Point of Care Testing for Enhancing Patient Centered Planned Care Delivery

1,654 views

Published on

PAFP 2013 Regional Lecture Series
Session 1 - Northeast
Presenter: Linda Thomas-Hemak, MD
The Wright Center for Primary Care
Broadcast live through the PAFP Community.
October 2nd, 2013 12pm - 1pm

Published in: Health & Medicine, Business
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,654
On SlideShare
0
From Embeds
0
Number of Embeds
68
Actions
Shares
0
Downloads
144
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Point of Care Testing for Enhancing Patient Centered Planned Care Delivery

  1. 1. Shaping the Future of Healthcare | www.thewrightcenter.org Point of Care Testing for Enhancing Patient Centered Planned Care Delivery Linda Thomas-Hemak, MD The Wright Center for Primary Care PAFP Community Regional Lecture Series October 2, 2013
  2. 2. Shaping the Future of Healthcare | www.thewrightcenter.org Learning Goals and Objectives • Review Availability, Advantages , Disadvantages and Challenges of POCT. • Describe how POCT for HbA1c and Lipids can contribute to improved team based planned care delivery in the patient-centered medical home. • Demonstrate a plan for effective, affordable implementation of Point of Care HbA1c and Lipid testing, including factors such as staff buy-in and effective use of Health Information Technology. 2
  3. 3. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Relevance • Care emphasis is shifting toward prevention and early detection of disease, as well as effective, facilitated self-management of multiple chronic conditions with development of low-cost technologies for POCT. • With miniaturized devices and wireless communication, doctors’ care for patients will change dramatically, and the role patients take in their own health care will increase. 3
  4. 4. Shaping the Future of Healthcare | www.thewrightcenter.org Definition and Aim of Point Of Care Testing • Point-Of-Care Testing is defined as testing at the patient encounter in whatever venue patient care is delivered. • The aim of POCT is to accelerate diagnostic and therapeutic processes. 4
  5. 5. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Empowers Providers and Patients • Promotes evidence based planned care at every visit. • Potential to address compliance, significantly impact health care delivery, enhance outcomes and reduce health disparities. • Enhances the shift to predictive, personalized and preemptive medicine with the development of portable diagnostic and monitoring devices. 5
  6. 6. Shaping the Future of Healthcare | www.thewrightcenter.org Implementing POCT • Obtain leadership buy in to coordinate POCT program in everyday workflow. • Understand POCT methodology and economics. • Financial modeling (Can we effort it?). • Define POCT role specific, team based work flow. • Keep it integrated in EMR MU and Lab interfaces. • Be certain lab orders are accommodated to avoid duplicated testing and denied service coverage. • Implement and Evaluate. 6
  7. 7. Shaping the Future of Healthcare | www.thewrightcenter.org POCT “Lean” Benefits • Rapid turn around time for diagnosis and management planning • Patient convenience • Reasonable cost • Improved patient planned care provided • Empowered patient self management • Improved office workflow through increased testing efficiency and less call backs • Reduction of length of stay in ER venues • Reduced ER and Hospital referrals 7
  8. 8. Shaping the Future of Healthcare | www.thewrightcenter.org Additional POCT Advantages • Small sample volume • Portable devices with wide menu of analytes • Unprocessed specimen • Ability to provide laboratory testing in a wider variety of sites or circumstances • Reduced potential for sample deterioration 8
  9. 9. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Disadvantages • Implementation is challenging and must be strategic. • Not all methods are appropriate for diagnosis or monitoring treatment. • Kits/devices may not be FDA approved for all uses of a similar test in central laboratories. • Different methodology, reliability, and precision • Variable coverage and affordability • Staff time and training • Staff inappropriate use outside of intended use or policy • Costs of specimen mistakes 9
  10. 10. Shaping the Future of Healthcare | www.thewrightcenter.org Affordability and Value : Complex POCT Economics • Staffing, training and visit time • ↓ Call backs but potentially ↓ # of clinic visits • More efficient and potentially more aggressive chronic disease management • Less inappropriate Rx • Potentially enhanced patient self management • Fewer unnecessary ER visits and admissions • ↓ ER and Hospital LOS • ↓ blood and blood product use • Potentially enhanced outcomes and QOL 10
