Lab and Imaging Integration¶

Overview¶

Laboratory and imaging services are essential components of primary care. While DPC practices don't typically perform these in-house, establishing efficient ordering, receiving results, and offering competitive pricing adds significant value for patients.

This guide covers setting up lab and imaging workflows for your DPC practice.

Prerequisites¶

• EMR selected (see EMR Selection Guide)
• Understanding of your service offerings
• Business entity and NPI established

The DPC Lab Advantage¶

Why Labs Matter for DPC¶

Patient value proposition: - Wholesale lab pricing (often 50-90% off retail) - Convenient ordering through their doctor - Results interpretation included - No surprise bills

Practice benefits: - Additional value beyond visits - Some revenue opportunity (if marking up) - Complete care coordination - Patient retention

Lab Services Options¶

Option 1: National Reference Labs¶

Major national labs: - Quest Diagnostics - Labcorp

How to establish accounts: - Apply as ordering provider - Need NPI and credentials - Set up electronic ordering/results (if available) - Negotiate pricing

Advantages: - Nationwide draw sites (convenient for patients) - Wide test menu - Electronic integration possible - Established processes

Disadvantages: - May not offer best pricing - Less flexibility - Corporate bureaucracy

Option 2: Regional/Local Labs¶

Options: - Hospital-based labs - Regional reference labs - Independent local labs

Advantages: - May offer better pricing - More personal relationships - Local service and support

Disadvantages: - Limited draw site locations - May have narrower test menu - Integration may be harder

Option 3: Direct-Pay/DPC-Friendly Lab Services¶

Companies catering to DPC/cash-pay: - Ulta Lab Tests - True Health Labs - Access Medical Labs - Various regional options

How they work: - Pre-negotiated low pricing - Easy ordering (often web-based) - Direct billing to patient or practice - Designed for cash-pay model

Advantages: - Very competitive pricing - Simple processes - DPC-focused support - No insurance complexity

Disadvantages: - May have fewer draw locations - Less integration with EMRs - Smaller companies

Option 4: In-House Point-of-Care Testing¶

Tests you can do in-office: - Glucose (glucometer) - Urinalysis (dipstick) - Rapid strep - Rapid flu - Pregnancy test - Hemoglobin A1C (some devices)

Considerations: - Equipment cost - Supplies cost - CLIA waiver required - Quality control requirements - Convenience vs. cost/complexity

CLIA Waiver: - Required for in-office testing - "Waived" tests have simplified compliance - Apply through CMS - Maintain compliance documentation

Setting Up Lab Workflows¶

Electronic Ordering and Results¶

Best case: Orders and results flow electronically between EMR and lab.

How to set up: 1. Identify EMR's lab integration capabilities 2. Contact preferred lab about interface 3. Set up connection (may require vendor assistance) 4. Test workflow 5. Train on process

If no electronic integration: - Paper/fax requisitions - Manual result entry or PDF upload - More work but functional

The Ordering Process¶

Standard workflow: 1. Provider decides labs needed 2. Order created in EMR (or paper req) 3. Order transmitted to lab (or given to patient) 4. Patient goes to draw site (or in-office) 5. Lab processes specimen 6. Results returned (electronic or fax) 7. Provider reviews results 8. Patient notified 9. Results documented in chart

Pricing Strategies¶

At cost: - Pass through wholesale price to patient - No markup - Maximum value for patient - No lab revenue for practice

Modest markup: - Wholesale + small markup (10-20%) - Covers administrative cost - Still much cheaper than retail - Small revenue stream

Included in membership: - Common labs included (annual panels, etc.) - Higher membership fee - Simpler for patient - More predictable costs

Common DPC approach: Pass through at cost or minimal markup; compete on convenience and value, not lab revenue.

Sample Lab Pricing (Wholesale)¶

Prices vary by vendor and volume; negotiate for your practice.

Imaging Services¶

Ordering Imaging¶

Common imaging: - X-rays - CT scans - MRI - Ultrasound - DEXA (bone density) - Mammograms

Where patients go: - Hospital radiology departments - Independent imaging centers - Specialty imaging (breast centers, etc.)

Finding Affordable Imaging¶

Direct-pay imaging centers: - Many imaging centers offer cash-pay pricing - Often significantly cheaper than hospital-based - Quality comparable - List on website or provide to patients

Negotiating relationships: - Contact local imaging centers - Ask about cash-pay rates for your patients - Establish referral relationship - May get preferred pricing or faster scheduling

Resources: - MDsave.com (imaging pricing transparency) - Local cash-pay imaging centers - Healthcare Bluebook (pricing comparison)

Imaging Workflow¶

1. Provider determines imaging needed
2. Order created with clinical indication
3. Referral provided to patient with imaging options
4. Patient schedules and has imaging
5. Results sent to practice (fax/portal)
6. Provider reviews and interprets
7. Patient notified of results
8. Follow-up arranged if needed

Communicating Lab Results¶

Result Notification¶

Best practices: - Review all results before releasing to patient - Notify patient of all results (normal and abnormal) - Provide context and interpretation - Document notification

Methods: - Patient portal (preferred for routine results) - Phone call (abnormal or sensitive results) - Secure message - At follow-up visit

What patients want: - Timely notification - Explanation of what results mean - What action (if any) is needed - Ability to ask questions

Documentation¶

Document: - Tests ordered and rationale - Results received and reviewed - Interpretation - Patient notification (date, method) - Follow-up plan

Checklist: Lab and Imaging Setup¶

Lab Services¶

• Identify preferred lab vendor(s)
• Establish account and credentials
• Negotiate or confirm pricing
• Set up electronic ordering/results (if available)
• Create lab requisition templates
• Define pricing strategy for patients
• Create patient lab pricing sheet

Point-of-Care Testing (If Offering)¶

• Identify tests to offer
• Purchase equipment and supplies
• Obtain CLIA waiver
• Train on testing procedures
• Establish quality control processes

Imaging¶

• Identify local imaging options
• Research cash-pay pricing
• Establish referral relationships
• Create referral workflow
• Compile imaging options for patients

Workflows¶

• Define ordering process
• Set up result receipt and review workflow
• Establish patient notification process
• Create documentation templates

Resources¶

• EMR Selection Guide - Integration capabilities
• Equipment and Supplies Checklist - Point-of-care equipment
• Quest Diagnostics, Labcorp - National lab accounts
• DPC-friendly lab services (research current options)

Next Steps¶

After setting up lab/imaging workflows: - Daily Workflow Optimization - Incorporate into practice flow - Patient Onboarding Workflow - Communicate lab value