Consultant Libby Knollmeyer’s Lab Machine Primer Series Part 1: Hematology Analyzers
When laboratories in physician offices move out of the Waived category into the Moderately Complex category, it is usually because they want to acquire the capability of testing CBCs (Complete Blood Counts). To date, there are no waived hematology analyzers, so to do CBCs in-office, the lab must be at least of moderate complexity.
The major difference between Waived and Moderate Complexity labs is that there is regulatory oversight for all non-waived labs (moderate and high complexity), as well as requirements for lab directors, testing personnel, proficiency testing, and biannual inspections that are not present for Waived labs, which all add to the cost of having a laboratory.
In general, however, CBCs are a profit-generating test and virtually every medical specialty can make use of hematological testing information. A single physician practice can generate a profit performing a minimum of 5 CBCs/day, even with the added financial burdens of having a non-waived laboratory. Preforming CBC tests is a great low-impact way to add revenue to your medical practice with diagnostic medical equipment.
The hematology analyzer analyzes whole blood and counts or calculates the following parameters:
My post from 2010 on how much healthcare managers make is one of my most-visited posts ever. It’s time to revisit the data and talk about the direction healthcare jobs are taking.
First, some clarification on Office Manager, Site Manager and Practice Administrator titles and job descriptions.
The Office Manager title applies in two situations:
The first is the top position in a small medical practice (three physicians or less) supervising at least two employees. In addition to managerial duties, the office manager often functions in a full-time or part-time staff position, either at the front desk or as a biller. The Office Manager in this situation does just about everything including the three Ps – Payroll, Payables and Purchasing.
The second situation is the #2 position in a larger practice. The title could also be Assistant Administrator or Operations Manager. This person is responsible for all day-to-day operations, human resource functions and all department activities. S/he typically directly supervises all supervisors and leads and/or all staff if no middle management position exists.
A Site Manager or Site Administrator is responsible for one or more locations of a multi-location practice or a group of hospital-owned practices. S/he has all the responsibilities of an Office Manager for the day-to-day operations of a practice, but typically has a central support system. Duties deferred to the central support may include finance, human resources, billing and purchasing. Policies emanate from central administration, therefore the Site Manager does not have the autonomy of the Office Manager or Practice Administrator.
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Most people who ask what I do have never heard of managing medical practices. Many people say “I didn’t know there was a job like that.” Medical Group Management Association’s (MGMA) definition of medical group practice and medical practice management is helpful:
Medical group practice is defined as three or more physicians engaged in the practice of medicine as a legal entity sharing business management, facilities, records and personnel. This includes single- and multispecialty physician offices, ambulatory surgery and diagnostic imaging centers, hospital-based practices and academic practices. (Medical Practice Managers) … are part of a large and growing field that requires broad knowledge, skills and experience for long-term success. And the decisions they make directly affect nearly every aspect of a practice’s operations, from financial performance to patient care.
The next question many people ask is “How do you learn to do that?” People who do what I do come from lots of different professional backgrounds.
It has been a fairly recent development that there are undergraduate and graduate programs for this field. Many physicians who are business-minded have pursued degrees that allow them to manage their own practices while practicing medicine, or enter the healthcare management field and leave active clinical practice. According to a recent Times article, there are 49 schools that currently offer a dual MD/MBA degree.
Here a few ways other than formal healthcare management training that medical managers enter the field.
Nursing/Clinical: I have known some excellent medical practice managers who have four-year nursing degrees, but I don’t know a lot of them. It seems that most nurses want to be nursing, not managing, and that they became nurses to care for patients in a hands-on way. I have observed that some managers with nursing backgrounds are instant fixers, and have trouble taking the contemplative route to problem-solving.
Management Experience: There is no question that private practices are coming late to the business party and that experienced managers bring a lot to the field. It can be hard, however, to jump into managing a practice with no former healthcare experience because so much is so different. The owners of the business (the docs) are also the ones producing the revenue. As my husband says, the job is very much like being the Commissioner of Baseball.
MBAs: Having a MBA brings a lot of tools and resources to the table, but is not the be-all and end-all, especially when it comes to people-management. The best managers in any field truly like and value people, have time for people, are collaborative with people, and care about people. Can this be learned? I don’t know. Probably not genuinely.
Technology: Managers who understand and embrace technology will have the advantage over every other manager. Healthcare and technology are becoming more and more wedded. Every priority technology function that healthcare managers have to outsource is an aspect of the practice that is somewhat out of their control. Think practice management systems, EMR, phones, PACS, email, knowledge management, lab interface, hospital interface, patient communication, etc.
Up through the ranks: Managers who have come up through the ranks have a big plus in their favor and a big minus. The plus is that they understand healthcare, the nitty-gritty functions of the practice, have experience relating to administrative and clinical staff, and know how to network. The minus is that they are usually undervalued due to the lack of formal education, and may also undervalue themselves for the same reason.
In the end, it’s not where a person comes from that makes the biggest difference, it’s who they are and what they’ve made of their career. Anyone can enter the field of healthcare management, but I do suggest these three prerequisites:
Compassion for patients (compassion for all people)
A desire to continuously learn; if you stand still you’ll get moldy
A sense of humor.
For information on organizations that award credentials click here.
Here’s an interesting history of the field of medical practice management.
When laboratories in physician offices move out of the Waived category into the Moderately Complex category, it is usually because they want to acquire the capability of testing CBCs (Complete Blood Counts). To date, there are no waived hematology analyzers, so to do CBCs in-office, the lab must be at least of moderate complexity.