  11. 11. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Improved Outcomes Examples • Faster diagnosis and treatment decision making: Chest pain, Drug O/D • Improved adherence to Rx: Diabetes & Glucometers • Faster therapeutic optimization : Anticoagulation • Reduced re-operation rate: Parathyroidectomy (with rapid point-of-care PTH assays) • Improved patient satisfaction: ↓travel, ↓cost,↑ownership of diagnosis • No validated primary care health outcomes yet 11
  12. 12. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Economics: Cost Cost must look at the whole process of patient care, rather than just the cost of an individual POCT method vs. laboratory test methods. – Management, billing and HIT plans – training testing personnel – labor to process/analyze specimens – maintaining equipment, annual reagent/controls – depreciation costs – state licensing for volume and test complexity – proficiency programs for testing performed. 12
  13. 13. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Cost Effectiveness • Many studies show POCT for various applications is a useful complement to conventional laboratory testing. • POCT should not be viewed as a significant profit generator. • The true value is lean improvement in care provided, patient satisfaction with their healthcare and possibly outcomes. • Future utilization will depend not only on technical advances, but also on enhancement in costs and reimbursement, as well as transformation from a volume driven to value based payment system. 13
  14. 14. Shaping the Future of Healthcare | www.thewrightcenter.org Available POCT • Cardiac markers • Drug/toxicology • Hemoglobin A1c • INR • Heparin • D-Dimer for VTE • Magnesium & Lactate • Lipids • Transcutaneous bilirubin • Micro-albumin, Creatinine • HIV • RSV, Influenza • Helicobacter pylori • Other bacteria • Urine dip tests including pregnancy 14
  15. 15. Shaping the Future of Healthcare | www.thewrightcenter.org POCT We Utilize • Sugar • Hg A1C • Lipid Profile • INR • Urinalysis and Pregnancy test • Lead and H&H • Rapid Strep • RSV • Rapid Flu A/B 15
  16. 16. Shaping the Future of Healthcare | www.thewrightcenter.org POCT Precision for HbA1c and Lipids • Comparison studies to reference labs are standardized and available • Scatter Plots useful • Correlation Coefficients > 95% • Correlation Variables < 2% 16
  17. 17. Shaping the Future of Healthcare | www.thewrightcenter.org HbA1c POCT Volumes All Patients Total tests performed (11/1/12 – 4/30/13) • # HbA1c on All Patients (DM, Pre-Diabetics, PCOS, Suspected diabetics) = 496 • # HbA1c done on All Patients by POCT = 207 • 42 % of all HbA1cs were performed in house for the entire population 17
  18. 18. Shaping the Future of Healthcare | www.thewrightcenter.org HbA1c POCT Volume of Diabetic Patients Total tests performed (11/1/12 – 4/30/13) • # HbA1c on DM Patients Total = 312 • # HbA1c on DM Patients done by POCT = 174 • 56 % of all HbA1cs were performed in house for the diabetic population 18
  19. 19. Shaping the Future of Healthcare | www.thewrightcenter.org Lipids POCT Volumes All Patients Total tests performed (11/1/12 – 4/30/13) • # Lipids on All Patients = 1136 • # Lipids done on All patients by POCT = 80 • Only 7% of all Lipid panels were performed in house for the entire population 19
  20. 20. Shaping the Future of Healthcare | www.thewrightcenter.org Lipids POCT Volumes Diabetes Patients Total tests performed (11/1/12 – 4/30/13) • # Lipids done on DM Patients Total = 225 • # of Lipids done on DM patients by POCT = 44 • 20% of all Lipid Panels were performed in house for the diabetic population 20
  21. 21. Shaping the Future of Healthcare | www.thewrightcenter.org Patient Volume for HbA1c & Lipid POCT 21 42% 56% 7% 20% 58% 44% 93% 80% 0% 20% 40% 60% 80% 100% 120% HbA1c (All Patients) HbA1c (Diabetic Patients) Lipid Panel (All Patients) Lipid Panel (Diabetic Patients) Patients with testing d OFFSITE Patients with testing d POC
  22. 22. Shaping the Future of Healthcare | www.thewrightcenter.org How HIT Can Promote Affordability and Value • POCT device costs and insurance checklists for covered services • POCT affordability reports can track service counts, charges and receipts • DM/HM Alerts can reflect coverage eligibility • Integrating with EMR Lab interfaces can optimize tracking • Customized EMR lab orders avoids duplicate tests • Inventory reconciliation can capture lost charges 22
