The "PEA" (Paramedical Examiners Anonymous)

Awesome!

Ditto

This was tried a few years ago by another paramed supply vendor. Are the kit components being purchased from the actual kit manufacturing companies that make them for the labs? I ask because last time this happened the labs began rejecting specimens due to the incorrect reagents in the kits. Just saying, not trying to be a wet blanket, I got a few chargebacks when it happened and other than kit "parts" ended up eating a couple hundred bucks on the kits the other guys were selling.

No lab will accept kits that are not manufactured by the laboratory unless they just happen to slip through their QC process. Every component of laboratory testing is controlled and regulated by federal and state authorities to assure accuracy and consistency. You have no way of knowing which specialized preservatives are in any given container, and how they interact with the reagents used to complete the testing. When you use a non-authentic lab kit you are placing yourself at risk of invalidating the accuracy of the testing completed on that specimen.

If an IC issues a life insurance policy based on flawed lab data which ultimately results in a contestable claim and it can be proven that the paramedical examiner used a non-authentic collection kit, you have just invalidated the reliability of the lab test and placed the carrier, agent and yourself at great risk of liability.

If you are buying lab kits you are charging for them. There is already a significant markup between the lab's price and the amount you bill the IC for the kit (or should be). This is your profit margin on the kit. Allow the lab to make their profit margin as well and assure that the integrity of the specimen can't later be called into question. Cutting corners to make a couple extra bucks places everyone in the chain at risk.

I've said before and now again, the labs should not be charging ANYONE ANTHING for the kits, but they do so to make themselves look more productive on paper. When I worked for a large medical practice we used three different labs and we always got our supplies for free. CRL, Heritage, and LabOne all know their kits will be coming back to them and their purchase/manufacture should be written off as a business expense rather than a highly inflated retail commodity on the other side of the ledger.

As far as componants are concerned, only the urine preservative is in question. We all carry extra blood tubes both tiger top and purple in case we blow out a tube or there is a defect. All purples and all tiger tops maunfactured by vaccutainer or any reputable mfgr contain the same additives.

My advice to my fellow examiners is to keep a box labelled "spare parts" in case you run out of kits. When a kit expires, pull the urine tubes and the serum tube as well as the lab form and add your unexpired blood tubes. Save boxes. Have on hand blank stick on labels to cover CRL prelabelled tubes, when necessary and write in the barcode # to correspond with the lab form. Save kit boxes and any other small boxes you come across so you can build a kit when you need to.

Personally I highly resent having to buy kits and would love to be able to get a 50%discount. - Angel

Really? Why do they accept one another's kits? Really? That might be true for patient testing but insurance? And why aren't their kits the same if this is "regulated"? Look at the label.
Examone's red top; BD Vacutainer SST REF 367987 7.5mL
Lavendar; BD Vacutainer K2 EDTA 7.2mg REF 367844 4.0mL
Do you think Becton Dickinson makes these only for Examone?
I guess somebody in our hospital lab steals them from E1.
I don't know what you're talking about with "our" profit margin. The exam companies probably figured out a way to make a profit on them but they don't pass it on to examiners. For examiners it's more often than not part of their overhead expenses. I consider myself lucky if I get reimbursed for them without a fight.

As someone else already pointed out, in businesses outside of this industry they're provided for free. Why is that? Because those businesses have a choice and the labs are competing for their business. They build those costs into their testing fees so the businesses they're competing for don't tell them to go pound sand.


Profit margin? I'm betting the labs are marking these up 300-400%. That's not a profit margin, it's rape. And it's not making extra money, it's cutting our costs.

By the way, which lab do you work for?

I still think it's an awesome idea!

This is what examiners should be thinking about ways to increase our revenue and help each other at the same time.

KUDOS! to the mastermind behind the idea

Hope it takes off.

I suppose the lab rep isn't going to answer but that's not surprising. I don't think it's a matter of looking more productive on paper as much as them wanting to protect their cash cow. I would put it at $2, maybe $3 at most for the actual cost to the labs for their kits. Probably less when you take into account the volume discounts they must get.

Just for the heck of it I googled lavendars and quickly found many sources for purchasing tubes. This one's prices (http://cruzmedical.com/BD-Vacutainer-Blood-Collection-Tube-4mL-13x75mm-Lavender-K2EDTA-BD367844BX100.htm) works out to roughly 29 cents per tube. And that's just for a box of 100. No volume discount at all. You can't tell me the labs aren't completely taking advantage of every one of us. Rape is an understatement.

I'm sending my contact info to NASCPE right now. I want to be at the top of the list when they become available.

maybe the class action attorneys can give us their 2 cents on this aspect of abuse.

