As a practice matures and evolves, decisions are made and changes are instituted to assure that the quality of care delivered is not compromised. Most of our decisions are driven by factors (medical, regulatory, legal) that are out of our control. There are two significant changes that we have had to make to our laboratory ordering process.
First, we now have preferred laboratories that have partnered with us. The results are expected to be sent to us electronically, which should cut down on the time between the blood drawing and when the results are available to us. The information on the preferred labs is located at: http://www.dssurgery.com/lab. Needless to say, there are no financial incentives for us. You should also check with one of the labs, as well as with your insurance company, to make sure that they are a contracted facility and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are in no way responsible for the verification of benefits for the laboratory services that we order.
Second, we have had to change the way we order our yearly lab work.
As most of you are aware, it is critical that weight loss surgical patients have continuous yearly follow-up care and monitoring. The close and detailed surveys of the laboratory studies are even more important within the first 3-5 years. With the majority of patients, most laboratories have it stable and normalized within that time frame. It is therefore critical that the patients continue to receive yearly follow-up care, not only by doing their scheduled laboratory studies, but also by a yearly exam.
As a part of our commitment to quality patient care, we provide a comprehensive two year follow-up to the patients with a Duodenal Switch or Revision. This includes ordering the laboratory studies, review and interpretation of the results, as well as office visits as frequently as required or deemed necessary.
After the initial two years, patients continue to get request letters, and in some cases, patients continue to follow up with us in the office for scheduled visits. In an overwhelming number of cases, however, patients started taking their laboratory studies to a primary care physician for interpretation, which was not ordered by them.
The standard of care would require that the physician ordering the labs would evaluate the patient and recommend treatment as necessary based on the evaluation and results of the studies.
What does this all mean? Every single patient will get his or her lab request letters starting this month. If your surgery was more than 5 years ago, this will be the last year you receive your letter, unless you contact us and request a follow up office visit and continuation of your laboratory draws on a year by year basis. This will be done based on our evaluation, regardless of whether the ordered laboratory studies are adequate or not. In some cases, we may require that you either see us for a follow up visit, or see your primary care physician and have their office order the studies.
We will continue providing the lab request letters to all outpatients for the first five years after surgery. We will then continue to monitor the patient if he or she contacts our office for follow up care and lab order requests.
This is to assure that we are not ordering tests on patients who will not follow up with us.
Over the years, patients have also requested that medication be prescribed solely based on lab results, even if the patient has not been seen by our office in years. We will not prescribe medication to any patient who has not been recently seen by our practice. An exception would be for patients or conditions whose treatment we have a firsthand knowledge of that are not new findings based on a patient’s long-term condition. There are cases when a patient calls our office 8 years after surgery asking for Flagyl to treat gas, which we will not prescribe.