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Tuesday, June 16, 2015

do you need a physician to order your blood tests?

There are a number of folks who want to eliminate at least one aspect of  gate-keeper role of the physician  or at least allow people  to order blood tests without getting a physician's order.

To name a few: Dr Eric Topol,Elizabeth Homes,and apparently the governor of Arizona.

Elizabeth Holmes is founder and CEO of a company named Theranos,which has developed a technology to enable a very large number of blood tests to be done from a few drops of blood,less than the tube drawn on a standard veni- puncture.

In April 2015 , the governor of Arizona signed a statute "allowing" clinical labs to perform blood tests without a physician's health care provider's order.

Laboratory Corporation of American has recently announced that they will perform lab tests on folks without requiring a doctor's order. See here for article.

According to the Bloomberg article linked above some twenty states already allow blood tests to be done without a physician's order.However according to this chart more states than that allow what is call "direct access testing". (This table is from a website called Longevity Testing.Com and I cannot attest to its accuracy as there are no links to supporting data.)

LabCorp and Quest and other large commercial labs have seen decrease in fees from CMS cuts and also from fewer referrals from independent physician's office as more doctors move to large groups or are being bought out by hospitals,who have their own labs. So they obviously welcome more direct assess customers.

In some instances a person's copay for a visit to a doctor to get a hall pass for a blood test may be more than the fee for service going the direct access route plus you do not have to wait in the doc;s office to see him and then wait for his office to send you your results.Of course,this assumes that the quality and resource conservation guidelines that he is "encouraged"   to follow will "allow" you to have the test.As you know the American College of Physicians and the American Board of Internal Medicine have declared that physicians are the "stewards" of the allegedly collectively owned national medical resources

Direct access testing fits in nicely with Dr. Topol's latest book The Patient will see you now in which he argues that smart phone based technology will go a long way to the democratization of medicine and the continuing stamping out of the lingering paternalism that was a regular feature of medicine for centuries.


Diane said...

This is awesome news for Patients. Should be awesome news for Drs. too.

Now to get insurance to cover self referral to labs, after all, they cover self referral to Specialist care.

Unknown said...

What actually happens with this policy; that is what tests do people order, and then what happens? Do older men get PSA's? What if there is a elevation; do the patients get a do-it-yourself prostatectomy kit?
I guess I am saying that this policy is an answer to a problem that I don't understand.

james gaulte said...

The prostatectomy app for the smart phone is not yet available.