Making a Point
Edition: April 2010 - Vol 18 Number 04
Author: Laura Thill
Point-of-care testing can play an important role in nursing homes and long-term-care facilities, say experts. But, they advise administrators to adopt testing programs not simply as a revenue source, but as a means to providing better, more efficient patient care. Yes, point of care testing makes a lot of sense from both a financial and patient care standpoint, notes Bryan Craven, sales manager of the medical division at Turenne PharMedCo Inc. (Montgomery, Ala.). “But, for nursing homes to invest in tests and staff training is a big decision,” he points out. “If they do this in the spirit of trying to provide better patient care, that’s worthwhile. If they do this in the spirit of trying to increase reimbursement, they are missing the boat.”
Take prothrombin time/international normalized ratio (PT/INR) testing, a big seller for Craven. A PT test is used to check for bleeding problems or to determine whether the patient’s anti-coagulant (blood-thinning medication), such as warfarin, is working to prevent blood clots. The “INR” stands for a way of standardizing the results of prothrombin tests, so that the physician can interpret the test results in the same way, even when they come from different labs and different test methods. “With regard to the PT/INR test, if [nursing home administrators] are basing their decision to add this test on revenue, that’s a bad decision,” says Craven. Although they may save money and generate revenue by running these tests in house, “It won’t be enough to justify the cost of adding the test,” he points out.
The bottom line is, point-of-care PT/INR testing provides results faster, such that they can be immediately reported to the physician in charge who can quickly adjust the patient’s medication if necessary. In the case of a patient who is bleeding profusely, this can be a life-saving decision, he adds. “In this situation, the test is a great risk reduction.”
Indeed, one of a sales rep’s greatest opportunities is to show his or her customers how to provide better patient care, according to Craven. And, as the price point of the machines used to run the tests has come down, and the PT/INR test has become more affordable, “the test has gained some traction in the last couple of years,” says Craven. “Three or four years ago, these machines were so expensive, it made it very difficult to justify PT/INR testing in a long-term-care setting,” he says. “Manufacturers have done a good job of making these tests more accessible to long-term-care customers.” So, when customers purchase a machine along with test strips, dealers like PharMedCo can discount the machine, he adds.
The fact that it’s CLIA-waived makes it that much more attractive to long-term-care providers. To be considered CLIA-waived, tests must either be simple laboratory examinations and procedures that are cleared by the federal government for home use; employ methodologies that are so simple and accurate that erroneous results would be negligible; or pose no reasonable risk of harm to the patient if the test is performed incorrectly.
Sometimes, nursing home customers in metro areas can be tougher sells than those located in rural areas. “Often, rural nursing homes gravitate toward point-of-care testing, while metro-based homes tend to partner with outside labs,” says Craven. Generally, metro labs can pick up a batch of tests in the morning and turn around the results very quickly, he explains, making this an attractive proposition for administrators. Nursing homes affiliated with hospitals also will not be target customers, he says.
Another point for sales reps to consider is that metro-based nursing homes tend not to run their patient testing programs on weekends, according to Craven. “Often, labs are closed over the weekend, or they charge a premium for weekend service,” he says. Some physicians or long-term-care providers might argue that patients can get through a weekend without having their medications adjusted, he points out. “But, it may be good for nursing homes to have a certain number of point-of-care tests on hand for weekend [emergencies],” says Craven. Particularly in the case of patients who are at risk for severe bleeding problems, point-of-care testing means better patient care, he reiterates.
How to sell
Sales reps should approach their long-term-care customers with several questions to gauge their need for point-of-care test programs. In the case of PT/INR testing, reps should ask the following:
• “How many of your residents are on warfarin?”
• “How often do you need to test the PT/INR levels of those patients?”
• “If you are outsourcing your tests, what is your relationship with your labs?”
• “Is there ever a situation where you must run PT/INR tests over the weekend? If so, why?”
Even when your customers are outsourcing their tests, they should be aware that they can bill for them, says Craven.
“Distributor reps may get some push-back from some of their long-term-care customers, because adding these tests does require some change on their part,” says Craven. They call for new responsibilities and training of staff, he points out. But, the tests are not difficult to run and, at the end of the day, nursing home administrators can rest assured their patients are receiving high quality care.