Medical Courier Services


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Medical courier services and the delivery of clinical laboratory specimens.

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  • Think of all that WORK to be picked up!
  • Medical Courier Services

    1. 1. Courier Services Pam Kotynski, MHA MT(ASCP)
    2. 2. Ideas o Employees o Costs o Training o Transportation o Dispatch Systems o Specimen Handling o Obamacare o Partnerships
    3. 3. Internal Couriers Facility hires and trains Part of the healthcare team Dedicated to pick ups including mail, x-rays, medical records, hospitals, clinics, physician offices and other departments Facility pays for company cars, salary and employee benefits
    4. 4. External Couriers Contracted with an outside source Logistics is managed by an independent vendor Employees hired and trained by the vendor Performance of courier outside of hiring hospital’s control
    5. 5. A Mixture of the Two Systems  Internal couriers may be used for established physician routes  External couriers may be used for routine routes between hospital sites  External courier services may be used for vacation, sick time, new routes, new areas  STAT’s  Internal couriers are supplemented using outside sources for a variety of functions
    6. 6. Courier Employee Positives  Good for standard route pickups  Work long hours  Work hard  Very courteous  Good employees, semi-retired  Good driving record  Valid driver's license  Good work ethic  Required to transport heavy packages  Working knowledge of municipal streets, state highway systems, maps, GPS, etc.
    7. 7. External Courier Negatives Not showing up for vacation coverage Not dressing professionally Falter at handling MD offices not knowing where to go to get lockboxes Calling off that day, not replacing and not notifying customer
    8. 8. Costs o Car maintenance o Training o Vehicles ($20K) o Insurance ($150/mo) o Gas credit card for drivers ($3.33-3.85/gal) o Driver’s education o Body work for fender benders ($819) o Salary and benefits ($28K)
    9. 9. Regulations 1. Occupational Safety and Health Administration (OSHA) 2. Centers for Disease Control (CDC) Bloodborne pathogens 3. Department of Transportation (DOT) 4. International Air Transportation Association (IATA) 5. International Civil Aviation Organization (ICAO) 6. World Health Organization (WHO) 7. Clinical Laboratory Improvement Amendments (CLIA)
    10. 10. And More Regulations  College of American Pathologists (CAP)  The Joint Commission (TJC)  Food and Drug Administration (FDA)  State such as Ohio Department of Health (ODH)  Health Insurance Portability and Accountability Act (HIPAA)  Business Associate Agreements (BAA)
    11. 11. Hazmat Employer  Does hospital send out staff need training if there is a courier packing the box?  If the staff is classifying/packaging specimens for transportation. The hospital, clinic and doctor's office are considered the shipper of the package.  Does the person placing specimens into a box for shipment need to be trained and certified?  Any persons handling specimens for transport must be trained and certified to handle medical specimens.  What Category of specimens require Dangerous Goods Training?  Staff must be trained if providing specimens (dangerous goods) for transportation.  Where can lab staff/couriers receive training for Dangerous Goods Handling?  Employers must provide training for their employees. IATA regulations require recurrent training every 2 years, unless there are regulation changes prior to that time. DOT regulations require all training records be held as long as the employee is retained and for 90 days thereafter.
    12. 12. Classification of Specimens 1. Exempt Human Specimens  Patient specimens where there is a minimal likelihood that pathogens are present are not subject to these regulations if the specimen is packed in a package which will prevent any leakage and is marked with the words “Exempt Human Specimen”. 2. Category B, Biological Substances (650)  UN3373; An infectious substance which does not meet the criteria for inclusion in Category A. 3. Category A, Infectious Substances (620)  UN2814; An infectious substance which is transported in a form that, when exposure to it occurs, is capable of causing permanent disability, life threatening or fatal disease in otherwise healthy humans.
    13. 13. Shipping  Packing methods and shipping guidelines are important in assuring quality patient care and maintaining specimen integrity .  For the safety of others, specimens need to be classified into respective shipping groups.  Standardized methods and procedures so that all specimens are packaged and transported correctly.  The temperature at which specimens are held and or transported is a critical component and different packaging will be needed for frozen, refrigerated and ambient temperatures to achieve optimal environmental control during transit.  Additional steps may need to be taken in seasons/locations where extremes of heat or cold could affect specimen integrity.  Basic infection control procedures must also be followed, including adherence to universal precautions protocols.  OSHA mandates all body fluids be considered potentially infectious and that appropriate engineering and work practice controls be implemented while handling the specimen.
