DOH/Provider Meeting: Urgent Issues related to Laboratory Services

Nancy Leveille and Stephen B. Hanse in Clinical & Quality

NYSHFA staff and representatives from our member organizations attended a meeting on September 4, 2018, with other state associations and various departments of DOH related to the impeding change of service starting to occur with vendor Laboratories as they begin to pull back services to SNF due to reduced reimbursement for those services. 

NYSHFA discussed that there are a number of positive elements to providing point of care service for residents, but there still are many issues that need to be addressed before these lab services are discontinued to ensure safety of the SNF residents. The ability to provide phlebotomy 24/7 is a main concern, along with the ability to purchase and become competent in utilizing a point of care system for a number of lab tests and the interface with the electronic health record. We discussed the need to create and critically assess a full business model and implementation strategy before the SNF could commit to taking on a larger portion of providing laboratory services.

Bio Reference Laboratories gave SNF in NYS a 30-day notice in late August, that they will no longer provide phlebotomy services to SNF at the end of September. NYSHFA encourages all SNF to prepare their facilities for this potential by assessing their ability to provide phlebotomy services 24/7; discuss assistance their hospitals may be able to provide, assess their current CLIA waiver and what may need to be changed and to explore other technology that could be utilized for point of care service. We will discuss this at our next Town Hall Meeting on Thursday, September 20 at 11:00 am.

NYSHFA asked DOH to schedule a follow-up meeting within the next month to assess the potential outcomes of this action.

Below is a summary the DOH provided of the meeting and next steps that were identified.

Challenges Nursing Homes are facing with respect to lab services

  • Some labs are no longer willing to provide phlebotomy services, some discontinuing this service as soon as the end of September
  • Nursing homes will need to find phlebotomist or train/hire staff to perform those services 

There is a consensus hybrid model needed

  • Hybrid model would consist of nursing home performing point of care lab work using waived tests and have outside lab/hospital lab perform more complex lab tests such as blood cultures  

Steps needed to implement hybrid model

  • Nursing homes need to find phlebotomist or train/hire staff to perform those services for point of care lab work
  • Nursing home needs to purchase point of care equipment and cartridges
  • Nursing home needs to train staff how to use point of care system
  • Nursing home needs to contract with outside lab or hospital lab to perform more complex lab tests such as cultures  
  • If nursing home using hospital to perform non-point of care lab work:
    • EHR connectivity needs to established with nursing home and hospital lab, easier if using hospital with robust outpatient lab
    • Need courier service to bring blood from nursing home to hospital lab in acceptable time frame
  • All required point-of-care tests may not currently be available as CLIA-waived so there may be some simple tests that need to still be done by a commercial lab. 

Next Steps

Task

Lead

Timeframe

Assess nursing home level of understanding of issues, as well as impact  

NH Associations

Before we meet again in early October  

Gather information regarding other states

NH Associations

Before we meet again in early October  

Perform a cost analysis of switching to hybrid model

Nursing home providers

Before we meet again in early October, if possible  

Reach out to hospitals regarding ability/willingness to provide lab services, phlebotomy and courier services

GNY and HANYS

Before we meet again in early October  

Perform HERDS survey to assess existing lab capability, as well as with respect to hybrid model

 

DOH-OPCHSM

Survey target date 9/10

Perform Webinar on CLIA- waived tests

 

DOH-OPH

Before we meet again in early October  

Meet in early October to discuss follow-up items as well as reimbursement issues

 

Entire group

Early October


NYSHFA CONTACTS: 

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20 

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11