Rapid testing: Is it right for your practice?

As flu and RSV season ramps up, primary care practices are under pressure to deliver fast, accurate diagnoses while keeping patient visits efficient. One strategy gaining attention is in-office point-of-care testing — but with a growing array of tests, regulatory requirements and workflow challenges, deciding which options to implement can feel overwhelming.

Physicians and practice managers are weighing questions that go beyond cost: Which tests truly benefit their specific patient population? How do they fit into existing workflows without disrupting care? And what are the legal and regulatory hurdles for performing tests in the office? From routine screenings to more specialized rapid diagnostics, these decisions can shape both the quality of care and the patient experience.

Experts say the process requires balancing clinical value, operational feasibility and financial considerations, while also considering factors such as patient demographics, practice location and access to external laboratories. Rapid diagnostic testing, in particular, is evolving quickly, offering new capabilities and raising questions about how primary care offices can safely and efficiently integrate these tools.

This presents challenges and opportunities for practices that want to stay competitive, improve patient outcomes and adapt to the growing emphasis on value-based care.

Where to start

The number of rapid tests available for medical practices can make finding a place to start daunting. Rebecca Andrews, MD, MACP, chair of the board of regents for the American College of Physicians, advises starting with one that can make your life easier.

“For example, if someone is on a blood thinner and you want to be able to adjust their dose and make sure they understand it, the test would help you provide safer care to them while they are in the office, which saves you a phone call,” says Andrews. “It should be something that makes your life easier, but also something that you do a high enough volume of, because you have to do quality control on the machine. If it’s something that you are using once every six months, to me, the cost is unlikely to be worth it, because that is an interval that’s too low to either reduce your workload or make it worth the purchase of the machine and training.”

Daniel Krajcik, DO, a family medicine physician at the Cleveland Clinic, agrees, saying that a close look at your patient population and the diagnoses you make throughout the day should help direct you to a test to start offering in your practice.

“Once you are able to do that, you learn the process, your nurse feels comfortable managing the test, your team feels comfortable using the tests, then I'd look into what the next one is,” says Krajcik. “It's always important to think about the costs of your test, both for the fixed, which is your up-front cost of buying a point-of-care machine, but then your variable costs, such as all the supplies needed to keep to actually run that machine.”

Another consideration that might come into play is what other options your patients have.

“If you're in a rural location or just somewhere where there might not be a lab close by, then you do need to consider the higher value for point-of-care testing,” says Krajcik. “If the closest lab is an hour away, asking patients to drive out there for these tests is definitely very different than asking them to stop on the first floor before they exit the facility to have these things done.”

Regulatory hurdles

In addition to equipment, performing rapid tests in your practice puts you under some of the same regulations as many labs or hospitals, and typically requires certification known as CLIA — Clinical Laboratory Improvement Amendments. This is a 1988 federal law that sets quality standards for all clinical laboratory testing performed on humans in the United States. The more complex the test, the more regulations will likely apply.

“The more complex tests will involve more staff training and procedures, but the types of testing that are most often used are things that produce a result very quickly, something like a machine to measure hemoglobin in a pediatrician’s office or hemoglobin A1c to evaluate the control of a patient who has diabetes,” says Andrews. “Those are pretty easy to use and only take a few minutes to get results, but they do have requirements, like proving that you have a room where you can do these tasks that are free of food and beverage, and that you can do quality checks to make sure that the machine is accurate.”

Integration into the electronic health record (EHR) isn’t required, but Andrews says it makes it easier so that you don’t have two different logs. If you have the choice between two supplier companies, one of which integrates with the EHR and one that does not, that might be a deciding factor, he adds. The integration enables data from the test to be directly entered into the record, along with the normal ranges for the test, eliminating the need for additional documentation.

Benefits to patient care and workflow

Offering rapid testing in-office probably won’t make a huge financial difference for your practice, but there is a direct benefit for patients.

“Everybody understands that these tests can make patient care safer,” says Andrews. “I don’t know that they’re a huge revenue generator, but they can make patient care safer, allowing you to adjust care while they are there in the office.”