    14. 14. Shipping Dangerous Goods o Shipper Marking: Indicating the name and address of the shipper o Consignee Marking: Indicating the name and the address of the intended receiver of the package o Responsible Party Marking: Indicating the name and phone number of a person “responsible for the shipment” o Class 6 Infectious Substance Label: Indicating shipment contains Category A Infectious Substance Affecting Humans o UN Specific Label UN2814
    15. 15. Dry Ice Label Class 9 Miscellaneous Dangerous Label o The quantity must be included on this label as (___kg). (no more than 2.2kg of dry ice is allowed per shipping container.) o Double up arrows pointing upwards must be on opposing sides of the box. o Place the pre-packed tape strip across the box only in one direction. o Care should be taken to allow enough space for carbon dioxide gas to escape as dry ice dissipates
    16. 16. Ground Transportation  Exempt Human Specimens are not regulated by ground transportation.  Category A and B specimens are regulated by the DOT.  Dedicated private or contracted carrier is defined as a motor vehicle used exclusively to transport biological substances or biological products.  While other medical or laboratory related materials may also be transported in this vehicle, its purpose is primarily to transport specimens.
    17. 17. Air Transportation o Charter, Commercial and Cargo Aircraft are used for transportation of specimens to reference laboratories . o IATA regulations must be followed for all of the listed air transport options. o Regulations include procedures for Dry Ice, Category A versus Category B specimens, labeling of shipments, and any documentation guidelines.
    18. 18. Factors Which Can Damage a Specimen During Transportation Not being able to:  Use a seat belt on cooler and place cooler in back or place on floor so the specimens are not jostled.  Keep tubes upright for proper position during clotting and transportation.  Division of cooler for ice and room temperature to maintain integrity.
    19. 19. Specimen Transportation Errors Lost or Compromised specimens major source of physician and patient dissatisfaction. o Losing specimens o Not picking up in a timely fashion or forgetting pickups o Not emptying coolers o Not maintaining the appropriate temperature for stability resulting in poor specimen integrity
    20. 20. Blood
    21. 21. Laboratory Tests Affected by Hemolysis  Concentration Increased potassium, phosph orus, LDH, TP, AST, a lbumin, acid phosphatase, Mg, Fe, Ca, ALT  Concentration Decreased RBC, Hgb, Hct
    22. 22. Decreased RBC’s  Red blood cells (RBC), perhaps, perform the most important duty in the body when it comes to blood. These cells carry oxygen from the lungs and deliver it to the rest of the body. Also, they bring carbon dioxide back to the lungs so that it can be exhaled.  Not having enough red blood cells deprives the body from getting the amount of oxygen required for its functioning. This condition of low red blood cell count is called anemia, and it may indicate several factors.
    23. 23. Decreased RBC Diseases  Lupus  Colon Cancer  Vitamin B12 or Folate Deficiency  Chronic Bleeding  Bone Marrow Insufficiency  Sickle Cell  Rheumatoid Arthritis  Iron Deficiency Anemia  And More….
    24. 24. Hemolysis
    25. 25. Hemolyzed Specimens
    26. 26. Increased Analytes  Aspartate aminotransferase (AST) in liver, heart, and muscle  Alanine aminotransferase (ALT) found in liver  Uric acid gout and poor diet  Total bilirubin in obstructive jaundice  Lactic acid dehydrogenase (LDH) elevates in response to cell damage
    27. 27. Are We Communicating? Two Tin Cans Smartphone
    28. 28. Dispatch Systems  Need to know neighborhood and routes  Online system to order stats  Can check back on specimens  Maintain the routes as physicians are added or lost  Rearrange routes to be productive  Know where the specimens are at all times  Change specimen pick up times
    29. 29. Courier Software Solutions  Streamline the process  Ensure reliability and accountability  Easy to use  Manage delivery system  Integration with other components and interconnection  The level of expertise and the performance expectation bar just keeps rising higher
    30. 30. Integration o Order entry o Dispatch o Tracking o Reporting o Barcoding o Scanning o Geographical footprint o Virtual nationwide network o Allows for the laboratory to plan workload and staff accordingly o Able to re-route drivers due to weather, STATS, or other environmental factors
    31. 31. Competitive Advantage Greater precision Increase accuracy Cost effectiveness Planning for expected volume of work Gain efficiencies High performance
    32. 32. Client Management  Allows for the customization of billing, rates and services  Dispatches know exactly where the drivers are, what specimens they have  Track orders on line  Delivery status, proof of delivery  Variety of management reports  Designed to fit specific customer needs
    33. 33. Healthcare Reform  Obama Program
    34. 34. Obamacare What does that mean?  The official name for "ObamaCare" is the Patient Protection and the Affordable Care Act, a bill signed into law to reform the health care industry.  ObamaCare requires that all insurance plans cover preventive services and stops insurance companies from dropping people when they are sick, as well as offering a number of other reforms and protections.
