$900 For A Flu Swab? Doctors Turn To Out-Of-State Labs Over UVM Medical Center

Jun 17, 2018

High costs for routine medical labs at the University of Vermont Medical Center are pushing a growing number of medical providers in Chittenden County to look for alternatives out of state.

David Lynch, of Hinesburg, came down with a 103-degree fever last fall.  He called his naturopathic doctor, who told him it was likely the flu. 

Three days later, the fever was still there. His doctor recommended a flu test, and Lynch didn't think twice.

"I had a fever, I was ill, I just was doing what the doctor asked of me," he said. 

His doctor dabbed a swab in Lynch's nose and sent the swab to the University of Vermont Medical Center to check for a handful of viruses. The doctor called the order "simple" and "routine." 

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The lab came back negative: Lynch didn't have the flu. But what he did have was a big medical bill.

Lynch would learn later that a different pathogen was making him sick, but in the meantime, Lynch owed UVM Medical Center $901.61 for the flu swab analysis.

Lynch has Blue Cross Blue Shield through the Vermont health exchange and a $5,000 deductible. According to Blue Cross Blue Shield's member price comparison guide, Lynch would likely have paid 10 times less if his doctor had sent his flu swab to — for example — a hospital in Albany, New York, instead of UVM Medical Center in Burlington. 

Now, at least six independent medical practices in Chittenden County are sending routine medical tests to for-profit labs out of state instead of sending them to the nonprofit UVM Medical Center.

One of those practices is Richmond Family Medicine, which primary care doctor Hannah Rabin owns with two colleagues.

"We had been hearing from patients that they were surprised by the high cost of their lab studies. These were recommended tests," Rabin said. "And they would come in with their bill from UVM Medical Center, and they were angry with us because we had recommended these tests and hadn't warned them of the cost. We, frankly, were surprised ourselves to see the high cost."

"We had been hearing from patients that they were surprised by the high cost of their lab studies. ... And they would come in with their bill from UVM Medical Center, and they were angry with us because we had recommended these tests and hadn't warned them of the cost." — Dr. Hannah Rabin, Richmond Family Medicine

This spring, Rabin’s practice stopped sending most of their routine labs to UVM Medical Center and started using Quest Diagnostics, which is headquartered in New Jersey and has labs across the country.

Rabin said Quest sends patients' lab results back to her office less than 24 hours after most patients' visits. 

Quest also pays a phlebotomist to work full time in Rabin's office. The phlebotomist collects blood and other samples from patients. Every evening, the company sends a courier to pick up the samples. Quest then sends the results digitally to Richmond Family Medicine by morning.

Rabin estimates the company charges patients a third or even less than UVM Medical Center.

Amy Vaughan, UVM Medical Center's director of revenue, finance and reimbursement, said it’s no secret the academic hospital's fees are higher than they would be at a for-profit lab like Quest Diagnostics.

"We're supporting an emergency department. We're supporting a Level I trauma center. We're supporting labor and delivery," Vaughan said. 

In short, Vaughan aruges running a lab that can serve complicated and emergency medical situations is simply less efficient than running a lab that batch-processes millions of the same tests each day. Still, Vaughan claims UVM Medical Center’s rates are similar to its peers. 

"We're actually significantly lower compared to other academic medical centers." — Amy Vaughn, UVM Medical Center

"We’re actually significantly lower compared to other academic medical centers," Vaughn said. 

But with routine labs, more independent doctors say they don't need the specialization of an academic hospital. 

However, there is a reason Rabin and her colleagues didn't make the switch to out-of-state labs sooner: According to Rabin, when UVM Medical Center does analyze a lab, the results are accessible to all UVM specialists and emergency room staff; With an outside lab, she said, integration is a lot harder.

"We can certainly fax labs to UVM Medical Center, but even that is a complicated phenomenon," Rabin said. "We find that a lot of records that come from our office into UVM don't get put into the UVM Medical Center chart."

Still, Rabin said, at this point saving money is more important to patients than having records at the emergency room. 

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