The MRSA Panic: This time, it's real!

My wife and I were having a discussion this weekend about the MRSA scare. We are both physicians, so we tend not to panic over these things.

We are also parents, so we tend to panic over these things.

In addition, as physicians she and I have had patients who are panicked. She asked me how I deal with their questions. I answered that I like to put the scare into perspective. Here's how I view it.

• Fall 2007 MRSA
• Fall 2006 Bird Flu
• Fall 2005 Influenza, with no available vaccine
• Fall 2004 SARS
• Fall 2003 Mad Cow
• Fall 2002 Anthrax

So in other words, the media for some reason that I just can't seem to understand, likes to scare us, in a public service sort of way.

In my view, the most significant impact of the MRSA scare has been on the cost-per-click amount for the keyword phrase MRSA. 1 week ago, I could have had my google adword banner shown for 10 cents per click at the top of the page. Now I am priced out of the market. In 3 weeks, after the media moves on to the next story, the keyword price will return to its usual levels. But by that point, MRSA profits will have dried-up.

So here's my take. If you have lots of money tied up in an anti-MRSA counter-top spray and you can't cash-out, panic. Otherwise, you have little to fear from MRSA.

Thanks,

The IU.

My VONAGE experience summarized

I finally switched from VONAGE, my VOIP phone service provider, to Optimum Voice, a local Long Island company and branch of Cablevision. In the end, I switched because my 2 office VONAGE lines went dead and VONAGE customer service was unable to remedy the problem. I think the lines died because of incompatibility issues with my VPN router, but this is just my own, admittedly ignorant, speculation. Since I use the VPN router daily for billing purposes, and reconfiguring the router's settings would cost me hundreds of dollars, I decided to switch to Optimum Voice.

But please do not misinterpret my impression of VONAGE, which is this. It is an absolutely fabulous system. If I had to do it all again, I would pick VONAGE again, and again, and again. In fact, I kept my third VONAGE line, which I have in my house as another office line.

Here are some of the great features of VONAGE.

• Cost: cheap
• Simulring: I found this feature indispensable. As far as I know, only VONAGE has it.
• Portability: Just re-locate the router
• Caller ID: many phones have this, but not as good as VONAGE's. Trust me.
• Call tracking: ALL inbound and outbound calls are logged. Other's services have this as well, but not quite as good as VONAGE.
• Voice Mail-Email notification: This came in handy once in a while.
• Network availability: great feature. If your internet goes down, VONAGE automatically forwards to a number of your choosing.
• Others that I did not need, but are really cool. Go to the site.

Here are the disadvantages:

• Unreliable: let me add a caveat. It is really only unreliable if the VONAGE routers are in line with other routers and switches, in my experience. My home VONAGE works fine.
• Technical support: Only by phone, so if you have a major issue, your SOL. For minor issues, their phone support is OK.
• Dropped calls: I had lots, but I think this had to do with my set-up, and not really with VONAGE per se. My home VONAGE phones does not drop.

That's it. In summary, I liked VONAGE and still do. I can contribute lots of my success to their ingenuity. Over 19 months, I never missed one call. Not one. I would recommend them to any small business.

Thanks for listening,

The IU.

A load of garbage

I was surprised to see this headline on MSNs search page: Healthy Outlook. The article talks about an economic boom in the healthcare industry. Jobs a plenty.

There's only one problem: No money, horrible hours, difficult work environment. I wonder who sponsored the article?

My lab has achieved prestigious accreditation

Great news! My lab achieved the prestigious accreditation from COLA, a major accomplishment. In order to become accredited, a lab must adhere to strict standards of quality control and quality assurance. The accreditation process took 18 months, involved an on-site survey, completion of a 20 hour lab director course, and continuous commitment to quality laboratory processes.
Not easy, but well worth it.
The IU.

Threats from all sides

Recently someone recommended that I do a SWOT. A WHAT? A SWOT. In other words, an analysis of my practice's Strengths Weaknesses Opportunities and Threats, ie SWOT. I enjoyed doing the S and O portions of the SWOT, but the T was very disturbing, both in raw number and in ratio form with the O. In other words, my T/O ratio appears out of whack. Not good.