Christi Siedlecki, MSN, FACMPE, the CEO at Grants Pass Clinic, which has 16 providers in Grants Pass, Oregon, says that rapid testing can help close gaps in care. For example, she says that it is not uncommon for patients to fail to follow up with their lab appointment for hemoglobin A1c testing.

“We incorporated point-of-care A1c testing to help close those gaps,” says Siedlecki. “We have found another benefit is having the provider share those immediate results with the patient. There is almost a dramatic effect as the medical assistant hands the results to the provider with the patient in the room. My providers have shared that quality helps them engage with the patient on the results to motivate the patient if change is needed to improve the results.”

She says that some rapid testing does generate revenue, but that’s not always the main focus.

“Certainly, quality of care and patient satisfaction are positively impacted with rapid testing,” says Siedlecki. “That said, there are a lot of variables to consider if generating revenue is a goal.”

Who handles the tests is a matter of how big your staff is, says Andrews, but in most cases, it will be a nurse or a medical assistant. Multiple people should be cross-trained so that the office has a backup in case the main person is out.

Although testing in-house might lengthen patient visits, it ultimately saves time because the treatment is established in a single visit. “It’s much less confusing than having a patient walk out of your office with one medication regimen, then calling and telling them their lab came back and to forget the refill they just got at the pharmacy and telling them you have to change their medication. Any situation where something goes wrong could take up more time.”

Krajcik agrees and says the time savings are real because if you get the lab results back while the patient is still in the office, all the adjustments can be made then, instead of having the patient needing to come back into the office, which saves time for the doctor and the patient. Patients like the convenience, and it may boost their opinion of the practice.

“I think it does make a practice much more attractive, and you are providing what every patient wants: comprehensive care,” says Andrews. “They can see in front of them that it's coordinated, and they start to understand that every member of the team is truly involved in their care, which is actually a benefit if you need one of your staff members to call them to check in, or we schedule them at a later time. They start to recognize that each one of us really does have a role and their overall health care.”

If you decide to implement rapid testing, Andrews advises letting people know. “Advertise for what it is,” says Andrews. “Look at this technology; it integrates right into our EHR, so I can get your results. It’s allowing me to take better care of you. Really illustrating for the patients what the benefit is to them helps them engage in their care with some agency.”

Krajcik says offering these tests could be a differentiator in a competitive market.

“There's a customer service benefit, especially if you're in an area where there might be multiple primary care practices, or where there are many freestanding urgent care practices around now that have point-of-care testing,” says Krajcik. “Part of their value proposition in the market is to offer lots of rapid testing for people who are sick and want a quick answer. So, if your office can offer rapid strep testing, maybe rapid flu or COVID[-19] testing, patients are going to want to come to you and have that testing done. But if they know that you don't offer those tests, it's obviously understandable that they're going to want to go to a place such as an external urgent care center that might offer them.”

SIDEBAR:

Calculating rapid testing revenue and cost

When trying to determine whether a particular rapid test is right for your practice, consider the questions the team at Grants Pass Clinic in Oregon uses:

What is the patient population, and what is the coverage mix? For example, rapid strep testing in our facility is predominantly used in the pediatric population. A significant portion of our population in this case is capitated, so we do a basic rapid strep screen rather than a more expensive molecular one.

What is the reimbursement? This varies by payer, and you will need to look at the contracts you have to determine what you will be paid. This is often tied to a percentage of Medicare reimbursement, which is problematic. The Medicare payment rates have been falling for years and are currently based on faulty data.

What is the cost of the test kit? I will often negotiate a price less than the list price on the distributor’s website. I also look at numerous distributors and factor in such things as shipping costs. For us, some distributors don’t charge for basic shipping.

Have you compared different brands of test kits? Distributor brands are often less expensive. You do need to compare the accuracy and the precision of each kit to make sure they are truly comparable. Package inserts for this information can be found online before purchasing.

What is the cost of staff? Calculate how much time it will take staff to run and report tests, run and record quality control tests and the administrative costs of reviewing and training. Assign a dollar value to this. Compare this to the staff cost of trying to contact the patient later and time spent answering questions at that time.

What are the regulatory requirements? You will need to have a waived testing CLIA license to perform most rapid testing. Review the documentation requirements and the cost of the license, and include this in your assessment.