I ordered a case of Heritage urine kits for their tubes and forms, and will purchase red and purple top tubes seperately,
and see what happens, I owe Heritage over $600 right now for 3 cases of blood kits, and thats more then my current paycheck,,

Just wondering: if you need 3 cases of lab kits how can your paycheck be less than






Just wondering, if you need 3 cases of lab kits how can your paycheck be less than $600???????














4600

over $600 sounds right for three cases but what difference does it make? seems the point just supports how criminal the prices are for kits and shows how unbalanced things are when your costs are more than your pay.

as for 2.9 cents for a purple top, do the math. if all five tubes were even 10 cents apiece, which is apparently way more than they actually are, that's only fifty cents. does the lab slip make up the eight dollar difference? how bout the needle, gauze, alcohol pad? maybe it's the hiv pamphlet or the shipping box with the pointless address/postage printing on it that costs so much.

i don't think anyone should have to BUY kits. like someone else said, it should be built into the price the labs charge the ICs and we should have absolutely no involvement in anything to do with kits except ordering them. but since they choose to do it this way there should be no profit margin let alone one that's clearly way beyond reasonable.

we are being held hostage, plain and simple, so if someone wants to make them available at a significant savings and make themselves some money at the same time, i'm good with that. it's called free enterprise and the labs are encouraging it by being so greedy.

if we're lucky, walmart will get involved.

Do any of these numbers figure in the cost of shipping the kits to and from the labs? Or is shipping on top of the charge to the IC? And what about the manpower it takes to put together the kits? I think if you are only looking at the cost per component you our not really looking at the big picture. But who buys kits anyways? Why are the PC's not providing them to you? Mine does...

If you work for RSA you have to supply your own kits. They will reimburse you $9 per kit but you have to supply the kit.

Yes and I much rather pay 5 rather then 9!

rather than

Interesting that you don't want the lab to make a profit on the kit but you are willing to do just that in paying $5 and getting $9. Just sayin...

I don't think many begrudge most businesses making a profit but you have to admit that the lab industry is different. They've set a precedent by supplying testing materials for free as a means of getting the testing work sent their way. They must have learned early on that charging for these materials resulted in driving people (who had a choice) away from sending them business. And it makes sense that that would be the result. Who willingly puts themselves at risk for eating those costs if they might end up with extras or because the materials expire?

And what if the lab makes changes and those materials are no longer used or accepted? Case in point; one of the labs changed their DBS kits and will no longer accept the former ones. Was there a buy back or trade-in offer? No. The people who thought they were being responsible and intelligent, by always having extra inventory on hand, got screwed. And that's yet another example of the greed being displayed by the labs.

It was their decision to change their equipment or testing procedure to such that requires these new kits but I seriously doubt that they stuck themselves with hundreds or thousands of the old kits in the process. The more likely scenario is they held off implementing the change until they could get rid of their old kit inventory. How did they get rid of it? By selling it to examiners and PCs who had no idea this change was coming.

In other segments of the business world a buy back or trade-in plan would be offered, if for no other reason, as a PR or goodwill gesture. A show of respect and concern for their customers and proof that they weren't trying to take advantage of them in the process of making changes.

As for examiners wanting to cash in and make a profit; can you blame them? Between the labs and the PCs taking bites out of our asses for years we've seen our pay plummet down to minimum wage. Why wouldn't we take any and every opportunity to bring our pay up and recoup some of our losses? Unlike the labs, that's not greed, it's survival and trying to gain some degree of control when we're usually powerless and lacking in options.

I've been following this thread and wondering why the labs haven't jumped in (we all know they monitor this board as much as others), then I figured it out.
They can't. They know we're right on target and there's nothing they can publicly say or do to refute the truth of what's being discussed here.

CIS

i don't know why this is a big deal. i've been making my own kits for years and i've never had any refused or gotten any grief about it. i just make sure i use the same tubes and vials as they have in their kits.

where do you get the various urine tubes from?

If you make your own kits and the labs accept them. How do you get the labslip and bar codes?

The lab will sell labslips/barcodes. I think Heritage charged me a dollar for them, (each) so 50 labslips = $50

If the labs were only concerned with the integrity and accuracy of test results you'd think they would gladly list what the specs are for proper specimen collection for their testing protocols.

I thought so too and gave them the benefit of the doubt until I decided that making my own kits was a good idea and called them to get that information. None of them would give me the specs. I either got the run around or was told I had to use their kits. I was shocked by the attitudes of the people I talked to. They reacted like I was asking them to expose national security secrets.

I'd expect that kind of reaction from Coca-Cola if I called them and asked for their secret ingredients, but didn't expect it from the labs.

I've always thought of myself as being a glass half full kind of person but as I learn more about the exam business I'm beginning to wonder if I'm really just dumb and gullible.