My threats include:

• rising insurance costs
• rising rent
• rising payroll
• rising administrative costs
• increasing oversight
• increasing regulation
• declining reimbursements
• litigation threats

Then yesterday, KevinMD ran a link the following post: http://www.emrupdate.com/forums/p/10746/72642.aspx#72642

Damn! I guess I now need to add that to my SWOT list. What if I just bought product A then United Health Care demands I buy product B, then Blue Cross demands I buy product C? Then what? Sheer craziness. I suppose it is legal for them to do that, but it strikes me as problematic.
In any case, I'll add it to the T's, which now vastly outweigh the O's.

Most of my threats are similar to threats to other doctors. Some may find some perverse comfort in the fact that we are all on a sinking ship together, but not me. I believe that when the bow of the ship goes under water, and the stern rises into the air, it'll be every man for himself. And it won't be a pretty picture.

Threats from all sides. How will it end. . .?

Have a problem? Talk it out.

My MA has been causing me some aggravation. As I said, she is fresh out of school--in school actually--and is doing her externship with me. She is a blank slate. Blank slates are good for many things, but they cannot be relied upon to send urine specimens to the lab.

As a urologist, I see many people with UTI's, or UTI related symptoms. I send many urine specimens to the various labs for culture. For my first 1 1/2 years on my own, our accuracy in sending patient specimens to the correct lab at the correct time was 100%.

Now that accuracy has fallen, and with that my headaches have returned. What am I to do?

Well, only one thing in my experience works with people, and that is talking. I asked her, "What can I do to make your job easier and improve your accuracy?" 60 minutes later she walked into my office and asked "Can I make a suggestion." Absolutely.

Her suggestion was to keep a running tally of the patients seen and the specimen to be sent, and at the end of the day she and I would spend 5 minutes confirming that patient A needed a urine culture, patient B needed a cytology, and patient C needed only a UA, ect.

Good suggestion, and you know what; it works.

Talking! Who knew?

Thanks,

The IU.

Sorry!

Much has been written, recently, about the positive effects of apologizing. Some risk managers tell us to say "I'm sorry" when we mess-up. They believe that these words can prevent a law suit from being brought forth, and thus recommend that we do it. Maybe. To that effect, every so often I read in the paper about a plaintiff who said something to the effect of, "Had the doctor just apologized, I would never have sued." Yeh, yeh right! At the risk of seeming cynical, which I am not, I believe that these people do not understand forgiveness.

I believe that we, as people, apologize because it makes us feel better. And sometimes it gets us off the hook. I think we learn this as children.

I do believe that the recipient benefits from an apology. Namely it makes them--the recipient--feel better. Most importantly, the act of forgiveness is very therapeutic to the forgiver, rather than to the person who is apologizing. It is simply unhealthy for people to hold onto anger and internalize it. So lets say that I am a big believer in the power of the apology. I'm just realistic about it what an apology can accomplish and when it ought to be used.

For example, should people be absolved of their wrongs simply because they apologize? I don't believe so. Recently, in NY, a woman had a bilateral mastectomy due to lab error. I don't think an apology would suffice in this case. Moreover, the error was the result of short-cuts taken by the technician in the lab. Something tells me, that his apology to the boss found deaf ears, as it should have. The technician may have been fired, but the owners of the lab may lose their livelihoods over this incident. No, I don't believe that an apology means much in this case.

In my own office, I had a receptionist download a file sharing program on the office computer. I discovered it instantly. She immediately apologized, but I fired her on the spot. Her contrition would not have corrected the many problems her act could have caused, such as data loss, data theft, or an RIAA lawsuit. Her apology meant nothing to me.

Two years ago, my 4 year old pushed my 1 year old, who fell down a step. The 4 year immediately apologized, because she saw that I was angry. I responded, "I don't care that you are sorry" and then I explained to her that her apology does not undue the pain she caused on her sister. The 4 year old--an exceptional 4 year-old--understood, and she has never pushed her younger sister again.

I think we need to re-learn the purpose of "sorry." If you find yourself apologizing for personal gain, you are doing it for the wrong reasons. The goal ought to be for healing. If the goal is for healing, and healing alone, then it'll be accepted.

Anyway, just my thoughts.

I thank you for your time.

The IU.

Memory Lane

I just found this picture.
My first day of surgical internship at Northwestern Memorial Hospital.
July 1994.
I was 26 years old. Bright eyed and bushy tailed. Eager and energetic.
I am holding up my rounds list, the first of many.
Wow!

A band aid to the rescue

Sometimes your organization can be in such disarray that you need major surgery to fix it. Other times, a band aid is all you need. Recently, I applied a band aid to my own practice. I purchased a cart.

