Implementing point-of-care testing (POCT) in a general internal medicine practice led to a statistically significant 99% reduction in letters to patients and demonstrated a net financial benefit to the practice of $11.90-$14.74 per patient visit. One strategy is to optimize pre-analytical inputs for STAT testing, namely specimen collection and processing, which tend to be more variable and more easily modifiable than analytical and post-analytical steps. The findings build on the authors’ prior research involving POCT implementation in an academic institution-based primary care office and confirm that POCT improves primary care practice efficiency to varying degrees.
To test the generalizability of POCT efficiencies in physician office practices, the authors explored the use of whole blood fingerstick POCT for HbA1c and lipid panel testing in a general internal medicine community practice in Waltham, Massachusetts. During the study period, 151 patients received 189 of these tests. The investigators compared variables extracted from the medical records for these individuals against 140 demographically similar historical control patients.
The practice’s licensed practical nurses performed the testing as deemed medically indicated by physicians.
In the POCT group, there was a 50% reduction in the number of follow-up tests resulting from an abnormal result and 75% and 39% decreases in the number of phone calls and in the number of follow-up visits due to abnormal lab results, respectively.
The authors calculated that the total testing cost per patient was $15.99. They estimated revenues based on Medicare fee schedules at $21.43 per patient, leaving a net margin of $5.43 per patient. They computed a cost per letter of $7.03 and cost per phone call of $28.30. Factoring in efficiencies from fewer mailings and phone calls related to patients who received POCT, the authors determined the total financial impact of implementing POCT in this practice ranged from $11.90 to $14.74 under two scenarios.