Doctor is Out--Patient Can Order Own Lab Tests

From the Virginian-Pilot (VA).

"Jean Sims has worried about her high cholesterol ever since she last had it checked - five years ago.

When the Chesapeake resident recently found out she could order her own test at Chesapeake Regional Medical Center, she jumped at the opportunity.

"What I like best about it is that I don't have to wait two or three hours for the doctor to come see me," said Sims, a 67-year-old retired manager. "I like going there, going just for cholesterol, then I'm gone."

In recent months, Chesapeake Regional began offering a service called "My Lab," which allows patients to obtain certain diagnostic tests without a physician's order.

The 17 options include tests for levels of vitamin D, vitamin B-12 and iron, as well as drug and blood alcohol screenings. Also available: tests that measure kidney and liver function and diagnose thyroid or metabolic disorders.

"We already do these tests. It's not anything that was extra work for us," said Cheryl Paige, the laboratory's administrative director. "It just gives the patients an opportunity to take care of themselves."

Sentara Healthcare has been expanding its SelfTest program since establishing it about seven years ago. Patients now can order from a menu of 20 lab tests at the system's hospitals and freestanding emergency departments in Hampton Roads. They can receive results on their computer or smartphone through the system's MyChart electronic medical information application. Soon, they will be able to request tests through Sentara's website.

"There are a lot of people who use the program to monitor their health, cholesterol, things like that," said Pat Mullin, Sentara lab sales manager. "We have a lot of calls from people who are getting ready for a pre-employment drug screen."

Only about 1,700 of the 7 million lab tests performed by Sentara's Hampton Roads laboratories each year are referred by patients, but the number increased by about 25 percent between 2010 and 2011, said Beth Deaton, director of consolidated laboratories.

Bon Secours Hampton Roads Health System doesn't offer the service, according to a spokeswoman.

The concept fits with health care's "consumerism" trend, in which patients are taking a more active role in their care as they become responsible for paying more of their own medical bills.

Insurance generally pays only for lab tests that are ordered by a physician, so direct-access programs tend to be self-pay. At Chesapeake Regional and Sentara, the rates range from $9 to $54.

With some health plans, self-referral can be cheaper than going through a doctor because facility fees aren't charged, said Christie Hudson, vice president of Roanoke-based Medical Billing Advocates of America.

However, some in the medical community are cautious about the idea of patients ordering lab tests.

Some doctors fear that the practice encourages a do-it-yourself approach to medicine. A possible misinterpretation of results could lead to a false sense of security or unmerited alarm, they say.

"The downside comes when people do these tests on themselves and they don't understand the results and they don't know what to do with it," said Kenneth Emancipator, an officer with the American Society for Clinical Pathology..

Even if patients understand a test's results, they may need their doctor to put the information in perspective with relation to their overall health, said Dr. Mitchell Miller of Coastal Family Practice in Virginia Beach.

"There's a lot more information than just that result that would be potentially relevant to that person's case, and I don't expect someone who's not fully literate in health care to necessarily know that," Miller said. "To some people, it's 'Hey, I got a test. I got a number. End of story.' But it's rarely the end of the story."

The labs at both Sentara and Chesapeake Regional directly notify patients if results fall in the "critical" zone, and they encourage all patients to contact a primary care physician with questions. Sentara's waiver form includes the phone number for the system's physician referral service.

Though some patients find it difficult to objectively manage their own medical information, others have been able to catch potential problems in their own care.

"Is there potential for this to find a few things that would come to our attention? Of course that would be true," Miller said. "Being trained in an era where we ordered everything, my ego isn't bothered by this."

Sims ordered her test on Wednesday. On Thursday, she received a call saying the results were ready and would be mailed. She was told she could call the lab Friday with questions.

If her cholesterol is as high as she suspects, Sims plans to try taking over-the-counter medication and cutting back on sweets.

"I would give myself maybe a month or so and see," she said. "If I get the over-the-counter stuff and it doesn't take it down in a month, I think I should seek other help."

This would do several things: free up doctor time to see sicker patients, spending more time per patient, cut the needless cost of an office visit, reduce waiting room capacity, and allow the concerned person to come on on THEIR available time, missing no work (and cutting into the boss's time and productivity).

I'm going to speak to my doctor about this--I really only need a once yearly physical from her, and the rest can be done through these self-requested labs (since I can't get machines for home-testing blood and urine, and cannot draw my own blood).

I do see a distinct possible downside: since the cost of an office visit would be cut out, what's to stop doctors, outside labs, and/or insurers from jacking up the lab test fees to compensate?

UPDATE: Walgreen's has something close and similar, but isn't available in all states. Too bad it isn't here, because (for cash payment) I could get a health screening that includes a CBC, urinalysis, BMI evaluation (like I trust that!), and blood pressure measurement for less than the cost of just showing up for an appointment at my doctor's office. Walgreen's also accepts some types of insurance, and will collect co-pays.

Exactly WHOM is having trouble accessing health care in this country? Let's be crystal clear: it isn't the ACCESS they're having trouble with, it's paying for it. This is why Medicaid and Medicare exist.

At these prices, if you were to throw in a regular physical once a year, along with everything else, this place would even beat Obamacare penalty premiums by far for basic health maintenance--even the poor would be over-paying if they're already in good health by conventional medicine standards.

The difference? No actual doctors or nurses--they use physician assistants and nurse practitioners, who went to med school just like the other guys, but have different licensing requirements. The only performance difference is that they aren't allowed to diagnose ailments, but I'm sure they'll refer you to a hospital for problems beyond their ability to perform. As far as drawing blood, using machinery, interpreting the results, and writing prescriptions, they're just as good as full-fledged doctors and nurses.

So would I drop my current health coverage if this were available in my state? No--the health insurance is a tax shelter to me, since the premiums come off the top before taxes come out. It's also there in case something happens that would be out of the realm of one of these almost-doc clinics, or specialized testing needed (such as an echocardiogram).