The cart is stainless steel, has 3 shelves, and sits on 4 wheels. It is approximately 24 inches wide by 36 inches long, and 36 inches high. I keep my portable sono unit on the top shelf and I keep the various probes on the middle shelf. On the bottom shelf I keep the phlebotomy kit, fully stocked, and the power cord for the sono unit.

I do a lot of scrotal sonograms for male infertility in addition to performing pelvic/bladder sonograms for post-void residual urine assessment. Often I have to change probes several times per day, or I need to re-charge the portable battery on the unit at random times. Because evrything sits on the cart, I can do these chores quickly and effortlessly "on the fly."

When I have a vasectomy, I place the sono unit on the middle shelf, then drape the entire cart in a sterile drape. I then place the vasectomy instruments on the spacious top shelf. I usually begin my vasectomies on the patient's left side, then I move on to their right side. I just wheel the cart along with me.

Within arms length of the cart, on the right side, is the counter top. On the counter top I leave open the paper wrap from the sterile gloves. As I use up the sharps, I place them on the paper wrap to my right side. At the end of the vasectomy, all that remains on the cart is non-sharp garbage, the soiled vas instruments, and the vasa themselves. Within 1 minute after completing the vasectomy, I can have the used instruments in the sink, the vasa in the specimen bottle, the sharps in the sharps container, and the remaining waste--wrapped in the sterile drape--in the garbage can. Voila! Done.

No wasted motion. Efficiency. And as far as a vasectomy can be, a thing of beauty.

And all because I purchased a cart with wheels.

Thanks,

The IU.

Gone Digital? 6 Essentials of Back-up

Though I'm no computer expert, I have an EMR, and I have had crashed drives and lost data. I've learned the hard way how to prevent data loss. Here are 6 crucial elements for back-up systems.

1. Automatic: Your system should back-up without your needing to ask it to do so.
2. Redundant: You must not leave all "eggs in one basket." This way, you will never lose your data.
3. On-and Off-site: What if you have a fire or flood in the office?
4. Daily: If you see more than 5-6 patients per day, you will not be able to remember encounters, let alone billing details.
5. Versioned: If files are corrupt, versioning will prevent the corrupt file(s) from being propagated to subsequent back-ups.
   
6. Recoverable: Back-up is only as good as your ability to retrieve the lost data.
   

If you have an EMR, you need to back-up.

Any other suggestions?

Thanks,

The IU.

A decent way to send and document certified letters

Remember Mad Libs, those funny word games available when we were kids. They were basically stories in which the critical verbiage, adjectives, or nouns were left blank, to filled in by you. Depending on your own creativity, it was possible to create some pretty funny things.

Sending certified letters to non-compliant patients is not funny business, but can be made easier by applying a Mad Lib approach to it, only without the funny adjectives, adverbs, and nouns.

Before I had an EMR, I had to dictate the letter, have it transcribed and printed, then I'd have to review it, make any necessary changes, then repeat above process. That is how I used to do it when I was part of a group. Worked well so long as you can afford a huge staff.

Now that I'm solo, I'm more frugal, and I have an EMR--a home grown one--but an EMR nonetheless.

Here is how I did it until recently. I created a template letter with the date, patient name, DOB, and Dear SoAndSo fields left blank. When generating a letter, I would simply insert the above information, print the letter, sign it, scan a copy back to chart, and send the original. Of course, we would save all the USPS documentation for proof.

Now I think I have even improved the process some more. Currently, I simply print out the blank template letters, have my staff write, by hand, the name, date, and etc onto the letter. The staff then brings the letter to me. I sign it. The letter goes back to staff, who then scans it into the patient chart, places it in the envelope, and then mails it with certified forms attached. We retain USPS forms, which are scanned into the patient charts as well. Takes about 10 seconds per letter, if that. Scanning time for the staff, with an automatic document feeding scanner, is only slightly longer.

My system certainly lacks the prettiness of what you'd expect from an expensive EMR, but what it lacks in style points, it makes up for in efficiency.

Let me know what you think,

The IU.

Can't sleep? Audit yourself.

Are you certain that your documentation is good? Are you sure that all labs have been received and filed correctly? Have all your bladder cancer patients had their cystoscopies and cytologies?

Well, though I'm sure you pride yourself on your recall systems, documentation, audit proof EMR's, and lab follow-up processes, despite the best of intentions, things will slip through the cracks. So if you are worried, and you should be, do an internal audit before someone else does it. You'll be surprised at what you find.