    35. 35. ObamaCare Medicare Advantage  The ObamaCare Medicare cuts will mainly affect reimbursement rates for hospitals and private health insurance companies.  ObamaCare also seeks to decrease the amount paid to hospitals for Medicare.  Hospitals have already agreed to this practice since everyone has insurance under the Affordable Care Act.  Systems will see a large influx in the amount of visitors to their hospitals, thus they should break even or possibly profit, while saving the tax payers money.
    36. 36. Medicare Value-Based Purchasing Program  ObamaCare's new Medicare Value-Based Purchasing Program means hospitals can lose or gain up to 1% of Medicare funding depending on 20 factors that gauge quality v. quantity care.  Hospitals are graded on a number of quality measures related to the treatment of patients with heart attacks, heart failures, pneumonia, certain surgical issues, re-admittance rate, as well as patient satisfaction.  The ratings will be measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  Hospitals have substantial incentives to make sure employees understand the legislation’s components, the 3rd party HCAHPS process, and strategies to maximize efficiency and customer service.
    37. 37. Value-based Payment Rewards Hospitals for Providing Quality Care  In other words if a hospital has a high re-admittance rate or rated poorly for treatment they can lose a percentage of funding or if they have a low re- admittance rate or score well they can gain funding.  Some hospitals have already been hurt, while others have gained significant funding. Although the drawbacks are obvious in the short term it has created an incentive to improve the quality of care in hospitals.  ObamaCare Medicare penalties / rewards will rise over the next two years to a total of 2%.
    38. 38. Medicare Spending  26% of the U.S. federal Budget  Medicare providers will see $11 billion in reimbursement cuts in 2013  Deficit reduction sequester was designed to achieve savings of $1.2 trillion through 2021  Millions of dollars in Medicare reimbursement are at stake for health care providers that succeed or fail to navigate health care legislations
    39. 39. Fun Facts  There are 9757 companies labeled as couriers.  Approximately 5,815 Registered Hospitals in the US. 5,010 Community Hospitals 213 Federal Government Hospitals 447 Non Federal Psychiatric Hospitals 129 Non Federal Long Term Care Hospitals 16 Hospitals of Institutions(Prison Hospitals, College Infirmaries etc...). (Wiki Answers, 2013)
    40. 40. Think of All the Work!  According to a report by the US Census Bureau there were over 661,400 doctors and surgeons practicing medicine in 2008. In 2003 the US Department of Labor broke down the categories to include 23,790 Anesthesiologists, 111,990 General Practitioners, 50,140 Internists, 19,180 OB/GYNs, 26,910 Pediatricians, 19,530 Psychiatrists and 49,730 Surgeons. (U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Physicians and Surgeons, on the Internet at (visited June 23, 2013).
    41. 41. So What’s Next? Win for the Courier Win for the Healthcare system
    42. 42. Partnership Willing to pay more for better service o Professionalism o Simplify process o Cost containment o Quality patient care o Safety o Reliability
    43. 43. Problems  Laboratory professionals work in one of the most highly regulated environments in health care  Small changes can be very difficult due to time, budget and staffing constraints  Very difficult for laboratories to maintain a high performing, cost effective courier service  Decreasing reimbursement environment and tight budgetary constraints for capital purchases  Competition between facilities
    44. 44. Laboratory Priorities  Phlebotomy  Quality Control  Patient Testing  Customer Service  Instrument Maintenance  Physicians, nurses, other ancillary departments for care coordination  Reference Labs  Courier Services
    45. 45. Solutions  IT solutions  Tough performance standards need to be met  Managerial expertise are needed to run these programs  Look at ways to reduce costs and maintain quality  Integration of services
    46. 46. Buzz Words
    47. 47. Healthcare Initiative Words  Think “Lean”  Kaizen  PDCA  TQM  CQI  Six Sigma  Add value
    48. 48. Questions?
    49. 49. Contact Information Pam Kotynski   513-673-2711 