Medical courier services and the delivery of clinical laboratory specimens.

1. Courier
Services
Pam Kotynski, MHA MT(ASCP)

2. Ideas
o Employees
o Costs
o Training
o Transportation
o Dispatch Systems
o Specimen Handling
o Obamacare
o Partnerships

3. Internal Couriers
Facility hires and trains
Part of the healthcare team
Dedicated to pick ups including
mail, x-rays, medical records,
hospitals, clinics, physician offices
and other departments
Facility pays for company cars,
salary and employee benefits

4. External Couriers
Contracted with an outside source
Logistics is managed by an
independent vendor
Employees hired and trained by the
vendor
Performance of courier outside of
hiring hospital’s control

5. A Mixture of the Two Systems
 Internal couriers may be used for
established physician routes
 External couriers may be used for routine
routes between hospital sites
 External courier services may be used for
vacation, sick time, new routes, new
areas
 STAT’s
 Internal couriers are supplemented using
outside sources for a variety of functions

6. Courier Employee Positives
 Good for standard route pickups
 Work long hours
 Work hard
 Very courteous
 Good employees, semi-retired
 Good driving record
 Valid driver's license
 Good work ethic
 Required to transport heavy packages
 Working knowledge of municipal streets, state
highway systems, maps, GPS, etc.

7. External Courier Negatives
Not showing up for vacation
coverage
Not dressing professionally
Falter at handling MD offices not
knowing where to go to get
lockboxes
Calling off that day, not replacing
and not notifying customer

8. Costs
o Car maintenance
o Training
o Vehicles ($20K)
o Insurance ($150/mo)
o Gas credit card for
drivers ($3.33-3.85/gal)
o Driver’s education
o Body work for fender
benders ($819)
o Salary and benefits
($28K)

9. Regulations
1. Occupational Safety and
Health Administration (OSHA)
2. Centers for Disease Control
(CDC) Bloodborne
pathogens
3. Department of
Transportation (DOT)
4. International Air
Transportation Association
(IATA)
5. International Civil Aviation
Organization (ICAO)
6. World Health Organization
(WHO)
7. Clinical Laboratory
Improvement Amendments
(CLIA)

10. And More Regulations
 College of American Pathologists (CAP)
 The Joint Commission (TJC)
 Food and Drug Administration (FDA)
 State such as Ohio Department of Health
(ODH)
 Health Insurance Portability and
Accountability Act (HIPAA)
 Business Associate Agreements (BAA)

11. Hazmat Employer
 Does hospital send out staff need training if there is a courier packing the
box?
 If the staff is classifying/packaging specimens for transportation. The
hospital, clinic and doctor's office are considered the shipper of the
package.
 Does the person placing specimens into a box for shipment need to be
trained and certified?
 Any persons handling specimens for transport must be trained and
certified to handle medical specimens.
 What Category of specimens require Dangerous Goods Training?
 Staff must be trained if providing specimens (dangerous goods) for
transportation.
 Where can lab staff/couriers receive training for Dangerous Goods
Handling?
 Employers must provide training for their employees.
IATA regulations require recurrent training every 2 years, unless there are regulation
changes prior to that time. DOT regulations require all training records be held as long as
the employee is retained and for 90 days thereafter.

12. Classification of Specimens
1. Exempt Human Specimens
 Patient specimens where there is a minimal likelihood
that pathogens are present are not subject to these
regulations if the specimen is packed in a package
which will prevent any leakage and is marked with
the words “Exempt Human Specimen”.
2. Category B, Biological Substances (650)
 UN3373; An infectious substance which does not
meet the criteria for inclusion in Category A.
3. Category A, Infectious Substances (620)
 UN2814; An infectious substance which is transported
in a form that, when exposure to it occurs, is capable
of causing permanent disability, life threatening or
fatal disease in otherwise healthy humans.

13. Shipping
 Packing methods and shipping guidelines are important in assuring quality
patient care and maintaining specimen integrity .
 For the safety of others, specimens need to be classified into respective
shipping groups.
 Standardized methods and procedures so that all specimens are
packaged and transported correctly.
 The temperature at which specimens are held and or transported is a
critical component and different packaging will be needed for frozen,
refrigerated and ambient temperatures to achieve optimal
environmental control during transit.
 Additional steps may need to be taken in seasons/locations where
extremes of heat or cold could affect specimen integrity.
 Basic infection control procedures must also be followed, including
adherence to universal precautions protocols.
 OSHA mandates all body fluids be considered potentially infectious and
that appropriate engineering and work practice controls be
implemented while handling the specimen.