• Do your consults have associated referral letters
• Do your no-shows have documentation regarding attempts to contact them
• Are all the ordered labs and studies in the charts
• Are certified letter documents in the charts
• Do all encounters have written notes
• Are informed consent discussions documented
• Are phone conversations documented
• Are all email communications saved in the chart
• Does the documentation fit the coding level

I know that good EMRs can do lots of this for you, but I still believe that random audits are warranted. We do them and find things frequently. I recommend it.

The IU.

A check-list to the rescue!

I recently hired a medical assistant. She came to me fresh out of school. Actually, she is still in school, technically, because she is doing her externship in my office. I am training her.

I like her. She is eager and honest, and for me, nothing else matters more. Otherwise, she is blank slate and knows NOTHING! That is how I wanted it.

However, blank slates don't know how to properly clean exam rooms, sterilize instruments, set-up for procedures, forward phone-calls, dip urines, or anything that is required and basic to medical practice. Despite my repeated efforts to train her, she just could not quite seem to "get it" and was messing up left and right.

Now I had 3 options.

1. Fire her


2. Promote her


3. Study her

I decided that the substrate was there and that I would need to figure out why she was failing me, or actually, why I was failing her. After a brief period of observation I learned that she was simply overwhelmed by the volume and was unable to remember her duties and to prioritize them.

The solution: a check-list.

I spent approximately 20 minutes brainstorming her duties and compiling them into a check-list format, which I then printed out and reviewed with her. I was afraid to insult her, so I told her that I used check-lists in college and medical school, and found them to be indispensable. All of which was true. She took the list in the vain that I had offered it and something amazing happened.

Her performance has taken a 180 degree turn immediately. Tasks are being completed on-time, without prompting, and I am free to pursue my duties. She is less stressed and happier, and so am I.

A check-list! Give it a try.

Thanks,

The IU.

The Free Market and Medicine

I often overhear in the physician lounges, or read on the internet, about many doctors' views on the free market. Typically, the doctors argue that "standard free market principles" do not apply to medical practice. Their arguments go something like this:

• I charge $180 for an new patient consult, but only get paid $90, and therefore, free market principles do not apply.
• I charge $5000 for a total knee, but only get $1200, and therefore, free market principles do not apply.
• A radical prostatectomy is worth $4000, yet I only get $900 and therefore, free market principles do not apply.

Over the past 7 years, I have heard this line of reasoning hundreds of times.

I don't think they understand the free market. Let's use another industry to elucidate and clarify the problem. Let's use the toy industry.

Mattel designs, markets, and sells toys, but they don't make them. Since Mattel is a corporation, it's fiduciary responsibility is to maximize profits. One way to do this is by minimizing costs. A great way to minimize production costs is to outsource manufacturing to countries that can do it more cheaply. Mattel outsources toy manufacturing to Chinese factories.

Mattel, like United Health Care, has lots of money and thus leverage over the manufacturers. Mattel uses this leverage to negotiate production costs for its toys. The Chinese factories can either take it or leave it. Since the factories can not remain viable without a contract from Mattel, they choose to accept the terms of the contract, and then attempt to maximize their own profits by cutting production costs and increasing production rates. The Chinese factory does this by paying workers extremely low wages, using cheap materials, and, as we have now learned, using inexpensive lead based paints on the toys.

Mattel pays the factories cut-throat rates, which forces the factories to cut corners to make a profit, which, unfortunately, can ultimately impact the consumer negatively. On the other hand, however, the consumers in the USA and Europe, don't want to pay a lot for their toys, so the cycle continues.

Sounds familiar, right.

United Health Care does not produce health care, it only pays for it. As a corporation, its fiduciary responsibility is to maximize profits. One way it can do this is by minimizing production costs. United Health uses it's leverage, much like Mattel and the Chinese factories, to negotiate cut-throat production rates to the factories, which in this case are the providers. Unable to remain viable without the contract, we chose to take it, rather than leave it.

Now, to maximize our own profits, we attempt to cut our costs and increase production. We do this by outsourcing services, downsizing office (factory) sizes, and hiring low wage personnel and then we see more and more patients. The downside of this is that ultimately the consumer--the patient--can get hurt because in our efforts to cut-corners and increase production, we may make mistakes and hurt people. As a society, we accept this because, like toy purchasers, consumers of health care don't want to pay a lot for the product and the cycle continues.

