The value of near patient testing is
proven. It reduces costs and improves
the care patients receive.
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    Breakthroughs in science and technological progress are tremendously beneficial, especially when focused on improving the quality of our lives. In the case of laboratory testing, human ingenuity has resulted in innovative technology which enables clinicians to perform real-time testing in a variety of care settings, including medical practices, nursing homes, patient-centered medical homes, accountable care organizations, and more.

     

     

    Near patient clinical laboratory testing is invaluable to early diagnosis and chronic disease management and it can prevent patients from accessing more expensive care settings. In cases where technology reduces healthcare costs downstream, we have the chance to improve the quality of our lives while being smart about how we spend our healthcare dollars.

     

    • EARLY DIAGNOSIS & TREATMENT

    Physicians across the United States share their knowledge on the importance of
    near patient (in-office) clinical testing to their medical practice and the implications
    to patient care if they are no longer able to provide these services.
    For more information, view/download this primer

    COMMON TESTS PERFORMED NEAR PATIENTS

    Vital to diagnosis and treatment of common acute illnesses and disease.

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    Also known as Glycated Hemoglobin A1c Test

    Diagnosis/Treatment Benefits: Developed to screen, diagnose and monitor diabetes and prediabetes.

    Who typically orders this test: Internal Medicine, Family Medicine, Endocrinology and Nephrology Generally, primary care physicians will order these tests to diagnose diabetes or pre-diabetes or to monitor a patient’s diabetic treatment plan.

    Endocrinologists, who care for patients with more advanced cases of diabetes, will order an A1c test in the ongoing treatment of patients. Nephrologists who are monitoring patients for diabetic nephropathy or diabetic kidney disease will also order an A1c in the course of caring for their patients.

    To see how this test will be impacted by significant changes in how the Center for Medicare and Medicaid Services (CMS) determines payment rates click here.

    If you want to know more about the benefits of this test visit:

    Learn More

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    Also known as Complete Blood Count with auto differential

    Diagnostic/Treatment Benefits: The CBC is used as a broad screening test to determine an individual’s general health status and is used to evaluate the three types of cells (red, white and platelets) that circulate in the blood.

    Who Typically Orders this Test: Internal Medicine, Family Medicine, Oncology, Pediatrics, Nephrology and Surgical Specialties This test is routinely ordered by almost all providers in almost every setting, from doctors’ offices to hospitals. Primary care physicians will generally order a CBC as part of a routine health examination to see if the results are within the normal limits. They may also order a CBC when a person has any number of signs and symptoms that may be related to disorders that affect blood cells, such as: fatigue or weakness or has an infection, inflammation, bruising, or bleeding. Then the primary care physician may also order CBC’s to help diagnose the cause and/or determine the severity of the blood disorder.

    Primary care providers and nephrologists will order a CBC on a regular basis to monitor a blood related condition and also to monitor if the treatment is effective. Oncologists will use real time laboratory information from a CBC to monitor the impact of chemotherapy on their patients and if a patient’s cancer treatment needs to be adjusted.

    To see how this test will be impacted by the 2018 Clinical Laboratory Fee Schedule Cuts click here.

    To learn more about the benefits of this test visit:

    Learn More

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    Also known as Comprehensive Metabolic panel

    Diagnostic/Treatment Benefits: The CMP provides preventative screening information about the current status of a patient’s metabolism and importantly the overall health and function of the kidneys and liver. It is also used to check organ function for patients with diabetes, liver or kidney disease, including kidney failure. The side effects of medications on major organs can also be detected through a CMP.

    Who Typically Orders this Test: Internal Medicine, Family Medicine, Oncology, Nephrology and Endocrinology Primary care providers use the information provided by CMP as a routine panel during the preventive annual physical for a patient to determine the current overall health position of their patient. Also, primary care physicians commonly use CMP when trying to diagnose an acute medical concern.

    Sometimes, several sets of CMPs, often performed on different days, may be used to gain insights into the underlying condition and if that condition is responding to a particular treatment. In addition, a Nephrologist will use a CMP to monitor kidney function in a patient. Endocrinologists will use the CMP to monitor organ function while treating a diabetic patient.

    To see how this test will be impacted by the 2018 Clinical Laboratory Fee Schedule Cuts click here.

    To learn more about the benefits of this test visit:

    Learn More

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    Also known as Thyroid-Stimulating Hormone

    Diagnosis and Treatment Benefits: The TSH is used for preventative screening and to assist in the diagnosis of thyroid disorders. It is also invaluable to monitoring treatment of hypothyroidism and hyperthyroidism.

