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The Heart of the Matter

An LCL Newsletter

2010 Updates

The year 2010 got off to a very good start. In February we sponsored the return of the Greater New Orleans Coagulation Conference. The excitement generated by the conference became the basis for an internal review of business operations. This has lead to a number of changes which have been implemented or which will be implemented during the first quarter of 2011.

We realize that many of you have also undertaken some transformations in a push to meet HITECH compliance goals for 2011 and 2012. Some of you have modified or restructured your hospital and/or laboratory information systems. You may have revised patient identification and product identification procedures to minimize identification errors and in turn improve patient safety. Many of you have included in your QA program a system of review of lab and pharmacy orders looking for ways to help reduce misinterpretation of those orders. There is a greater emphasis on the creation of a better system for the dissemination of patient data among various medical services involved in the medical decisions related to the care of the patient.

All these changes are designed 1) to create a health care system with higher safety standards used in the delivery of patient care and 2) to give physicians better access to patient data from all medical services when this information will impact the decision making process related to the care of the patient. These factors are especially important in today's world of the mobile patient.

With some of these changes there are budgetary concerns to consider. Changes related to providing better electronic access to patient data will have a major impact on any budget. Some clients have chosen to offset this economic impact by creating alliances, joining networks or restructuring internal operations. Some physician offices and specialty centers, such as our hemostasis reference laboratory may remain independent. We are all striving to create a medical community where patient data is more accessible, accurate and portable.

Our goals here at LCL are to compliment the needs of our clients in the delivery of better patient care while contributing to the overall reduction in cost of that care. We design parts of our daily routine to be in partnership with you in your delivery of patient care. Here are a few examples of some of these routine procedures.

LCL staff members routinely review incoming requisitions. We are looking at the relationship of the tests, the medication and diagnosis as listed to detect a possible test request error.
Example: A Factor X activity is ordered on a patient on Lovenox when the doctor wants a Heparin anti-Xa level to use to monitor the Lovenox.

Test results are reviewed for clues related to a specific diagnosis. If an additional test would be helpful to the physician to confirm or rule out a particular diagnosis we will make that suggestion known. Physicians or lab personnel are alerted when we see abnormal tests results which may be a result of prescribed medication rather than a change in a patient's clinical status.
Example: A patient with a positive HIT is switched to Argatroban. We will remind the client that Argatroban will prolong the Protime, APTT and a number of other coagulation procedures.

Our medical director is informed when unusual or rare test results are detected. This usually opens up a dialogue between the physicians and together a plan of action is outlined.
Example: A patient with a moderate to severe congenital factor deficiency requires an invasive procedure such as cardiac surgery. Plans will include type of therapy needed, type of monitoring and a schedule of when to monitor therapy using lab test results.

LCL has provided support to our clients who may require around the clock coverage for emergency and critical care situations.
Example: A patient with a severe factor deficiency is seen in the ER and requires emergency surgery followed by a week of close monitoring of the factor levels. The factor levels are to be checked three or four times a day for the first few days. Then the levels are checked twice a day for an additional several days. We assign staff members to be available for the time in which testing is needed.

We provide diagnostic coagulation testing for many clients within this medical community. When patients change doctors or hospitals within the community, we can assist with the transfer of information between physicians or institutions. In some cases we have noticed the change in providers and have initiated the transfer of information.

These are some examples of our efforts to work within the mandates of the "meaningful use" initiatives. We hope that the changes we are presently implementing will be an added benefit to direct patient care while offering an overall economic benefit to our clients. Your continued support is appreciated. We at LCL agree with the motto of CAP "Each Number is a Life". We will continue to demonstrate that fact in the performance of our daily routines. We are pleased to partner with those in our medical community by continuing to provide them with readily available services of a coagulation reference laboratory "Where Testing and Diagnosis Meet".

2010 Laboratory Updates

The February 2010 Greater New Orleans Coagulation Conference was the first regional conference we sponsored since the cancellation of the 2005 conference due to Hurricane Katrina. The past conferences were organized by our former lab manager J. Kay Levens. In her business dealings and with her interaction with our clients Kay was always putting her best foot forward. In memory of her dedication and service we initiated an award. You can see pictures from the 2010 conference and the Spirit Award winner by visiting our website.

