Username: Password: Forgot your login or password? ACOFP About The ACOFP Mission Constitution & Bylaws Policy Manual History News Room Contact ACOFP What is a D.O.? Find a D.O.? Osteopathic Oath Osteopathic Pledge of Commitment What is an osteopathic family physician? Disclaimer Advocacy Education Certification CME Education & Research Foundation Program Directors Osteopathic Residency Assistance Program Leadership Join ACOFP Member Resources Auxiliary Benefits E-Newsletters Ethics Practice Management Leadership Opportunities Online Member Directory OMT Resources Media Resource Center Preventive Medicine Additional Resources State Societies Young Physicians & Residents Resident Paperwork Resources Students Student Benefits Financial Benefits Osteopathic Schools Search for a Preceptor Preceptorship Program Evaluation Personal and Professional Growth Opportunities Residency Program Directory Publications OFPNews Current Issue CME Quizzes Article Archives Article Submissions Advertising Public Search Find a DO

Practice Tips For Enhancing
Your Reimbursement

Procedures that family physicians need to do in-house versus sending them out.

By D.E. Kotoske, DO, FACOFP

Why do you need to do in-house testing? The answers are:

1. To receive information you and your patients need, plus, they want it – conveniently. Meaning the results are back while they are still in your office.
2. Acquisition of new patients by word of mouth when your patient tells their friends that you are miles ahead of other physicians.
3. Increase your reimbursement.

Basic Equipment
Family physicians should procure a chemistry profile machine to screen for liver DX, kidney DX, diabetes, pancreatic DX, calcium deficiencies, cholesterol, triglycerides, bile system DX and gout. Regarding liver disease, can you imagine how many lives you can influence or save if the patient shows elevated liver enzymes on your machine and you send them out for a hepatitis screen for A, B, C and they come back positive for Hepatitis C and never knew it. This happens often in my office. The gastroenterologist will love you for the constant referrals.

What about the patient who shows elevated cholesterol and triglycerides? By inserting the proper panel in the machine you can do a lipid profile. Treat them and monitor them every four months until they are stabilized within normal limits.

What about the patient who has elevated liver enzymes without Hepatitis C or B positivity? Do a toxic drug panel on the same machine. If they are on lipid lowering agents that are known to cause liver enzyme increase (some of the psychotropics will also do this) you had better know it. You prescribed these drugs and you had better know what they are doing to the liver. If you do not and the patient goes into hepatic failure, you can be sued.

What about the patient who comes in with elevated bun and creatinine – is this because of normal aging, diuretics, prostate enlargement that is causing hydronephrosis, or due to the non-steroidal arthritic medication they are on? You had better know the answer.

How about the blood sugar on a fasting patient who does not know he has diabetes at 140, or the non-fasting patient who has a sugar of 180. Obviously, they need a glycosylated hemoglobin that you will do in your office.

What about the patient who comes in with severe arthritic pain and you find, on your machine, an elevated uric aid. The rheumatologist never said the patient had gouty arthritis. Put them on the proper medication and become a hero. Do a follow up arthritic panel.

What about the little old lady with low calcium and a hump on her back? She will need a dual photo bone mineral density test that you will do in your office with your machine, initially, and after you have started the calcium with vitamin D and Fosamax or Actonel.

What about the patient with an elevated amylase or bilirubin? They are candidates for an abdominal ultrasound that will be done in your office, not the hospital. I will show you how.

The CBC Machine
This is the tandem machine to your chemical profile. It will give you RBC’s, hematocrit, platelets, WBC count, MCB, MCHC and other parameters. Get the results in eight minutes. Good for the patient. Good for your knowledge.

The Electrolyte Machine
You need to do this to discover problems with sodium, potassium and chloride. The elderly frequently have electrolyte problems that go undetected. Do you know what the potassium level is on all those people who are on diuretics? You should.

The Complete Urinalysis Machine
This is the last of the basic four. Look for positivity on sugar, leukocytes, nitrites, specific gravity, ketones, bilirubin and other parameters.

Caveat #1
All of these machines must be calibrated, controls run and written, and C.O.L.A. lab accreditation must be complied with. It does not take a rocket scientist to do this. It takes someone with a good brain and a desire to learn. I took an intelligent lady out of a factory, hired her and now she is my lab director and medical assistant. She does a wonderful job. My office has three lab assistants, all certified by the machine manufacturers.

Caveat #2
Do not every buy new unless you have to. Used machines with a warranty are much less expensive than a new one. Reconditioned, used machines are available everywhere. Do not let anyone tell you that they are not available.

Caveat #3
If you lease, get the lowest rate you can with a constant supply of reagents, controls and solutions free.

Learn a Lesson
I just bought a used $160,000 ultrasound machine for $40,000 with a year’s warranty to do all my echocardiograms and all of my ultrasounds. Get started. Everyone wins.

---

D.E. Kotoske, DO, FACOFP, OMM is a graduate of the University of Notre Dame School of Business and is an award winning national writer with over 1000 radio, TV, video and speaking productions.