Core Group
Darlene Benson
UCONN Health Center/John Dempsey Hospital

Cathy Coyle
Norwalk Hospital

Laurie Flamino
Hartford Hospital

Diana Luca
St. Vincent's Hospital

Dr. Salvador Sena
Danbury Hospital

Andrea Spence
Hartford Hospital

Hospital Demographics

Survey Results

Questionarrie
CVPOC Home

Point-of-Care Discussions
and Reflections

The following is a recap from our inaugural meeting at the Connecticut Hospital Association in Wallingford, CT on September 24, 2002.

ATTENDEES

  • Cindy Dubowski, Waterbury Hospital

  • Gail Sawyer, William Backus Hospital

  • Darlene Benson, UCONN Health Center

  • Cathy Coyle, Norwalk Hospital

  • Vijaykant Kambli, Norwalk Hospital

  • Diana Luca, St. Vincent’s Medical Center

  • Karen Scorel, Yale New Haven Hospital

  • Lisa Vaccarelli, St. Mary’s Hospital

  • Rose Riordan, St. Mary’s Hospital

  • Nancy Ryan, Greenwich Hospital

  • Judy D’Amico, Middlesex Hospital

  • Shala Stickney, Charlotte Hungerford Hospital

  • Marcy Anderson, Medical Automation Systems

12:00-12:20pm
  • Registration:   Contact information updated

  • Name Tags issued

Sign-up for breakout groups:  

  • Billing

  • QC

  • Connectivity

  • Regulatory Compliance

Welcome and opening remarks by:

  • Marcy Anderson, MAS – sponsor and organizer

  • Core Group:                  

  • Sal Senna

  • Darlene Benson

  • Cathy Coyle

  • Diana Luca

12:20-12:50pm Lunch courtesy of Medical Automation Systems
12:50pm

Ice Breaker (Marcy Anderson):
Yarn Activity introducing ourselves and stating the POC subject in which we are most interested.

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Name

Issue

Diana

Wants limits on what ER does

Lisa

Documenting QC

Paul

Review and discuss billing of POCT

Gail

Just keeping track of everyone who is doing testing

Judy

Complete Connectivity; LIS to HIS.

Rose

We have a POC committee- don’t use forms.  We buy equipment without knowing all the ramifications.

Shala

Upgrading glucose meters and adding connectivity.

Cathy

Competencies and physicians and residents documenting QC

Barbara

Competencies; Keeping track: What is the best way to do this?

Cindy

Dating reagent test bottles and QC vials.  There is no compliance.

Karen

ACT instrument replacements.

Sal Sena

Wish nurses would think like med techs.

Darlene

Connectivity!!

Dr. Kambli

Usage of test strips and why so many are being used.

1:00-2:00pm Break Out Group Discussions – designed to help the group get organized as to future programs to present (summaries below)
2:00-2:15pm Survey of attendees conducted (click here)
2:15pm Shared Summaries from Breakout Sessions

REGULATORY COMPLIANCE – Issue to Consider

1.       A facility POCT Committee should include:

  • Lab

  • Purchasing

  • Nursing

  • Director/Pathologist POCT

  • Biomedical Engineering

2.       POCT in the Emergency Room

  • Urine HCG

  • Rapid Strep testing

  • Bayer Clinitek 50 Urine Analyzer

3.       Form used to introduce POCT in a facility/location

Purpose:   

a.  pinpoints why the central lab is not meeting the testing need, giving the laboratory an opportunity to consider resolutions without  POCT

b.       motivates the requesting site to give serious consideration to the POC accountability required for POC, and to whether or not there would actually be an improved outcome for the patients.

c.       helps the POC committee document the history of having considered each test, and the rationale for acceptance/denial.

d.   Identifies responsible person on the patient care unit

            - attendees with such a form offered to share with those who do not.

4.       Competency documentation

5.       Performers of POCT

6.       Documentation of QC

7.       Reference ranges on patient flow sheet

8.   Barcode wristbands

9.   Automated QC lockouts

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CONNECTIVITY

ADVANTAGES

  • Billing compliance

  • Real time QC/QM
    -  critical values

  • Saves time/labor

  • Data capture

  • Regulatory compliance

  • Inventory tracking and control

  • Report with reference ranges

  • Electronic medical record

  • Data analysis (diabetes educator
    -  QA

PITFALLS

  • Large number of network connections

  • Budget considerations

  • Who is responsible?
    - Maintaining network
    - Troubleshooting

  • I.T. support

  • Who pays?

  • Administrative support

  • Patient identification issues

  • Bar-coded wristbands
    – without the barcodes proper patient ID entry remains manual and subject to error

KEY IMPLEMENTATION STEPS

1.       Get administrative support - discussions related to medical errors

2.       Form interdisciplinary planning and implementation group

- should include Lab, Nursing, Purchasing, Information Services, Performance Improvement Dept.  

 - Use all the support the vendor can offer.

3.       Budget planning

4.       Patient identification – standardize the process

5.       Mechanism for error corrections

6.       Plans Outcomes Measurements

Also to consider:

-  Connectivity for Non-instrumented tests  (dipstick, occult blood, etc.)

-  Standardization issues (connectivity consortium)

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BILLING

Group would like a speaker to address questions related to billing and reimburssement:

  • what can you bill for?

  • -when should the billing occur? – Medicare requirements within 24/48 hours?

  • how do we verify that billing for the service has actually occurred?

  • what is the reimburssement rate for each test? (and would we be reimbursed at all?)

  • what are common reasons for payment denials?

  • How do we verify accounting balances:   # of tests performed/ # billed/ # reimburssed?

  • Billing is different for inpatient vs. outpatient

    • Inpatient = DRG/ bundling

    • Outpatient = CPT with modifier codes  (what are appropriate modifier codes and when should they be used?)

  • How do we monitor compliance with manual charge-posting systems

  • What references are available to us to help us with these questions?

  • Would also like related HIPPA information - diagnosis codes; regulations/limitations

    • ABN’s

    • LMRP

Recommended speaker:

Chris Fetters, consultant

- Would CHA have a contact for more local billing regulations

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3:00pm

Dr. Sal Sena shared Survey summary
(click here for results)

  • Group prefers quarterly meetings:  making the next one in December 2002

Suggested speakers/ presenters:

  • Chris Fetters, consultant   -  Billing (inquire as to his fee and ask him for recommendations regarding vendor sponsorship for his topic – previous experience)

  • Marcia Zucker from ITC = coagulation tests

  • Sharon Ehrmeyer = regulatory Compliance

  • Jim Nichols = CIC and other POCT topics

  • Lou Dunka = Connectivity globally

  • Marcy Anderson = connectivity/Data management

  • Amy Nix = Thermobiostar has offered to sponsor our group and can present their new POC UA analyzer, and  a rapid RSV test.

  • Steven Kellett, Senior Products Manager, POC platform, Phillips Medical – Contacted Diana when learning of our group organizing and is looking for opportunities to test and validate a series of new product concepts for a ‘next generation POC platform.

Also consider:

  • A CAP inspector from home office to come out and talk

  • JCAHO inspector form home office

  • CT State Inspector to come and talk

  • Someone from our own institutions may be able to address cardiac markers, pro times etc.

  • Consider sharing meeting information with the Baystate Group (MA)

3:00pm Meeting Adjourned

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Last updated: 10/07/2002
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