Even Coca-Cola has a cheaper generic version

examiners are finally waking up

I looked into this a while ago and found out the lab slip costs are in the vicinity of 50 cents apiece because the labs order them in high quantities.

i guess not. quick! somebody check the other 3, my money's on the gauze

In the ExamOne kits the preservative is Cargille Stabilur (says it on the back of their lab slip) and Cargille says the shelf life is 5 years, so no worries about expiration dates.

Good information. What about CRL and Htg urine tubes?

I don't understand why you all think you have to eat the cost of the specimen kit. ICs expect to pay for the kit and handling when the exam is billed by the PC. If the PC you work through is keeping the kit and handling revenue for themselves they should be supplying you with the kit. If you are buying your own kits then the PC you work through should be compensating you for the kit and handling fees. If they are not then your complaint should be with the PC and not with the lab.

The labs (all of them) do indeed make a couple of bucks off of a kit when they sell it to the PCs or whoever. What is wrong with that? Labs, just like paramedical companies and examiners exist to make a profit. The PC then makes money when they sell it to the IC. If you are only in on half of this cycle (buying kits but not getting paid for selling them) then you have only yourself to blame.

Portamedic Direct is the only company I'm aware of who allows the examiner (if the examiner supplies the kits) to get anything at all for kits, but even then they take a significant piece of that (30%). Why they take anything at all, let alone 30%, I can't come up with any other explanation for except greed. It can't be costing them anything, in terms of kit charges being extra billing work on their end, and they're not doing any work in regards to obtaining the kits.

They can argue that they negotiated the kit fees with the ICs and should get something for that but why 30% instead of the 10%-15% that's become the standard? Again I can only point to it being greed. To their credit they at least let examiners in on this to some extent. The others keep all of it by providing kits or reimbursing for kits. And some of the PCs who reimburse put a cap on how much they'll pay and that cap is lower than the actual cost of the kits.

Let's not forget the history of how kit pay came into being. The PCs made kit fees a separate charge to the ICs so they could get more money out of the ICs. They could give the ICs what they wanted by cutting prices on the exam services then turn around and recoup their losses by charging the ICs more for kits. Examiners were the ones who really got burned because their percentage was now based only on the fee for the service and those fees had been lowered.

Your statement "If you are only in on half of this cycle (buying kits but not getting paid for selling them) then you have only yourself to blame" implies we have control over this when we don't.

But you're missing the point and by saying "The labs (all of them) do indeed make a couple of bucks off of a kit" I'm inclined to think it's intentional. The labs make a lot more than merely a "couple bucks" as can be seen by the breakdown above on component prices, but that's not the only issue. The other issue, as has already been stated, is we are being held hostage. For all intents and purposes each lab is running a monopoly. If they weren't we wouldn't be discussing this because there would already be several vendors selling them in whatever quantities we wanted.

CIS

RSA pays $9.00 for each kit used for an exam. They have now begun to make kits available to examiners, but we have to purchase them. Still, we get the money back at $9 per exam and we can buy the kits in small amts, unlike trying to purchase them from the labs with a minimum of 25 kits per order.

Even with RSA they reimburse you $9 but if you buy them from them they charge you $9.50.

And they're getting nervous because of all this talk. Been hearing about some behind the scenes things they're doing to try to kill anything and everything perceived as a threat to this 400%-500% golden goose mark-up.

Again - There should be NO CHARGE from the labs for kits. Labs' cost of components is a direct business expense. Labs' cost of packaging is for their convenience, and a business expense. Labs' cost for shipping is a business expense. If this expense is to be passed on it should be passed on to the customers (the insurance companies) not to PCs and examiners.

If I worked at a Quest drawing station or a hospital lab, would I be charged for the supplies I use? First time would be the last time, fer sher! - Angel

Just want to say I appreciate what NASCPE is trying to do and want to know if they need any help getting this off the ground?

I'd like to offer to help also if they need it or want it

I all boils down to the blood and ua tubes. I have sent in my own boxed up kits before and many of us have used replacment tubes when the kits tubes have lost the vacuum. Never had a problem.

"The Sherman Act outlaws all contracts, combinations, and conspiracies that unreasonably restrain interstate and foreign trade. It also makes it a crime to monopolize any part of interstate commerce. An unlawful monopoly exists when only one firm controls the market for a product or service, and it has obtained that market power, not because its product or service is superior to others, but by suppressing competition with anticompetitive conduct.”

I found this on paramedicalexaminer.net Might prove helpful. - Angel

anyone else see a connection with this subject and the labs now refusing the use of zip slips?

looks like they're getting nervous about examiners coming up with a plan B and stopping the gravy train called the Overprice Express.

bout time somebody stops their monopoly.

Just got a fax from Superior it seems one of the labs notified SMM about 3RD party lab kits (I assume they are talking about NASCPE) and how the consent on those 3RD party kits lab slips is out dated and does not meet the criteria of the labs and insurance companies and any samples sent with those kits will be rejected and the examiner will get fined on the exam and have to go back out and redraw the blood at the examiner's expense.