  23. 23. Shaping the Future of Healthcare | www.thewrightcenter.org POCT CHECK LIST OF WCPC 23 87880-Strep Allowance Cost Medicare $15.13 $1.87 $13.26 Profit MA products $6.30 $1.87 $4.43 Profit Geisinger $12.31 $1.87 $10.44 Profit Blue Shield $15.29 $1.87 $13.42 Profit First Priority Life $11.76 $1.87 $9.89 Profit 81025_Pregnancy Test Medicare $8.70 $1.00 $7.70 Profit MA products $4.00 $1.00 $3.00 Profit Geisinger $7.07 $1.00 $6.07 Profit Blue Shield $7.83 $1.00 $6.83 Profit First Priority Life $6.47 $1.00 $5.47 Profit 87807-RSV Medicare $16.49 $11.36 $5.13 Profit MA Products $12.31 $11.36 $.95 Profit Geisinger $12.31 $11.36 $.95 Profit Blue Shield $11.89 $11.36 $.53 Profit First Priority Life $15.00 $11.36 $3.64 Profit 87804-Rapid Flu A/B Medicare $16.49 x 2 = $32.98 $12.50 $20.48 Profit Ma Products $11.35 x 2 = $22.70 $12.50 $10.20 Profit Geisinger $12.31 x 2 = $24.62 $12.50 $12.12 Profit Blue Shield $14.84 x 2 = $29.68 $12.50 $17.18 Profit First Priority Life $11.76 x 2 = $23.52 $12.50 $11.02 Profit
  24. 24. Shaping the Future of Healthcare | www.thewrightcenter.org POCT CHECK LIST 24 80061-Lipid Profile ALLOWANCE COST Medicare $18.42 $10.80 $7.62 Profit Ma Products $14.00 $10.80 $3.20 Profit Geisinger $14.98 $10.80 $4.18 Profit Blue Shield $15.25 $10.80 $4.45 Profit First Priority Life $21.73 $10.80 $10.93 Profit 83036 - Hg A1C Medicare $13.34 $8.33 $5.01 Profit Ma Products 0 Geisinger $10.85 $8.33 $2.52 Profit Blue Shield $9.63 $8.33 $1.30 Profit First Priority Life $9.92 $8.33 $1.59 Profit 83655-Lead Medicare $16.64 $7.32 $9.32 Profit Ma Products $10.00 $7.32 $2.68 Profit Geisinger $13.53 $7.32 $6.21 Profit Blue Shield $11.65 $7.32 $4.33 Profit First Priority Life $12.37 $7.32 $5.05 Profit 85013 - Medicare $3.26 $0.58 $2.68 Profit Ma Products $3.27 $0.58 $2.69 Profit Geisinger $2.65 $0.58 $2.07 Profit Blue Shield $2.34 $0.58 $1.76 Profit First Priority Life $2.42 $0.58 $1.84 Profit 85018 - Medicare $3.26 $0.57 $2.69 Profit Ma Products $3.27 $0.57 $2.70 Profit Geisinger $2.65 $0.57 $2.08 Profit Blue Shield $2.34 $0.57 $1.77 Profit First Priority Life $2.42 $0.57 $1.85 Profit 85610- Protime Profit Alone 99211 - Level 1 OV Profit w/Level 1 Medicare $5.40 $4.69 $.71 Profit $19.24 $19.95 Ma Products $4.00 $4.69 $20.00 $19.31 Geisinger $4.39 $4.69 $20.08 $19.78 Blue Shield $3.78 $4.69 $30.00 $29.09 First Priority Life $5.62 $4.69 $.93 Profit $26.00 $26.93 With the Coumadin Clinic we charge a Level 1 visit along with the 85610
  25. 25. Shaping the Future of Healthcare | www.thewrightcenter.org Track, Promote and Determine Affordability 25 Allowance Cost Profit 80061-Lipid Profile Medicare $18.42 $10.80 $7.62 Profit Ma Products $14.00 $10.80 $3.20 Profit Geisinger $14.98 $10.80 $4.18 Profit Blue Shield $15.25 $10.80 $4.45 Profit First Priority Life $21.73 $10.80 $10.93 Profit 83036 - HbA1c Medicare $13.34 $8.33 $5.01 Profit Ma Products 0 Geisinger $10.85 $8.33 $2.52 Profit Blue Shield $9.63 $8.33 $1.30 Profit First Priority Life $9.92 $8.33 $1.59 Profit
  26. 26. Shaping the Future of Healthcare | www.thewrightcenter.org 6 Month Revenue Generated 26
  27. 27. Shaping the Future of Healthcare | www.thewrightcenter.org Affordability Punch Line • HbA1c Per Service Collection $7.83 versus cost of $8.33 – Net Loss of $ 49 over 6 month period • Lipids Per Service Collection $14.10 versus cost of $10.80 – Net Profit of $280 over 6 month period 27
  28. 28. Shaping the Future of Healthcare | www.thewrightcenter.org Affordability Punch Line Excluding Uncovered Services • HBA1C Per Service Collection $ 9.85 versus cost of $ 8.33 • Six Month Profit: $259 28
  29. 29. Shaping the Future of Healthcare | www.thewrightcenter.org Have we changed patient outcomes? • A complex question • Providers and patients reportedly like it and believe it enhances planned care provision and chronic disease management at POC. • Staff aren’t complaining. • There was no time based overlay in our HBA1C or LDL process or outcomes run charts with POCT implementation. 29
  30. 30. Shaping the Future of Healthcare | www.thewrightcenter.org Conclusion Selective POCT makes sense, especially for high volume primary care delivery test metrics like HbA1c and Lipids. Test cost: reimbursement of HbA1c and Lipids are close to neutral. Affordability and value delivery assessments are complex. 30
  31. 31. Shaping the Future of Healthcare | www.thewrightcenter.org 31
  32. 32. Shaping the Future of Healthcare | www.thewrightcenter.org For HbA1c testing we use • Afinion AS100 Analyser for HbA1c • The coefficient of Variability (CV) is 1.51% to 1.97% 32
  33. 33. Shaping the Future of Healthcare | www.thewrightcenter.org For Lipid testing we use 33 • Cholestech LDX for lipid • The Coefficient of Variability (CV) is 2-3%

×