14. Shipping
Dangerous
Goods
o Shipper Marking: Indicating the
name and address of the
shipper
o Consignee Marking: Indicating
the name and the address of
the intended receiver of the
package
o Responsible Party Marking:
Indicating the name and phone
number of a person “responsible
for the shipment”
o Class 6 Infectious Substance
Label: Indicating shipment
contains Category A Infectious
Substance Affecting Humans
o UN Specific Label UN2814

15. Dry Ice Label
Class 9 Miscellaneous
Dangerous Label
o The quantity must be
included on this label as
(___kg). (no more than 2.2kg
of dry ice is allowed per
shipping container.)
o Double up arrows pointing
upwards must be on
opposing sides of the box.
o Place the pre-packed tape
strip across the box only in
one direction.
o Care should be taken to
allow enough space for
carbon dioxide gas to
escape as dry ice dissipates

16. Ground Transportation
 Exempt Human Specimens are not regulated by
ground transportation.
 Category A and B specimens are regulated by the
DOT.
 Dedicated private or contracted carrier is defined
as a motor vehicle used exclusively to transport
biological substances or biological products.
 While other medical or laboratory related
materials may also be transported in this
vehicle, its purpose is primarily to transport
specimens.

17. Air Transportation
o Charter, Commercial and Cargo Aircraft
are used for transportation of specimens
to reference laboratories .
o IATA regulations must be followed for all of
the listed air transport options.
o Regulations include procedures for Dry
Ice, Category A versus Category B
specimens, labeling of shipments, and
any documentation guidelines.

18. Factors Which Can Damage
a Specimen During Transportation
Not being able to:
 Use a seat belt on cooler and place
cooler in back or place on floor so the
specimens are not jostled.
 Keep tubes upright for proper position
during clotting and transportation.
 Division of cooler for ice and room
temperature to maintain integrity.

19. Specimen
Transportation
Errors
Lost or Compromised
specimens major source of
physician and patient
dissatisfaction.
o Losing specimens
o Not picking up in a timely
fashion or forgetting pickups
o Not emptying coolers
o Not maintaining the
appropriate temperature for
stability resulting in poor
specimen integrity

20. Blood

21. Laboratory Tests Affected by Hemolysis
 Concentration
Increased
potassium, phosph
orus, LDH, TP, AST, a
lbumin, acid
phosphatase, Mg,
Fe, Ca, ALT
 Concentration
Decreased
RBC, Hgb, Hct

22. Decreased RBC’s
 Red blood cells (RBC), perhaps, perform the
most important duty in the body when it
comes to blood. These cells carry oxygen
from the lungs and deliver it to the rest of the
body. Also, they bring carbon dioxide back to
the lungs so that it can be exhaled.
 Not having enough red blood cells deprives
the body from getting the amount of oxygen
required for its functioning. This condition of
low red blood cell count is called
anemia, and it may indicate several factors.

23. Decreased RBC Diseases
 Lupus
 Colon Cancer
 Vitamin B12 or Folate Deficiency
 Chronic Bleeding
 Bone Marrow Insufficiency
 Sickle Cell
 Rheumatoid Arthritis
 Iron Deficiency Anemia
 And More….

24. Hemolysis

25. Hemolyzed Specimens

26. Increased Analytes
 Aspartate aminotransferase (AST) in
liver, heart, and muscle
 Alanine aminotransferase (ALT) found in
liver
 Uric acid gout and poor diet
 Total bilirubin in obstructive jaundice
 Lactic acid dehydrogenase (LDH)
elevates in response to cell damage

27. Are We Communicating?
Two Tin Cans Smartphone

28. Dispatch Systems
 Need to know neighborhood and routes
 Online system to order stats
 Can check back on specimens
 Maintain the routes as physicians are
added or lost
 Rearrange routes to be productive
 Know where the specimens are at all
times
 Change specimen pick up times

29. Courier Software Solutions
 Streamline the process
 Ensure reliability and accountability
 Easy to use
 Manage delivery system
 Integration with other components and
interconnection
 The level of expertise and the
performance expectation bar just keeps
rising higher

30. Integration
o Order entry
o Dispatch
o Tracking
o Reporting
o Barcoding
o Scanning
o Geographical footprint
o Virtual nationwide network
o Allows for the laboratory to plan workload and staff
accordingly
o Able to re-route drivers due to weather, STATS, or other
environmental factors

31. Competitive Advantage
Greater precision
Increase accuracy
Cost effectiveness
Planning for expected volume of
work
Gain efficiencies
High performance

32. Client Management
 Allows for the customization of
billing, rates and services
 Dispatches know exactly where the
drivers are, what specimens they have
 Track orders on line
 Delivery status, proof of delivery
 Variety of management reports
 Designed to fit specific customer needs

33. Healthcare Reform
 Obama Program

34. Obamacare
What does that mean?
 The official name for "ObamaCare" is the
Patient Protection and the Affordable Care
Act, a bill signed into law to reform the health
care industry.
 ObamaCare requires that all insurance plans
cover preventive services and stops insurance
companies from dropping people when they
are sick, as well as offering a number of other
reforms and protections.

