lab, and are paid a salary or retainer. In some cases, the pathologist is associated with the group to meet professional or legal requirements.

Quality control. Contrary to what many readers may think, quality control is important to those surveyed. A majority use both an external QC program, such as those of the College of American Pathologists, the American Association of Bioanalysts, or the Centers for Disease Control, and internal QC such as patient controls and purchased standards and controls.

The majority (65 per cent) do not use Westgard rules for interpreting Levey-Jennings charts in their quality control program, and half of the responding labs are not accredited. The fact that Westgard rules are not widely used indicates less sophisticated quality control programs. The study also noted that accredited labs tend to use CAP or AAB and an active internal QC program.

Determining test charges. Most group practice labs report they use prevailing "usual and customary' area charges to determine the normal charge for a procedure. The next most mentioned method is formal cost accounting, which uses a cost per test plus profit approach, and the third most popular method is a historical group fee schedule.

Approximately 57 per cent of the respondents determine the actual cost of producing a specific lab procedure, and these same respondents say they have determined the actual cost per test for about 63 per cent of all the procedures they perform.
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:laboratory testing
Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Feb 1, 1986
Previous Article:How to succeed with a lab-hospital interface.
Next Article:Survival through expert power.

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