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Practice Tips For Enhancing
Your Reimbursement

Ancillary medical testing that you absolutely must do in your office.

By D.E. Kotoske, DO, FACOFP

Glycosylated hemoglobin machines
America is the land of the obese. Look at the couch potato kids. No exercise and their primary diet is from McDonalds and Burger King. There is no parental diet control. In view of these facts, it is no wonder that 25 percent of today's kids will be diabetic by the age of 35.

To relate this to adults look at all the diabetes you have in your practice. You know as well as I do that diabetes is the disease of atherosclerosis. These people have to be taught to monitor their sugars, depending on the severity of their diabetes. If they are severely involved, they need sugar checks before each meal and at bedtime with a written record, that you, the physician, can read at visit time.

If they are very stable and well controlled, perhaps fasting AM sugar and two hours after supper (and recorded so you can read the results) may be sufficient. Above all they absolutely must have a glycosylated hemoglobin done at your discretion. In the newly discovered diabetic at perhaps eight weeks and until stable. For your stable diabetics, perhaps every four months. The bottom line is this ­ three and four-hour glucose tolerance tests are out. Glycosolated hemoglobin or hemoglobin A1C, as you may wish to call it, is a necessity.

The question is why in the world would you send someone to the lab for a sugar and hemoglobin A1C when you can do these in your office; have one result in 30 seconds and the other in eight minutes? By doing it in the office, you have results at the time of counseling for the best treatment for the patient.

We were the first non-medical center, non-hospital, to do glycosylated hemoglobin in the private practitioner's office starting many years ago.

Glycosylated hemoglobin machines for your office are readily available, invaluable in timely treatment of the patient, and the reimbursement is excellent. You could train a monkey to run the test ­ it is that easy. If you are not doing hemoglobin A1C's in your office and you are sending them out -- you are losing out.

H. Pylori
The next test is also of vital importance. We, again, were the first private practice office to do H. Pylori testing in the office. How many people do you see in a week with ulcer, heartburn, colitis, and functional bowel problems? Do you realize that almost 20 percent of these patients harbor the H. Pylori organism? You know the consequences of untreated H. Pylori as well as I do ­ heartburn, peptic ulcer disease, colitis and diarrhea. It is easy to treat but you first have to make the diagnosis. The testing is easy. A simple blood test on a simple machine. We have been doing it for years.   When you do this test, you have truly helped the patient. You have helped yourself also - in that the reimbursement is excellent.

Streptococcus infection
The next test you should be doing is a simple throat swab for detecting the presence of streptococcus infection. When I have a positive strep screen the comes back to me in eight minutes, I am very careful to give adequate antibiotic treatment for ten days with a follow up in 14 days to make sure the bug is gone. Simple test that is done in your office, quickly, with simply materials.   If you are not doing this test you are missing out. With this test you are helping the patient, and also your reimbursement.

Pregnancy Test
The last test is the pregnancy test.  How many patients do you see who have not taken their birth control pills the way they should have, and, they are in doubt as to the presence of pregnancy?   

How many women do you see who have been to Planned Parenthood who have received the injection of Depo Provera and are worried to death about the second month when there is no period? How many parents do you see with their adolescent child, who have just learned that intercourse has started and want their child on birth control pills? Are you going to comply without a pregnancy test? Particularly in the face of amenorrhea? I do not think so. Do the test in your office. Get an answer now. Know where you stand relative to treatment.

In this article, we have covered four ancillary laboratory tests that are simple to do, can be done easily and are a benefit for the patient and for your bottom line.   If you are not doing them, we highly recommend their employment.

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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.