This is part 1 of our white paper, it discusses what is a POL, history and trends, why POLs exist, and other introductory material.
All of the sections for this paper have a youtube video as well.
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Practical guide to the U.S. physician office laboratory (POL) Part 1
1. The practical guide to the U.S. Physician office
laboratory (POL)
Part one: What is a POL?
Laboratory Informatics Institute
May 2014
2. The practical guide to the U.S. Physician office
laboratory (POL)
Part one: What is a POL?
Laboratory Informatics Institute
May 2014
3. โ Types of POLs and workflow.
โ History and market trends.
โ Why do POLs exist?
โ Advantages and Disadvantages of running a
POL.
โ How POL integrates with the entire practice.
โ POL or reference lab?
4. What is a POL?
โ POLs are laboratories that are owned,
operated, and managed by physicians.
โ In some states POLs are managed only by
individual physicians, not physician groups.
โ POLs are NOT laboratories that are owned,
operated, and managed by hospitals,
managed care organizations, or other
corporate entities.
5. Types of POLs
โ Primary Care: Doctors trained to provide
primary care to patients.
โ Specialist: Doctors trained to provide
specialized care to patients.
โ For more information about this go to the
white paper using the link at the end of the
slideshow.
7. History and Trends
โ Early Diagnostic Testing.
โ
Diagnostic Testing in the 20th
Century.
8. Early Diagnostic Testing
โ Hippocrates in Ancient Greece.
โ Instituted diagnostic criteria including: listening
to patient lungs, observing skin color, and
examining urine.
โ 50 A.D. Blood in urine is linked to renal failure.
โ 180 A.D. Galen links a normal fluid intake to
normal urine output amounts. Describes
Diabetes as โdiarrhea of urine.โ
9. โ 900 A.D. Isaac Judaeus established a protocol
for using urine in patient diagnosis.
โ 1300 A.D. Examination of urine under a
microscope becomes nearly universal in
Europe.
โ
17th
century sees many innovations in
diagnostic technique, including literature
related to body structures and the formation of
scientific societies.
10. โ First attempt to use pulse and temperature as
indicators of illness.
โ Intravenous drug injections.
โ Identification of sweet tasting urine in patients
with Diabetes.
โ
18th
century also saw many innovations in
diagnostic testing.
11. โ William Hewson develops methods for
measuring coagulants in blood. This set the
stage for modern diagnostic laboratory
practices.
โ Methodology for the use of blood pressure
and temperature as diagnostic indicators
refined.
โ James Currie treats his Typhoid patients by
putting them in a cold bath.
12. โ Sir John Floyer's pulse measuring technique.
โ Tichy's urine analysis technique.
โ Dobson proves that sweetness in blood and
urine for patients with Diabetes is caused by
sugar.
โ Homes develops a yeast test for sugar in
urine.
13. โ
19th
century is the era of Public Health.
โ Independent laboratories begin to develop.
โ Many American physicians go to Europe for
training in laboratory techniques.
โ American opposition to laboratory practice
wanes, as older physicians retire from faculty
positions.
14. โ Pasteurization
โ Aseptic methodologies resulting in fewer
deaths after surgery.
โ Greater emphasis on hygiene practices.
โ X-Ray.
โ Microscopy.
โ ~1850 first hospital laboratories established.
Prior to this testing is done in the physician
office or at the patient bedside.
15. Diagnostic Testing in the 20th
Century
โ Stratification begins: Public Health, Forensic,
and Clinical.
โ 1928 Alexander Fleming accidentally
discovers penicillin.
โ Domagk discovers sulphonomides do not
harm humans, possess antibacterial
attributes.
โ Fleming ushers in the antibiotic age, and
combined with Domagk's work, allows for new
treatments of infections.
16. โ Organizations are founded to certify laboratory
personnel. American Society for Clinical
Pathology (ASCP) founded in 1922.
โ Organizations like ASCP, combined with the
new treatments coming out of laboratories
earn professional respect and legitimacy for
laboratory personnel by the end of the 1950s.
โ 1965 Medicare is seen as โFree moneyโ in the
health care industry.
17. โ 1967 Clinical Laboratory Improvement Act
(CLIA) took effect as an attempt to regulate
laboratory practice across state lines.
โ 1988 CLIA is amended to include nearly all
laboratories operating in the U.S.
โ 1989 an estimated 98,400 POLs operated in
the U.S.
โ 20,000-200,000 variation is due to lack of
standard definition of POL and self reporting
of status by physicians.
18. โ Some issues related to standardized
definitions persist today.
โ 1989: 25% of all laboratory testing conducted
in POLs.
โ 1989: $20 Billion spent annually on laboratory
testing. POLs received $5 Billion.
โ 1989: Medicare was paying over $400 million
to POLs.
โ 1989: 16 states had laws related to POLs.
19. โ 1995 onward finds that clearer understanding
of regulations and acceptance of regulations
results in CLIA waived tests growing from 8 to
40.
20. Market Trends
โ December 2013 number of POLs 120,399 or
49% of all laboratories in the U.S.
โ 2013: 60% of POLs running CLIA waived
testing.
โ 2013: 24% hold certifications for provider
performed microscopy (PPM) testing.
21. โ Growth of POLs is expected to increase.
โ Aging population of baby boomers with money
to finance laboratory tests.
โ Increased awareness of health care topics.
โ Softening stance of payors related to testing.
โ Expansion of CLIA waived testing list.
22. Why do POLs exist?
โ Subset of point of care testing (POCT).
โ Testing done at the patient's location.
โ Clinical medicine became more complicated
and physicians needed to perform these tests.
โ Industry was looking for a cheaper way to
provide laboratory services.
โ Additional revenue stream for physician.
โ Provide quality diagnoses, treatment, and care
to patients.
23. Advantages and disadvantages of
running a POL
โ In the early days lack of regulation could have
been considered a disadvantage.
โ These lists are not exhaustive.
24. Advantages
โ Quicker access to laboratory test results for
the clinician, resulting in expanded pool of
treatment options for patients.
โ Greater efficiency of clinical workflow.
โ Cheaper testing: subject to individual test
pricing.
โ Patient comfort and happiness, including time
saved by having to go to only one location.
25. Disadvantages
โ Physician office being the only point of
access: some physicians may be reluctant to
release results to a third party e.g. hospitals.
โ This may be eliminated per the February 2014
changes that require a laboratory to give
results directly to patients when requested.
โ Physicians may not see the value in having a
laboratory as part of their practice.
26. โ Patients may feel uncomfortable about the
physician office being a central repository of
information.
โ Cost of compliance with local, federal, and
state regulations dependent upon the
regulatory environment of individual practice.
โ Not an exhaustive list.
27. How the POL integrates with the entire
practice
โ Stores patient laboratory data in a form that
improves information exchange between
laboratory and broader patient record.
โ Avoids disconnect between reference lab and
physician office, allowing for tighter
integration.
โ POL can assist the financial department by
supplying data to track cost and revenue
trends.
28. โ POL can use laboratory data to assist with
population trends, leading to appropriate
interventions such as community education
programs.
29. POL or reference lab?
โ Many POL tests are CLIA waived and simple
to perform.
โ In a rural environment the POL may be the
only option.
โ The decision should be based on a balance of
appropriate measures that serve the needs of
both practitioner and patient.
30. For more information
โ Link to white paper with references:
http://tinyurl.com/oqorxvu
โ Contact the institute via our website:
http://tinyurl.com/o5o23fp