Could an in-house lab be right for your practice?

Key Points

Seven years ago, at an annual ACP meeting, a vendor asked me who was performing my lab work. As an internist, I use lab data as an integral part of the information I gather to help me treat and advise patients.

I replied that a major lab company was doing my lab work and that I had little control over quality and the reports I received. He countered that I was throwing away $120,000 a year, especially on the Medicare lab draws. He also told me that lipid profiles and chemistries for office and independent labs were reimbursed at a good rate.

After approval by our group, we asked a vendor to develop the plans for a draw station and the conversion of our lunch room to a lab. We discussed the purchase of lab equipment with our banker, who agreed that it was a good move. We borrowed $250,000 over a 5-year period and hired a lab technician who had 25 years' experience. The technician hired a former lab colleague. We also found a specialist who wrote our lab manual.

OVERCOMING A FEW HURDLES

Of course-as with everything-eventually some problems occurred. One employee's behavior become problematic and he quit when confronted. We hired a replacement who has worked out well.

When seeking reliable lab personnel, ask your local hospital's technicians for recommendations. Also, rely on your lab director's expertise when staffing your lab.

We have two full-time lab personnel who work in shifts; one arrives early to start-up the equipment and the other stays late to close down the lab. A part-time staff member picks up specimens and helps out in the lab. We now have two phlebotomists, a lab director, and a lab technician.

We purchased a chemistry analyzer that the salesperson insisted would serve us well. It was designed to run panels in a moderately complex lab. Unfortunately, this analyzer took 2 hours to bring online, calibrate, and run standards. Results never were accurate. We asked the salesperson to take it back and get us another machine; he refused. Subsequent legal action led to a settlement. Our lab director guided us to a quality machine that fit our needs, and it has performed well since we installed it.