Clinical Outcomes and Economics of Point of Care Testing

Meeting Minutes:

The meeting was held at the Hershey Medical Center with Peter Gawron and Bette Seamonds, PhD as hosts.  The meeting was called to order at 0915 with opening remarks made by Peter Gawron.  At this time Dr. Seamonds was recognized for her help in organizing the meeting.  Also recognized were all vendors for their participation and advocacy toward KEYPOCC.

The Benefits of Point of Care INR Testing

Dr. Alan Jacobson (click here for bio) presented on the Benefits of Point of Care INR testing.  He began his presentation by discussing the challenges of anticoagulation therapy.  He further discussed the advantages and disadvantages of three models of monitoring patient anticoagulation therapy : Central laboratory testing with professional management of results, Point of Care Testing with professional management and Point of Care Testing with Patient or Professional Management of results.  His discussion of these models was followed by Dr. Jacobson’s presentation on an anticoagulation management approach known as “”Systemic Anticoagulation Management”.   The essence of such an approach is direct, active management by a qualified healthcare provider ensuring:

• Reliable patient scheduling and tracking

• Accessible, accurate and frequent PT testing

• Patient specific decision support and interaction

• Within a context of ongoing patient education and QC

Dr. Jacobson concluded his presentation by discussing the financial considerations of Systemic Anticoagulation Management.  The economic analysis discussed in Dr. Jacobson’s presentation demonstrated that systemic anticoagulation management is a more cost effective strategy than routine medical care for patients on anticoagulant therapy.  Cost savings under the Systematic Anticoagulation Management strategy were achieved through the reduction of costs associated with decreased thromboembolic and hemorrhagic adverse events, although costs for drug monitoring were greater under this strategy than for rationale management.

POCT Impact on Patient Outcomes

Speaking on POCT Impact on Patient Outcomes was Gregory Shipp, M.D. (click here for bio).  Gregory is the Vice President of Medical Affairs for i-STAT Corporation.   Greg cited several studies of how positively POCT impacts patient care outcomes.  He gave information of what is needed to perform an outcome study:

• Do a true observational study

• Do study prospectively

• Minimize the sources of variability

• Use management algorithms that assure consistent intervention

• Choose outcome measures that may be quantitated.

• Use outcome variables whose values become determined in close proximity to the testing event.

• Use outcomes that may be surrogate names for long term outcomes

• Choose outcomes that have intrinsic financial value

• Identify specific factors that may have effected the results.

Click here to view presentation

Billing for POCT

Speaking on “Billing for POCT” was Joan Logue (click here for bio).  Joan Logue is a principal with Health Systems Concepts and its affiliated company Clinical Laboratory Concepts.  Joan discussed the cost considerations necessary when undergoing the task of determining whether your institution should bill for point of care testing. 

• Estimate your potential revenue by looking at your projected volumes and at your payer mix.

• Measurements of success would be to evaluate the additional revenue captured and the reduced cost of patient care.

• Capturing Point of Care Testing charges is dependent on the complexity of the clinical setting, the availability of efficient communication technology and a thorough understanding of the various payment criteria.

• Joan urged POCCs to ensure that the POC laboratory tests that are performed by non-laboratory departments, have CPT codes that are consistent with the revenue codes of 300-309 (lab).

• Investigate compliance issues such as coding, medical necessity, documentation, National Coverage Policies and Local Medical Review Policies.

Joan added an interesting note: She stated that the goal for waived testing on the Clinical Laboratory Fee Schedule was to reduce payment.  There is a perception that waived POC Testing is “simple” which translates to “pay less”.

Business Meeting

Following an Italian lunch sponsored by Abbott Diagnostics KEYPOCC held its Business Meeting.

Beverly discussed the Non-Profit Status of the group.  KEYPOCC must go thru an “advanced ruling period” or probationary period, which will last four years.  At the end of the four year period the “not for profit status” will be finalized.  The Constitution and By Laws were amended by the officers of KEYPOCC on 9/17/02, under the advisement of Beverly McAllister.  Amendments were made in regards to the organizations purpose, maintenance of funds, and dissolution of the organization.

Beverly further discussed the Treasurers Report.  She will begin looking for an interest bearing account to help our funds grow.

Nomination and Election of 2003 Officers were discussed.  Wendy handed out ballots to all KEYPOCC members.  She announced that a mailing would go out to the group informing all of the nomination process.  Nominations are being accepted up until November 1, 2002.  After all nominations are received Wendy will contact all nominees.  On November 15^th all willing nominees will be placed on the election ballot which will be distributed to the members of the group.  All election ballots must then be returned to Wendy Van Dyke, secretary by December 1, 2002.  New officers will then be presented at the December KEYPOCC meeting.

On behalf on Jackie Kennedy, Dawn Earnest announced that Roche will be sponsoring AACC Audioconferences which will be held at Brady Hall located at Harrisburg Hospital.  The first two audioconferences will be held on November 13^th and November 20^th.    More information will be sent to the group from Dawn Earnest.

December Meeting plans were discussed.  The December meeting will focus on POL testing.  Perspective speakers are Dr. Robert Sautter speaking on PMPP; Dr. Wallace Green from Hershey speaking on Influenza Testing, and Dr. Arthur Crist from York Hospital speaking on Rapid Strep Testing.  Dawn Earnest and Jen Barkman will host the meeting.

2003 Meeting hosts were selected:

Information packets were given to all new hosts to help them prepare for their upcoming meetings.  Evaluation of the meeting was favorable and the meeting was adjourned at 1530.

Minutes respectfully submitted by Wendy Van Dyke

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