See, our health care model is the epitome of the free market, and anyone who suggests otherwise is wrong.

Thanks for listening,

The IU.

Another Blogging Success Story

I got a new patient today. . .from India. He has been a devotee of Dr Schoor's Urology Blog, and is town on business. He has liked what he has read, and is coming to see me as a patient.

Cost to me: $0.00

Not Bad.

A View From My Window

I have a corner office, 2nd floor, that has a commanding view of my parking lot and road that leads up to it. I often use the window onto the lot as a sort of extension of my physical examination. Here are some things about patients that I have seen and learned from my window view.

• Angry: On several occasions I have seen patients of mine honk, yell, or gesture angrily at other drivers in the lot. These people are uniformly lambs in my office, but this tells me that they are not very nice people at their cores.
• Unethical: Once in a while, people park in the handicapped spots, yet are not physically handicapped. I know this because I take their histories. What they don't know is that I witnessed them committing these acts. Again, these people are always nice to me, but dishonesty is dishonesty, and their actions point towards their ethics.
• Aggressive: Long Island has no shortage of aggressive drivers. So does my parking lot. Aggressive drivers cause many problems for society in general and basically these people think that they own the roads.
• Selfish: Taking up 2 spots: People do this for 2 reasons: they have a nice car or they don't care about others. Either way, I think it suggests that they are either selfish or vain.
• Inattentive: I can tell this when I see patients leave my office, go to their cars, then pull out of their space without looking, while simultaneously smoking a cigarette on the cell phone. Multitasking has it's place, but not while driving. It also suggests to me that I may want to have another informed consent discussion with the patients.

Maybe I'm overreaching, but I think that private behaviors go towards personality types in general. I just feel like I know these people better by witnessing an admittedly small sample of their driving.

Hope you enjoyed the post.

The IU.

Four Sure-Fire Methods to Go out of Network

Every physicians' dream is to go out of network and really "stick it" to the insurers. Just follow these 4 steps, and you too can do it.

1. Become a regional, national, or better yet, international name in your specialty. Have patients travel from far and wide to see you. It'll help if you write a book that becomes an international best-seller and in the process, you become Oprah's friend and confidante. Alternatively, you can invent a truly life saving or life- improving medical device. Either way, this'll get you there.
2. Change to a specialty that sees predominantly emergencies and relocate your practice to a hospital that sees only well insured, non-medicare patients, then gouge the hell out of the patient's insurance policies. Also, hope that state legislators continue to turn a blind eye to this consumer-unfriendly practice.
3. Become an out-of-network anesthesiologist and price gouge off the backs of your hard working in-network surgeons and hospitals.
4. Join a top-tiered academic medical center, then rise through the ranks of your department until you are a huge national or international name. Also, see method #1.

See, it's easy.

The IU.

Cost Containment: Here's some tricks

With declining reimbursements, the only way to to remain viable is through revenue generation coupled with cost containment. I'd like to talk a bit about costs, and some obvious--and not-so-obvious-ways to minimize them.

Fixed Costs: These are items like rent and insurance. While you probably have little negotiating power in this area, with regard to rent you can keep costs down the following ways:

• Maximize productive use of space. I pay $26 per square foot, and use all of it productively. An EMR helps here, because I don't need to dedicate several hundred square feet to chart storage. Also, mobile units, such as portable sonogram machines, client computers, and portable lab equipment, also helps. And of course, I have VPN, because it essentially converts my house or Starbucks, or anywhere with an internet connection into an extension of the office.
• Maximize revenue generation areas of the office. These areas include exam rooms, your office, and the lab. Back office functions, such as insurance claims submissions and billing work, can be virtual, via your VPN, yet remain "in-house" as opposed to being outsourced. With a well networked office, exam rooms can serve as exit offices while you go to the patient in the adjacent room.
• On-demand Supply Ordering and Smart Storage: Closets = Square footage = $$. With some thought and planning, shelving, exam tables, cabinets, and closet space can be used for maximal storage at minimal square foot usage. In addition, I order supplies as needed, since my vendor, PSS Worldwide Medical, always delivers next day.

Variable costs: These include costs for items such as medical supplies, payroll, utilities, stamps, etc, and can be determined by examining the profit-loss statements prepared by the accountant. here are some ways to keep variable costs down.

