These days, as hospital systems’ stomachs appear to be growling for physician practices (and vice versa), lab professionals, the sales reps who service them and patients themselves are caught in the middle. Should the hospital system take on some or all of the lab testing done in those offices, thus fully using its experienced staff and state-of-the-art equipment? Or should the physicians’ offices hold on to their analyzers in the name of better patient care?

Repertoire examines this in its July cover story.

The question will come up with increasing frequency: “Hospitals are grabbing physicians as fast as physicians are running to them,” says Patrick Creager, medical technologist ASCP, HS, and president of Guidance Healthcare Consulting, Grand Rapids, Mich.

That these decisions will have to be made is inevitable. They already are, and the results aren’t predictable.

“As a broad observation, ‘If you’ve seen one, you’ve seen one,’ or put another way, the model varies widely from deal to deal,” says Sumner Spradling, CEO, Infolab Inc., when asked about which way hospitals and doctors are going on the centralized-vs.-decentralized lab debate. “Whether or not the hospital assumes the lab testing depends on how the deal is negotiated.

“Generally speaking, lab testing is addressed during the negotiating process between the hospital and the physician. So if a physician sees value in the laboratory and wants to retain it as part of the practice, then the hospital is likely to accommodate the doctor during negotiations. But if it gets overlooked or if there is no strong voice, then the hospital is highly likely to assume some or all of the lab testing.

“We see widely divergent outcomes in this regard, but most acquisitions result in some if not all lab testing migrating to the hospital. Unfortunately, many times the physician lab is simply an unintended casualty of the transaction.”

The tests that tend to migrate to the hospital include what Spradling calls the “Big Four” — hematology, chemistry, immunoassay, and coagulation. Rapid diagnostic tests are typically left on site at the physician office, he adds. “But it is important to restate that there is no standard pattern as to how lab testing is handled in an acquisition.”

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