    Who Typically Orders this Test: Internal Medicine, Family Medicine and Endocrinology The TSH is commonly ordered by primary care physicians when diagnosing a thyroid disorder, or screening newborns for an underactive thyroid or helping to diagnose and monitor infertility problems in women. An endocrinologist will order a TSH to monitor treatments for hypothyroidism such as thyroid replacement therapy or anti-thyroid treatment in people with hyperthyroidism.

    To see how this test will be impacted by the 2018 Clinical Laboratory Fee Schedule Cuts click here.

    To learn more about the benefits of this test visit:

    Learn More

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    Also known as Prothrombin Time

    Diagnosis/Treatment Benefits: A prothrombin time (PT) is a test used to help detect and diagnose a bleeding disorder or excessive clotting disorder.

    Who Typically Orders this Test: Internal Medicine, Family Medicine, Oncology, Cardiology, General Surgery and OB/GYNs The PT is used by physicians to assist in the diagnosis in the cause of unexplained bleeding or inappropriate blood clots. Physicians will also order a PT test to monitor patients who are on anticoagulant (blood-thinning) medication. Physicians will do this to ensure that the patient is not receiving too much or too little medication and will adjust accordingly.

    To see how this test will be impacted by the 2018 Clinical Laboratory Fee Schedule Cuts click here.

    To learn more about the benefits of this test visit:

    Learn More

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    Also known as Assay of Natriuretic Peptide

    Diagnosis and Treatment Benefits: The BNP helps physicians detect, diagnose, and evaluate the severity of congestive heart failure. Congestive heart failure or heart failure, is when the heart can no longer pump blood as efficiently as it used to. This causes blood and other fluids to back up in the body, particularly in the liver, lungs, hands, and feet.

    Who Typically Orders this Test: Internal Medicine, Family Medicine, Emergency Medicine The BNP is used when congestive heart failure is suspected along with other tests to confirm a diagnosis. This test can also be done by a
    primary care physician or a cardiologist to monitor the effectiveness of a treatment regimen.

    To see how this test will be impacted by the 2018 Clinical Laboratory Fee Schedule Cuts click here.

    To learn more about the benefits of this test visit:

    Learn More

    • NEAR PATIENT TESTING SAVES LIVES IN RURAL COMMUNITIES

    “The results would have been too late. The patient would have died without it.”
    Clinician, Rural Kentucky Community

    Physicians in rural communities share their views on the value of the near patient testing in their communities as well
    as the impact on elderly patients. This research study reveals the unique challenges of elderly patients residing
    in our most rural communities in accessing clinical laboratory services.

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    “Patients are waiting in the emergency room because their diagnosis is delayed.”

    According Dr. ID, near patient testing enables early diagnosis and treatment, which can help the patient avoid a medical emergency.

    “I see patients in the emergency room because they have a diagnosis that is delayed.” This leads to “increased cost of care because you did not know sooner” also creating “increased hospitalization and ER visits…” and then we “wonder why we didn’t take care of it during their office visit.”

      Download to read ID story
    Download to read all stories

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    “As an oncologist, I need lab information right away.”

    The experience of Dr. MI, who practices in a rural community, vividly illustrates near patient testing as integral to crafting a patient’s treatment plan. If a cancer patient’s kidney function is abnormal, Dr. MI explained the treatment may need to be adjusted. As revealed by Dr. MI dynamic, real-time laboratory information is crucial to treating cancer.

    According to the oncologist, a patient’s condition “can change over days or hours. To have testing on the day of treatment, before we start, is very important.”

     

    Download to read MI story
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    “The LAB is Essential to our Practice.”

    In this rural community the closest laboratories are 80 and 100 miles from the clinic. For Dr. WY, this means if the clinic “no longer provided lab work, elderly patients would have to travel a long distance.”

    Elderly patients who are reluctant to give up their car keys put their safety at risk. “One of my elderly patients fell asleep while driving her car and drove off the road,” shared Dr. WY.

     

    Download to read WY story
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    “It would have a devastating effect in our community.”

    Dr. OK is a family physician practicing in an entirely rural community. During the interview, Dr. OK shared about the scarcity of access to laboratory services in this community.

    Dr. OK shared that the closest laboratory is “300 miles away.” If the 3 physician practice no longer provided laboratory services “it would be devastating to our community,” Dr. OK added.

     

    Download to read OK story
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    “As rural as you can get.”

    In dialogue with Dr. KY, it was revealed that this community is “as rural as you can get.” According to Dr, KY, cell phone use “is nil” and land-line use is limited. “It can be very difficult to reach patients.”

