The successful laboratory outreach program must be able to deliver results that are timely and accurate in order to establish and maintain stability. Hospital-based laboratory outreach programs serve a variety of customers, a term which tends to be overused in health care. For this article’s purposes, the customer is defined as the purchaser of the laboratory testing service. Therefore, in addition to, ultimately, patients, laboratory customers can include provider offices, other institutions (eg, skilled nursing facilities, hospitals), and payors (ie, government or commercial insurers). Each of these four types of customer has different goals, and the successful outreach laboratory will be able to provide a competitive and effective service to meet them all in order to become (and remain) the laboratory of choice.
The Value of Outreach
In my experience, when asked what three things are most important to customers of laboratory outreach services, the first two responses are nearly always quality and turnaround time. As for the third response, there are two common and related themes: the first being excellent customer service for the provider and office staff, and the second being a good experience for the patient, from phlebotomy to billing.
In most markets across the US, the provider’s office rarely receives a bill from the laboratory; rather, the provider can recommend that a patient’s tests be performed at a certain laboratory. To gain these recommendations and ensure success with an outreach program, it is important to determine how to adapt the lab’s services to meet the varying needs of a broad and diverse customer base.
End-User and Decision Maker
For all clinical laboratories, accuracy is integral to daily performance. In the hospital setting, by having access to the patient’s data across the continuum of care, the laboratory has the ability to track additional quality measures, such as delta-checking or trending, to ensure the accuracy of results. Given the local nature of most laboratory outreach programs, turnaround time for results is commonly expected within the same day, sometimes within a few hours of specimen collection.
Given that quality and turnaround time are core aspects of laboratory performance, existing standards generally meet or exceed the providers’ expectations. That said, customer service expectations by a provider office may vary, and the outreach program may seem to excel in some areas of service and struggle with others. A selection of common service expectations can be seen in TABLE 1.
Trusting, yet Discerning
Most patients are unaware of the differences between a laboratory outreach program and other competing laboratories. Unless they have a prior poor experience, most patients will follow the provider’s recommendation for a laboratory. Given that patient impressions based upon poor experiences can also impact the provider’s recommendation or laboratory choice in the future, preference must be accounted for.
With the laboratory, patient preferences are similar to those used to select a primary care provider, including location, hours of service, prior experience, brand, and cost. As different patients rank these aspects in various ways, it is important to gain an understanding of this from the provider. To this end, The Advisory Board has published extensive research on patient preferences related to primary care.1-5 Assuming that primary care and laboratory have similar criteria, this research can provide insight on these patient demographics so that laboratory services can be refined accordingly. For example, TABLE 2 lists patient preferences for primary care that vary based on age.
Across the board, patients expect short phlebotomy wait times and reasonable out-of-pocket costs. Outreach programs usually receive high patient satisfaction scores for phlebotomy services, providing excellent services with low wait times. Conversely, hospital-based outreach programs may lack competitive pricing structures and struggle with patient satisfaction around out-of-pocket expenses driven by deductibles and co-insurance.
In addition, patients may not be aware of in-network and out-of-network differences for laboratory testing. Out-of-network services increase a patient’s out-of-pocket costs and decrease their satisfaction with the laboratory. An analysis of claims data shows that for the 6% of patient laboratory charges that were out-of-network, out-of-pocket spending was $25 higher, with an additional $81 balance bill average.6
As patients become more engaged in their own care, the hospital outreach laboratory has an opportunity to shift the conversation away from cost and toward value. For patients, having access to integrated laboratory data is important as they work to manage their own health.
Aligned, but Demanding
A health care institution that uses a hospital laboratory outreach program as its reference laboratory will have different needs than a physicians group office or an individual patient. As a similar type of provider, these customers are aligned in their care mission and need a reference laboratory partner that provides the testing support they need to care for their patients. Customers in this category include hospitals, skilled nursing facilities (SNF), and other organized care facilities. Many will ask for a discounted fee schedule so they can manage their own billing processes. For a laboratory outreach program, this may require a separate pricing and billing process. Additionally, it is important to have a working knowledge of Anti-Kickback regulations, which will help keep the laboratory free of legal entanglements.
Many of the same service attributes in serving a provider office remain in place, but often are elevated in complexity. These attributes can be seen in TABLE 3. When serving as a reference laboratory for a health care institution, the outreach laboratory is able to provide an aligned service.
Recall that the customer is the purchaser of the service; the one who pays for laboratory testing. With the exception of the non-insured patient and the institutional customer, the party that pays for nearly all laboratory testing in the US is the payor. Prevalent payors in the US include the federal government (Medicare/CMS), state (Medicaid), and numerous private insurance companies (health plans). Payment for laboratory testing may be bundled, capitated, or fee-for-service.
Most payors are removed from direct patient care activities and do not tend to require the same service elements from an outreach laboratory that were discussed herein. A commercial health plan’s customers are typically employers that purchase the health plan for employees. The health plan’s goal is to provide access to high-quality, affordable health care coverage for its members.
Laboratory testing represents a very small percentage of the overall health care spend, but payors (private and public) are focused on securing the best service for their members at the lowest price. Because the laboratory outreach program is far-removed from the payor, it is important to bear in mind that payors seek to keep the cost for laboratory outreach testing affordable. To be considered affordable, the laboratory may create a competitive fee schedule or establish in-network status that helps keep patient out-of-pocket costs low.
Health plans also seek a laboratory that can serve a broad population of members. A hospital laboratory outreach program that has expansive patient service center (PSC) locations and hours will have a competitive market advantage when compared to laboratories with little coverage. Combining expansive access with low wait times and an excellent patient experience will help ensure a high level of satisfaction among health plan members.
Of note, a valuable byproduct of the laboratory outreach program is the ability to generate influential data, which can be used to help manage complex and preventative care, and drive population health and wellness initiatives. Health plans require providers to submit Healthcare Effectiveness Data and Information Set (HEDIS) on members. There are several HEDIS measures that include laboratory test data, such as Hemoglobin A1c, blood lipids, and fecal occult blood.7 Further, the hospital is able to provide fully integrated clinical HEDIS measures (combining other patient data with laboratory data), which increases value for the organization overall.
In an ever-changing and competitive health care marketplace, well-run laboratory outreach programs retain a strong position. Through the provision of integrated care and data, a hospital laboratory can gain and maintain a competitive advantage with payors and providers. By extending the hospital’s mission into the community, the outreach laboratory complements and enhances the care provided by other health care institutions. Through a continued focus on the patient and by adapting to shifting needs and demographic changes, the hospital laboratory outreach program can continue to be a successful endeavor, and help yours remain the laboratory of choice.
Jane M. Hermansen, MBA, MT(ASCP), is manager of outreach and network development at Mayo Clinic Laboratories in Rochester, Minnesota. She received a BA in medical technology from Concordia College in Moorhead, Minnesota, and an MBA from the New York Institute of Technology. Jane’s 25+ years of clinical laboratory experience spans clinical research; process engineering; project management; and laboratory outreach consulting, training, and facilitation.
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