• On-demand supply ordering. DELL Computers uses this concept. I do as well, just make sure you don't run out of Foley drainage bags after you've already placed the Foley.
• Part-time employees: Simple. They cost less than full time employees, plus no overtime.
• On-demand staffing: I staff heaviest on the busiest days. Plus, since I am capable and willing to pick-up slack on days that we are inadvertently short staffed, this method works out well. Busy days or light days, open or closed, phones are always!!! staffed.
• Amortization of utility payouts. Most utility companies will estimate a fixed monthly cost for you to pay based on a prior years consumption. I like it for cash-flow management.
• Have your phones (VOIP), cellphones, & internet on fixed plans, so that costs do not soar with usage. Get the maximum minutes for cell phones, since the incremental costs of the plan are much less than overage payments. VOIP is cheap, plus never varies with usage. On the balance, I've been happy with it, yes, even for the "mission critical" functions. I'm talking to you, Sunrise.
• Fax. Why snail mail when you can fax the referral letter. Not only is it faster, more efficient, and trackable, it is cheaper. I love my fax. Yeh, yeh, yeh, I know, HIPAA. But it can be done and still be in compliance

Direct costs: These are costs that are directly involved in patient care. Here's how to minimize these costs.

• Everyone does everything. MA's do data entry, answer phones, clean rooms etc. The docs answer phones (if they are not seeing patients) when needed, clean rooms, order supplies, schedule patients, e-file labs. Again, an EMR and a VPN helps here as well.
• Part time employees and on-demand staffing: see above.
• Creative patient scheduling: Figure out which works best for you; clinic, open access, proportional, or wave scheduling, and then determine minimal staff requirements for your office hours.
• Ergonomic room design. I have rigged my rooms so that I can do a many procedures without an assistant present. I learned these skills as a surgery resident in central line clinic. In fact, I can prep with my left hand, place the scope with my right hand, and simultameously do a UA with my toes (kidding!). If you have 2 hands, a brain, and a Mayo Stand, you can make it work as well, and in the mean time, you'll free up staff to answer phones and book new patients or enter claims.
• Training and process management: Training employees well and developing efficient processes of doing business will allow you and your employees to work smarter and with less mistakes and to get the job done right the first time. This simply saves money.

Indirect costs: These costs cover non-patient care activities, such as back-office staff and billers. Here's how to minimize these costs.

• See direct costs.
• VPN
• EMR
• Embrace technology
• Multi-task
• See training and process management

Hope you enjoyed the post and thanks for listening. And Seaspray, thanks for the baby card. Unexpected and appreciated.

The IU.

Why I recommend a VPN

I have exactly 5 seconds to publish to the blog, so I am going to be brief. VPN's--virtual privacy networks--are among the best features of the modern computing age. Here are some reasons why you may wish to invest in one for your office.

• Ability to check labs and study reports from home or away
• Ability to catch up on charting from home or away
• Ability to access schedule from home or away
• Ability to put drug-seekers in their proper place
• Ability to access charts when not in the office
• Ability to always seem omniscient
• Ability to grow faster by "booking" patients that call during "off" hours
• Ability to submit claims remotely
• Ability to have multiple offices with one central chart storage system
• Ability to stay connected yet have a life at the same time

And others. At the risk of stealing from MasterCard's add campaign:

• 8 port VPN router $200
• Computer guy to set you up with VPN ~ $500
• Checking labs while giving your newborn a midnight bottle Priceless!

Get a VPN. You'll like it!

Thanks for listening,

The IU.

A little known side of urine analysis

Urine analysis by dip stick is a CLIA waived lab test. What this means is that as long as you follow the manufacturers directions, exactly, you will be in compliance with CLIA'88 regulations and will not need not anything other than a CLIA Waived Certificate to legally do the tests and bill for them. But here is the rub. You must follow the manufacturers directions exactly, because veering from the package insert directions automatically converts your waived lab into a high complexity lab, and you don't want to go there. Below is a description of the QC (quality control) requirements for urine analysis.

• The package insert from the test strips recommend that QC (quality control) be performed on every new package of test strips.


• QC, according to the package insert, involves 2 sets of negative controls, and 2 sets of positive controls


• If you use an automated test strip reader, the manufacturer recommends that, at the very least, QC be performed daily, as above, on all testing days.


• Each test costs 33 cents (PSS brand) or 50 cents (Bayer Brand), thus daily QC just for UAs costs netween $1.20 and $2.00, or between $370 and $624 per year.

If you don't, then in essence you are converting a waived test to a high complexity CLIA test. Good luck.

Dr Schoor

www.ilabtqm.org.