    When asked about the relevancy of access to laboratory testing in their rural-community practice, Dr. KY described it is as “very important.” Dr. KY was asked to elaborate on the significance of lab testing access by way of an example of patients who benefited from having laboratory testing services in their rural clinic…

     

    Download to read KY story
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    • THREATS

    In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to direct the Centers for Medicare and Medicaid Services (CMS) to develop a market-based methodology for determining the future rates Medicare will pay for tests under the Clinical Laboratory Fee Schedule (CLFS). To date, CMS has collected data from laboratories nationwide who were required to report private payer rates under the PAMA regulations. However, there is widespread concern that the data is fraught with inaccuracies.

    Despite these concerns, CMS released the preliminary rate determinations on September 22, 2017 and cuts in routine tests that physicians use every day to diagnosis and treat patients will be even more than projected. Fortunately, physician organizations, led by the American Medical Association, are now lobbying Congress and CMS to ensure that patients continue to receive the benefits of patient testing clinical laboratory testing in their community.

    PDF download: Primer on PAMAPAMA Coalition

    NEAR PATIENT TESTING
    DURING AN OUTBREAK

    Our interconnected society makes it vital that our public health professionals get quick, real-time access to diagnostic information when the next epidemic disease breaks out so they can quickly identify the disease and a possible treatment. Physicians who provide laboratory services in their practice are able to rule out other potential infections fast in their own laboratory while the patient waits.  If the infection is not identifiable, the physician can quickly refer the specimen to a reference laboratory or directly to the public health lab. The faster these diseases are identified, the faster we can treat these patients and the more likely we will save their lives.

    RECENT NEWS & EVENTS

    Feb132020

    COLA Inc. Releases Preliminary Data from 2019 PAMA Impact Survey

    Under the Protecting Access to Medicare Act (PAMA), Congress changed the way Medicare determines rates for the Clinical Laboratory Fee Schedule (CLFS), and the implementation of PAMA led to a significant cut for a majority of the routine tests relied upon every day in the diagnosis and treatment of patients. Concerned about the impact of…

    Aug152019
    PAMA’s actual effects

    COLA Inc. Conducting New Survey on PAMA’s Impact on Clinical Laboratories

    COLA Inc., a nationally-recognized private, non-profit laboratory accreditation organization, is inviting clinical laboratories to participate in a new survey to gather data about how cuts in Medicare’s Clinical Laboratory Fee Schedule (CLFS) are impacting their services to patients. Since the implementation of the Protecting Access to Medicare Act (PAMA) of 2014, clinical laboratories have experienced…

    VIEW ALL NEWS

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    EXPLORATIVE RESEARCH STUDY

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    COLA is gathering information through in-depth interviews and a national practice survey. The interviews are being conducted in a semi-structured, confidential manner. Study participants are encouraged to share specific patient positive or negative experiences of the impact of access to laboratory services on patient care.

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    COLA is making the preliminary findings of this explorative study available as a way of contributing to the broader policy discussions related to Medicare. These stories shine a light on the unintended impact of national policy decisions on the lives of people at the local or community level. The preliminary findings of this study are not meant to represent all experiences of patients, elderly patients, or healthcare providers.

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    Further research is needed to support physicians and their patients in the area of access to near patient laboratory services. Additional research can serve to portray a comprehensive representation of common experiences and existing challenges due to the current status of laboratory services in communities nationwide.

     

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    Rural community physicians providing clinical laboratory services within their medical practice were randomly contacted to participate in this study.  Specifically, COLA contacted physicians with in-office laboratories, who are located in counties that make up some of the most rural counties in the nation.  Researchers defined a rural county in the United States as a county with a total resident population of only 19,999 or less based on the online public data classification of the United States Department of Agriculture (USDA).

    The interviews were semi-structured and conducted in a confidential manner. The semi-structured format enabled our researchers to capture specific data, while at the same time, allowing free space for the physicians to have an opportunity to engage in conversation in order to enrich our understanding of the clinical importance of lab testing.

    In addition to the in-depth interviews, COLA designed a national practice survey to gather additional quantitative and qualitative data relating to the value of near patient testing to diagnosis and treatment for patients.  The survey was administered through Survey Monkey.

    A literature review is also a part of this study.  If you are interested in receiving further information, email the COLA Research Team at research@cola.org

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    Thank you for your interest in the information provided by COLA on our website.  To use information, publications, or data we have shared on this website in any manner, requires permission from COLA.  Please contact COLA’s Research Team in writing for permission.  Please include your contact information and describe what information or data you will use and how it will be used.  You may reach us by email at research@cola.org.  Study results found on this website currently represent the preliminary data for our study on the value of near patient testing.  Visit this site regularly for research updates or subscribe to our email alerts.