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Setting up a successful courier service.

Setting up a successful courier service

In the year since this laboratory went on the road, it has not only regained lost accounts but has become the largest outpatient courier service in town. By Tristram S. Rogers, MT(ASCP)

Walk-in outpatient services, currently an important part of hospital laboratory operations, are vulnerable to competition. Patients often find it burdensome to go to the hospital to be drawn, so their physicians are eyeing more convenient, less costly alternatives. To hold onto valuable business and give doctors the flexibility available elsewhere, hospital laboratories can institute courier service.

Our 250-bed hospital lab took that course and pumped up its outpatient volume. Other hospital labs can duplicate our success by following this five-step plan:

Establish your need for a courier. Do laboratory courier systems currently operate in your area? Have they eroded your laboratory's outpatient base? Is your lab getting less business or no business at all from physicians who would normally use its outpatient services? Are many physicians in the area not using the lab's services?

In 1986, we answered yes to most of these questions. Some of our physician clients, including one high-volume account, had begun sending their test work to two national reference laboratory chains that offered daily courier runs. In addition, the other major hospital in town had introduced courier service.

To prevent an erosion of our solid outpatient base, we moved to provide this same service and retain -- and in some instances regain -- the physicians' loyalty to our laboratory.

Analyze and better the competition. The next step is to thoroughly research the competition and determine their service levels and price structures. Then offer a better deal.

Physician loyalty was our primary asset going into this new venture. Doctors at our hospital would use the outpatient laboratory service if we made it feasible for them to do so. However, they would not favor us over the competition if it meant losses in test reliability or turnaround time. Nor would they subject patients to generally higher walk-in laboratory fees or to the inconvenience of traveling to the lab to have a specimen drawn.

The best way to learn what physicians want in a courier service is to ask them. When doctors help design the service, they are more likely to use it.

At our lab, 100 physicians were ordering outpatient tests, but 20 of them accounted for 75 per cent of the workload. Our primary concern was to keep high-volume accounts satisfied. So we asked our three major clients what their needs were. The doctors were flattered by our interest and made several valuable suggestions that helped us market the service to other physicians.

We discovered that we had lost one of our largest accounts because the reference laboratory's courier service was more economical and more convenient for patients than our outpatient testing service. And we learned that this former client would gladly return if we could at least match the other program.

Our status as newcomers to courier service actually worked in our favor. We were able to evaluate the other laboratories' price lists and formulate fees that are either the same or lower for virtually all tests. We offer bargains on some of the more popular procedures, charging an average of 10 per cent below the going rate on such procedures as complete blood counts, chemistry profiles, electrolytes, and thyroids. We also offer special discounts to larger-volume clients.

Determine startup costs. Look for an inexpensive, high-mileage car -- one that gets at least 20 miles to the gallon. It should have air conditioning to insure an even temperature for the specimens.

The hospital's finance department can help determine whether purchase or lease is the best choice for your laboratory's situation. We decided to lease an American-made car at a rate of $170 a month, which includes insurance. Fuel runs about $40 a month, and maintenance has been minimal.

Staffing is another key expense item. Drivers must be reliable, personable, and well groomed since they will serve as your representatives. Retirees are exceptional candidates, with high work standards that are hard to find these days. We hired two retirees who are conscientious and well-liked. They work for us on a part-time basis, so we save money on benefits; as retirees, they have no pressing need for benefits anyway. Each puts in three six-hour days per week and backs up the other for vacations and illness.

Figure I lists the start-up supplies our laboratory provides to a physician's office. You cannot charge the client for the tubes, needles, and other supplies needed to draw blood. These materials are part of your cost, whether the patient is drawn in your laboratory or in the physician's office.

Some offices will require a small centrifuge, which you also should supply at no charge. Thanks to a volume discount, we were able to obtain suitable centrifuges for about $200 each. Our lab retains title to this equipment and handles any necessary service or training.

Depending on the hospital's billing procedures, you may need a separate requisition slip for courier work to distinguish it from other outpatient testing. Our laboratory's check-off form, shown in Figure II, is easy for doctors to use and tells us at a glance what we have done for each office every day. There are copies of each requisition for our business office, the laboratory, and the doctor's office.

Be sure the requisition contains all the necessary information for test analysis and billing, including Medicare and Medicaid requirements. The business office should help you design the form and set up billing procedures for the courier system.

