Postgraduate Medicine

ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20

Readers' Forum William R. Kleis MD & Robert W. Matthies MD To cite this article: William R. Kleis MD & Robert W. Matthies MD (1992) Readers' Forum, Postgraduate Medicine, 92:8, 37-37, DOI: 10.1080/00325481.1992.11701547 To link to this article: http://dx.doi.org/10.1080/00325481.1992.11701547

Published online: 17 May 2016.

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Date: 17 June 2016, At: 01:56

READERS' FORUM

The impact of CLIA

Downloaded by [La Trobe University] at 01:56 17 June 2016



• If not for your editorials on the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) [beginning in the April issue], I would probably be breaking the law, as would several other physicians in my area who were unaware of the regulations. Although I used to perform only a few simple lab tests in my office, I would not have qualified for the waiver. Thus, rather than be subjected to yet another government regulation, I decided to cease all lab procedures. However, as I expected, I find it very trying to wait for the results of urinalyses and culture sensitivities for 2 days and 4 or 5 days, respectively. When I performed the tests myself, I was able to have urinalysis results before the patient left my office and culture results within 24 to 36 hours. By the way, I tried dialing the CLIA hotline number. Would it surprise you to know that I never got through? The number was usually busy. I called several days before 8:15 AM and was greeted by an answering machine. The taped message stated that the office was open 8 AM to 5 PM Monday through Friday. By chance, I did get the line to ring one time about 8:25 AM. I let it ring for almost a minute; then I heard a click and a dial tone. I immediately redialed, but the line was busy as usual. Can you imagine what it will be like to

get through to the administrative offices of our new national health plan?

William R Kkis, MD Cleveland, New .l0rk



• I thought you might like to share with your readers the following letter, which I wrote to the speaker of the house, Rep Tom Foley (D, Washington). Dear Congressman Foley: I decided recently to stop doing most of the laboratory tests that we had been performing in our office. This is a direct result of the onerous regulations placed on us by CLIA. I made this decision after having a survey of our laboratory and experiencing the punitive approachofthesurveyoL The consequences of this decision will be that patients will now have to go to a local laboratory. Then there will be a delay of 24 hours in getting the answers, and these answers will be given to the patients over the telephone. I have a large Medicare practice, which means many elderly patients who may have a slight decrease in mental acuity and who perhaps do not hear as sharply as they might. When my nurse or I call these patients at home to give them a laboratory repott and then give advice about adjusting medications, this is fraught with the potential for error because of patients' decreased hearing and intellectual capabilities. I

VOL 92/NO 8/DECEMBER 1992/POSTGRADUATE MEDICINE

strongly contend that CLIA is not increasing the quality of medical care and, in fact, is decreasing quality and significantly increasing the risk of mistakes involving medications. An alternative would be to have patients come to my office to review laboratory findings and then discuss changes they might make in life-style or medication use. Of course, this would require another office visit, which is often a hardship for these patients and which would increase the cost of medical care, not a minor consequence. Contrary to popular opinion as well as that of some members of Congress, I was not getting rich performing laboratory tests in my office. As a matter of fact, it is doubtful I was making any profit at all. This is a service that most family physicians want to provide, because we believe it improves the quality of care that we can give our patients. CLIA is one more example of regulations that not only interfere with the practice of medicine but actually have a negative impact on it. I strongly urge you to assist in the repeal of CLIA. I don't think you appreciate the negative impact of government regulations on family practice. This impact will have negative consequences on the health of America ftom a physical and a morale standpoint. RIVI

Robert W Matthies, MD Spokane, Washington 37

The impact of CLIA.

Postgraduate Medicine ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20 Readers' Forum William R. K...
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