Our next New Orleans regional conference will be in February 2012. We will host a mini coagulation conference for laboratory personnel in 2011. Details of both conferences will be available by the end of the year. Watch our website for details.

We are happy to announce two new additions to our lab family. Some of you have already met Joseph Bogle, our new courier. Joey has taken the place of the courier service which we formally used for a number of years. We are expecting this to be very advantageous to all. We have already seen a better turn around time in the handling of STAT cases. Feel free to let Joey know when you are in need of supplies.

Our second addition is S. Nichole Justelien, a recent graduate of the University of Southern Mississippi. She successfully completed her board exam this past August and is showing a great interest in the subject of coagulation. Her youthful energy is a positive addition to our team of experienced technologists and we are happy to have her onboard.

We are grateful for the support which our clients have given us throughout our 18 years in business. We have experienced steady growth during these years. We now find ourselves in a position to thank you verbally but also in a manner which may result in a positive impact to you economically. Starting in January 2011 we will begin billing all clients based on a set price list designed around that particular client's needs and contribution to our business. We will no longer set prices based on a percentage discount. Your pricing will be reviewed annually. Billable services may be discussed and your specific needs will be taken into consideration. We feel that our new approach allows us to be competitive in setting our pricing guidelines.

The additional services we offer related to the generation of a test result we hope will continue to carry some weight in your decision to use us as your diagnostic coagulation reference laboratory. Call to set up an appointment with one of our staff representatives to discuss your specific needs. If we do not hear from you, your new price list will be set based on your present percentage rate.

Our patient data management services will undergo some changes during the first quarter of 2011. We will implement direct faxing of reports to hospitals as well as doctor's offices. We will also begin work on a 24/7 access system. The initial access may be for reports only. At some point this access will include order entry and report access via the web. As this undertaking evolves we will keep you abreast of the availability of these services.

2010 Testing Updates

We have expanded the list of profiles we offer. You have been asking for suggestions for tests to order under specific circumstances. These new profiles represent some of your requests. Please review the profile list (see attached form). You will find that the test grouping will be beneficial in several ways. 1) The list will reduce test order errors when multiple tests are needed related to a specific circumstance. 2) It will act as a suggested list of test groups to use when ordering. 3) It will reduce cost when the order is placed as a profile rather than when the order is placed by individual tests. You can select the groups which meet the testing patterns most commonly used by your physicians. Check with us to get a price for the profiles you will most often use. We hope that you will take full advantage of these profiles by entering these groups into your test order information system.

We are hoping to take better charge of the acquisition of patient information to be used in conjunction with platelet aggregation studies. We have revised the patient information form and will be emphasizing the importance of having this form completed by the patient when they come to have the platelet aggregation samples collected. The form will be distributed to clinics and lab personnel who deal with scheduling these studies. This form along with a copy of the new requisition will also be available on our website. We will also ask for contact phone numbers so we can remind patients of appointments and to complete the forms.

There is another change related to platelet aggregation studies. You can now order the platelet aggregation studies based on the specific type of study required. Each panel will have a separate price and testing will be reported using only the agonist indicated for that particular panel. Below is a list of the platelet aggregation study panels.
Antiplatelet Therapy
Dysfunctional Platelets
Hyperactive (sticky) Platelets
RIPA aggregation related to vWD cases
Platelet Aggregation with luminescence **

**The expansion of our staff has allowed us to restart the studies related to luminescence. These procedures will be available early in 2011.

Outlined below is the profile for the evaluation of ADAMST13 as performed by the Blood Center of Wisconsin. The activity is performed initially. The inhibitor is then performed if the activity is < 30. Some cases depending on the inhibitor results will require antibody testing. Each test has a separate price and a separate code.

                ADAMTS13 Activity: CPT Code-85397
                ADAMTS13 Inhibitor: CPT Code-85335
                ADAMTS13 Antibody: CPT Code-85999

Because of the various changes related to how orders may be placed we have revised our requisition form. It will be a two sided form. The tests associated with each profile will be listed on the reverse side of the order portion of the form. See sample form. We will be revising the complete catalog by the middle of 2011.

As with all laboratory procedures, the reliability and quality of test results begin with proper specimen collection and handling. Please call 1-866-2LA-COAG with any questions, suggestions or concerns to help us improve our services to you in this ever changing field of coagulation and hemostasis.