What I have done in the past is buy UA kits from the labs and buy my own tiger top (25 cents each) and purple top tubes (12 cents each), cotton balls, tape, gloves and needles I save and clean the vacutainers that come in the lab kits) and never throw away a torniquet and I can make blood kit for about half the cost and the lab can not say a thing since I am using their lab slip and UA tubes. They can give you some song and dance about the additives in the different brand tubes not being compatible with their equipment but it is just a song and dance. I find that Billing through SMM and them providing them kits is a better deal on most exams. Regarding Portamedic Direct I almost signed up with them but I can bill through my local Portamedic office at 15% they provide the kits and no $2.25 admin fee and they take the billing since it increases their monthly numbers and makes them look good.

I assume you meant 85% but is that 85% of 100%, or is it 85% of 85%?
If I'm not mistaken PM corporate pays branches 85% of the total they get from the ICs.

So are the labs now expecting examiners to throw away kits because they're saying the forms expire too?

Talk about song and dance; Is it legal for them to destroy specimens because they don't want anyone else getting in on their action?

It sounds like they're making up a whole lot of shit to keep NASCPE and us in the position of having to buy kits from them. Seems like a textbook example of what would constitue a violation of the Sherman Act.

yeah, that's my question to.

You are mistaken PM home office doesn't take any % - PM is a publicly held corporation not franchise. So it is 85% of 100% and kits are provided.

I think a BIG thing to remember here is there is PC behind every lab now.

Whoa hoss. Is this true?
If I use one of there forms and it's outdated they'll throw away the specimens? WTF???

If I ever see that happen, I don't care what form it was done on, I'll be letting the patient know exactly why they're going through another draw and I'll be giving them the phone number for the lab. I'll also tell them to lodge a complaint with the insurance company and the agent. This is BS and there's no way in hell I'm taking heat for some stupid red tape about the lab's paperwork.

So does anyone know if it is legal or does anyone know how to find out if it's legal?

This sounds like a very important issue. Can examiners be held responsible for something the labs do?

I will run it by little brother, He is a lawyer that specializes in health care, malpractice, and contracts. And housing defects.

Thank you very much. Again, please contact us at admin@nascpe.com

That would be awesome if your brother can help. These labs are ripping us off charging double or triple what the kits actually cost and it's obvious they're gonna keep raising their prices until some form of competition forces them to stop.

I have no desire to make my own kits but I'd like to know I can. And I believe examiners being able to use home made kits would be enough competition to make them rethink their pricing. I don't doubt they'd rather we use their kits, even if they weren't making a profit on them, because processing their own kits probably allows them to work faster and more efficiently. But I'm not gonna get gouged AND make their job easier. If they'd prefer to have us use their kits because there's an upside for them, make it attractive for us to go that route. Otherwise I'll go with an option that saves me money and too bad for them if it makes their job harder.

I'm also very keyed in on this to see what our options are for using zip slips. I love those things but CRL's threats to throw away specimens if we use them make me nervous. I don't think they should be able to dictate how we do our job or what we use for tools.

Thanks for looking into this and doing something about it.

here here

Anybody know if they contacted NASCPE yet? I'd like to start using my quick slips again too.

It is absolutely song and dance. Tigers and purples are universal. Look at the tubes that come in there kits, they have the manufacturer's name and reference numbers. As long as those match whatever they use in there kits, there's no way they would even know, forget about be able to prove, that they weren't from there kits.

Here's an interesting difference. The labs are more than willing to deal with shipping charges for receiving kits and billing the InsCOs for those but they want nothing to do with billing the InsCOs for kits and there S&H charges. Pretty obvious how they can make more money doing it this way. They can get paid for every kit they sell, whether or not they get used or expire, and make a profit there. Then on the other side, since the InsCOs have no way of knowing if kits were received one at a time or bundled, the labs can boost the shipping charges by telling the InsCOs they were mostly singles and pocket the extra money on ones that were actually bundled.

Okay. So from now on, no more bundling of kits to the labs. Each in its own separate pouch, until such time as the labs stop charging for kits. You in? - Angel

I'm in. If they're willing to throw us under the bus and be there scapegoats why should we do them any favors.

Has nascpe heard anything from this poster yet?

Unfortunately, no, we haven't heard from this poster's brother/lawyer.

We are still trying to find out what the legalities are surrounding destruction of specimens but haven't found anything definitive as yet, so we'll throw it back out there and ask for help.

If anyone can give us guidance on where we can find this information, please let us know.

Thanks,
NASCPE

Do you remember who the vendor was? I'm asking because that might be useful in the FTC complaint to show the labs thwarted attempts by others to sell kits.
Thanks