Gain administrative approval. Submit a formal request to establish a laboratory courier service, along with a detailed operational plan, to your hospital administrator. The actual cost of establishing a courier service probably won't be the biggest obstacle. The administrator is more likely to be concerned about a possible loss of outpatient lab revenue because the laboratory will charge physicians a much lower price than it charges walk-in outpatients.

To overcome this concern, emphasize that more and more outpatient laboratory testing is being generated from physicians' offices and less of it from hospital visits. Walk-in testing has a doubtful future. Physicians are too conscientious to allow their patients to pay $20 for a test that can be done elsewhere for $10.

Your courier service will attract additional doctors, and the increased volume should offset revenue dilution from lower charges. That is exactly what happened in our venture.

An added argument: We found that we can save the hospital several thousand dollars a year in taxi fares. Virtually every department has borrowed our couriers at least once. We are happy to oblige as long as the errands don't interfere with scheduled pickups.

Market the courier service. You have gotten the go-ahead, hired drivers, bought or leased a car, and stocked the necessary supplies, equipment, and forms. Now you must drum up some business. Target a small group of prime prospects and go after these doctors first. We began with just three accounts -- the same high-volume users who helped plan the program.

Don't waste your efforts on clinicians who have little need for lab testing (e.g., surgeons) or a courier service (most pediatricians prefer not to draw blood). Concentrate on such areas as internal medicine, family practice, and obstetrics and gynecology.

We learned that quality preoperative laboratory workups are keenly sought by podiatrists, most of whom perform the surgery in their offices. They were our easiest sell.

Make doctors' offices a top priority, but don't overlook clinics, health maintenance organizations, nursing homes, visiting nurse associations, and veterinarians. Our client list currently includes a cardiology clinic and a car manufacturer's local division.

We started our marketing campaign by mailing a brochure to 150 doctors within a 35-mile radius. This drew few responses, though it did have some value as a means of announcing our new venture.

Sales calls followed. I conducted them myself, but I think in retrospect that a lab manager should assign sales to someone else, a laboratorian known and trusted by the physicians you want to enlist. This person should have the answers to doctors' questions and the authority to make final arrangements. Don't assume you will get a second chance to sit down with the doctor because questions couldn't be answered or decisions made the first time around.

One of the worst mistakes you can make is to flag down physicians in the hall to discuss the courier service. They will inevitably be between rounds or duties, looking at their watches and not really paying attention. For the same reason, it's unwise to invite physicians to your office.

Make an appointment to call at the doctor's office at his or her convenience. The doctor will be more relaxed and attentive, and you will usually get much better results.

A sales call may last 15 minutes to a half hour. Arrive fully prepared. Bring along promotional materials, a price list, and a courier manual that spells out procedures.

Emphasize the benefits to the physician -- control over when and where the patient gets lab work, and the ability to offer a convenient, economic service to patients. Play up your local availability and the laboratory's accreditation, reputation, and high level of quality control.

Be honest and don't make promises you can't keep. For example, everyone wants to have a late-afternoon pickup, but the courier can make only so many stops at the end of the day. Our largest accounts get the best pickup times, and other clients accept this because they know we are willing to make a special run whenever necessary. A beeper system enables us to alert the couriers to unscheduled stops along the route.

Flexibility is important. We have gained customers by our willingness to accommodate individual testing needs. For example, we have developed a series of customized profiles for different physicians.

We have added a couple of new accounts each month since the courier service began, and now it is the largest such service in town. The laboratory staff has been able to absorb a 10 per cent increase in outpatient workload, but we may soon have to add another technologist and possibly one more car and driver.

This year, the laboratory will become completely computerized. We are also thinking about installing teleprinters in physicians' offices, and we have begun experimenting with a second daily pickup for the larger practices.

Our goal is to make the operation so good that nobody can compete with it.

Target a small group of prime prospects for test work and go after these doctors first.

Figure I

Courier's checklist for doctor's office start-up supplies Courier booklet (1) Order/charge forms (100) Tubes, red -- large (100) Tubes, red -- small (100) Tubes, gray (100) Tubes, lavender (100) Tubes, blue (100) Vacutainer holders (4) Vacutainer needles (100) Syringe needles (100) Syringes, 10 cc (10) Microscope slides (288) Tourniquets (4) Urine containers (10) Centrifuge, when needed (1) Model #___________ Serial #_______________

Figure II

Lab courier order and charge form
COPYRIGHT 1988 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Title Annotation:outpatient courier service
Author:Rogers, Tristam S.
Publication:Medical Laboratory Observer
Date:Apr 1, 1988
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