Demonstrating clinical value

When patients transition from a hospital to a skilled nursing facility, an outreach program can ensure testing is performed on the same platforms used during their hospital stay, promoting consistent results and supporting a contiguous medical record. Local testing also enables same-day results and supports real-time treatment and intervention. In addition, longitudinal data allow for effective tracking and trending, helping guide more informed care decisions.

Providing operational support

Operationally, the outreach laboratory must provide timely, high-quality specimen collection and transportation for skilled nursing facility customers. As more post-acute care is delivered in these settings, laboratory testing can be a high-demand service, with some patients requiring multiple blood draws per week and frequent STAT requests. Routine care, along with ongoing infection surveillance across a diverse resident population, further underscores the need for reliable laboratory support. Outreach programs can support testing in this environment by focusing on:

• Phlebotomy management. Effective scheduling is essential for managing phlebotomy services. Establishing a routine schedule for phlebotomy services, such as two to three days per week, may be adequate for some locations while others may require daily service. Because serving a skilled nursing facility often requires phlebotomists to travel onsite, consider establishing a minimum patient volume per day to better manage staffing costs and workload.
• Supply management. For specimens collected by skilled nursing facility staff, including cultures and even blood draws, the laboratory must supply appropriate collection materials and transport containers.
• Staff support. Many skilled nursing facilities experience high staff turnover, making it important for outreach laboratories to provide routine inservice training to keep staff current on protocols. Clear written instructions further support staff in proper specimen collection, labeling, and storage.
• Courier support. While phlebotomists can transport most non-blood specimens when returning to the laboratory after their routine rounds, it may be beneficial to provide a daily courier or on-call service for specimens collected after the phlebotomist’s visit. It is important to manage STAT requests by establishing clear limits or fees to prevent overuse.
• Customer service. Open lines of communication, supported by routine visits, help laboratory outreach programs build and strengthen relationships with key skilled nursing facility staff. This collaboration improves processes, reduces errors, and minimizes friction.

Offering business support

Beyond high-quality testing services, a successful relationship with a skilled nursing facility also depends on efficient results reporting, competitive pricing, and effective billing and compliance. Because testing in these settings is typically routine and reimbursed at lower rates, efficiency across these processes is essential. The following insights can help achieve efficiency in these key areas.

• Results reporting. Most skilled nursing facilities use computer systems to support patient care. Some prefer fully integrated, electronic laboratory test results, while others prefer hard copies. Many facilities also want results sent directly to the ordering physician, who may or may not routinely access the facility’s system. To ensure accurate and effective reporting, clear communication is essential. Understand each facility’s unique needs, preferences, and system capabilities. Common solutions include portal access to the hospital’s electronic health record, laboratory middleware, or custom interfaces.
• Billing. For Medicare Part A patients (stays of up to 100 days), client billing must be directed to the skilled nursing facility. For Medicare Part B patients (stays of 101 days and beyond), third-party billing is preferred. Daily census management is essential to ensure accurate, compliant billing. For Part B services, include the skilled nursing facility’s location codes and applicable trip fees to help optimize reimbursement.
• Pricing. For Medicare Part A patients, skilled nursing facilities may request a discounted fee schedule from the laboratory and expect that pricing is aligned with the Medicare Clinical Laboratory Fee Schedule.
• Billing and payment. Managing the Part A billing process requires timely, accurate invoices and monthly monitoring to ensure suitable payment.