35. ObamaCare Medicare Advantage
 The ObamaCare Medicare cuts will mainly affect
reimbursement rates for hospitals and private
health insurance companies.
 ObamaCare also seeks to decrease the amount
paid to hospitals for Medicare.
 Hospitals have already agreed to this practice
since everyone has insurance under the
Affordable Care Act.
 Systems will see a large influx in the amount of
visitors to their hospitals, thus they should break
even or possibly profit, while saving the tax payers
money.

36. Medicare Value-Based
Purchasing Program
 ObamaCare's new Medicare Value-Based Purchasing
Program means hospitals can lose or gain up to 1% of
Medicare funding depending on 20 factors that gauge
quality v. quantity care.
 Hospitals are graded on a number of quality measures
related to the treatment of patients with heart attacks, heart
failures, pneumonia, certain surgical issues, re-admittance
rate, as well as patient satisfaction.
 The ratings will be measured by the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS).
 Hospitals have substantial incentives to make sure
employees understand the legislation’s components, the 3rd
party HCAHPS process, and strategies to maximize efficiency
and customer service.

37. Value-based Payment Rewards
Hospitals for Providing Quality
Care
 In other words if a hospital has a high re-admittance
rate or rated poorly for treatment they can lose a
percentage of funding or if they have a low re-
admittance rate or score well they can gain funding.
 Some hospitals have already been hurt, while others
have gained significant funding. Although the
drawbacks are obvious in the short term it has created
an incentive to improve the quality of care in hospitals.
 ObamaCare Medicare penalties / rewards will rise over
the next two years to a total of 2%.
http://obamacarefacts.com/obamacare-facts.php

38. Medicare Spending
 26% of the U.S. federal Budget
 Medicare providers will see $11 billion in
reimbursement cuts in 2013
 Deficit reduction sequester was designed to
achieve savings of $1.2 trillion through 2021
 Millions of dollars in Medicare reimbursement
are at stake for health care providers that
succeed or fail to navigate health care
legislations

39. Fun Facts
 There are 9757 companies labeled as
couriers.
 Approximately 5,815 Registered Hospitals
in the US.
5,010 Community Hospitals
213 Federal Government Hospitals
447 Non Federal Psychiatric Hospitals
129 Non Federal Long Term Care Hospitals
16 Hospitals of Institutions(Prison Hospitals,
College Infirmaries etc...). (Wiki Answers, 2013)

40. Think of All the Work!
 According to a report by the US Census
Bureau there were over 661,400 doctors and
surgeons practicing medicine in 2008. In 2003
the US Department of Labor broke down the
categories to include 23,790
Anesthesiologists, 111,990 General
Practitioners, 50,140 Internists, 19,180
OB/GYNs, 26,910 Pediatricians, 19,530
Psychiatrists and 49,730 Surgeons. (U.S. Department of
Labor, Occupational Outlook Handbook, 2012-13 Edition, Physicians and Surgeons,
on the Internet at http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm (visited
June 23, 2013).

41. So What’s Next?
Win for the Courier Win for the Healthcare system

42. Partnership
Willing to pay more for
better service
o Professionalism
o Simplify process
o Cost containment
o Quality patient
care
o Safety
o Reliability

43. Problems
 Laboratory professionals work in one of the
most highly regulated environments in health
care
 Small changes can be very difficult due to
time, budget and staffing constraints
 Very difficult for laboratories to maintain a
high performing, cost effective courier service
 Decreasing reimbursement environment and
tight budgetary constraints for capital
purchases
 Competition between facilities

44. Laboratory Priorities
 Phlebotomy
 Quality Control
 Patient Testing
 Customer Service
 Instrument Maintenance
 Physicians, nurses, other ancillary
departments for care coordination
 Reference Labs
 Courier Services

45. Solutions
 IT solutions
 Tough performance standards need to be
met
 Managerial expertise are needed to run
these programs
 Look at ways to reduce costs and
maintain quality
 Integration of services

46. Buzz Words

47. Healthcare Initiative Words
 Think “Lean”
 Kaizen
 PDCA
 TQM
 CQI
 Six Sigma
 Add value

48. Questions?

49. Contact Information
Pam Kotynski
www.linkedin.com/in/pamkotynski/
www.beakerspeakers.com
513-673-2711
pam.kotynski@gmail.com