The Pandemic Intensified Chronic Lab Worker Shortage

by Jondavid Klipp | Sep 15, 2021 | American Society for Clinical Pathology, COVID-19

The Pandemic Intensified Chronic Lab Worker Shortage

There are approximately 338,000 clinical laboratory technologist and technician jobs in the U.S., according to the U.S. Bureau of Labor Statistics. Hospitals account for 47% of these jobs; independent labs, 20%; physician offices, 9%; schools and universities, 6%; and other settings, 18%. While the Covid-19 pandemic has increased the visibility of the clinical lab industry, it has also intensified the chronic shortage of lab workers. A new report (The Clinical Laboratory Workforce: Understanding the Challenges to Meeting Current and Future Needs) published by the American Society for Clinical Pathology (ASCP) and the Center for Health Workforce Studies at the University of Washington, provides an in-depth look at the lab worker shortage and strategies to increase the pool of qualified personnel. For more insight, Laboratory Economics spoke with the study’s lead author Edna Garcia, MPH, Director, Scientific Engagement and Research at ASCP.

How has the pandemic worsened the lab worker shortage?
It’s made it difficult for students studying medical laboratory science to get onsite at clinical rotation sites. Many sites didn’t want students due to Covid-19, and some programs turned away students weeks before they were scheduled to start rotations. As a result, the pipeline of new histotechnicians, medical laboratory technicians and phlebotomists entering the workforce has been disrupted.

There were steep declines in the number of new histotechnicians, histotechnologists, medical lab technicians and especially phlebotomists last year [see table].

At the same time, labs have experienced higher-than-average staff departures mainly due to early retirement taken by employees with health concerns. Some lab employees in the age range of 55-64 have retired early because of burnout and/or fear of catching Covid.

Finally, there has been increased demand for lab workers due to the high volume of Covid-19 testing, demand for rapid turnaround time, and the thousands of new Covid-19 testing labs that have

What’s your take on the high sign-on bonuses being used to attract lab workers?

For more than 20 years, labs have competed for workers by offering sign-on bonuses. What’s new is the size of the bonuses, which have increased from roughly $1,000 to $5,000 in the past, to as much as $10,000 to $20,000 currently. Labs are also now frequently tying sign-on bonus payouts to required employment of two years or more to prevent “lab jumping.” We’ve also seen institutions that offer to pay for licensure fees, discounts on car/homeowners insurance and cellphones.

Which positions are in highest demand?
Medical lab technicians, histotechnicians, and phlebotomists have the highest vacancy rates. We also see many opportunities in molecular pathology departments, and the need for technologists with molecular biology (MB) and molecular pathology (MP) certifications.

The long-term trend in new clinical laboratory science program graduates is flat.
Yes, the total number of new graduates for all lab degrees (HT, HTL, MLS/MT, MLT, etc.) has been stable for the past 10 years (see chart). But stable isn’t good enough to keep up with the growing demand.

Will increasing technology and automation alleviate the worker shortage in the lab?
From our data and conversations with lab staff and managers, the role of lab professionals is going to change with automation, but it’s not going to reduce the number of techs required. There will be a need for staff who are knowledgeable in using and operating these machines in the near future.

What can be done to increase the pool of qualified personnel?
Our report outlined three strategies. Number one, we’ve got to raise awareness of lab career opportunities at an earlier age. Specific activities and program content geared toward elementary and middle school students are needed. Incentives should be offered to encourage lab employees to participate in educational and awareness-building activities at elementary schools.

We’ve also got to do more to improve workforce retention. Too many lab employees leave the field to pursue new careers by enrolling in nursing or medical school. We need to keep existing employees by providing more opportunities for career growth through tier levels, increases in pay, and
elevated titles.

Finally, we’ve got to encourage diversity in academic recruitment by partnering with STEM programs to recruit students from underrepresented groups, developing more scholarships, and recruiting more men, the non-dominant gender in this field.

New Lab Formations Continue To Boom

by Jondavid Klipp | Aug 15, 2021 | CLIA, CMS, COVID-19, Laboratory Economics

New Lab Formations Continue To Boom

The extraordinary demand for Covid-19 PCR, antigen and antibody testing continues to fuel a record number of new CLIA-certified lab formations, according to the latest CMS data analyzed by Laboratory Economics. More than 7,000 new CLIA lab certificates were issued in the second quarter (April 1-June 30, 2021). The all-time high (12,000+ new CLIA labs) occurred in the fourth quarter of 2020. The boom has created a huge demand for lab workers that had already been in short supply before the pandemic.

Volume Surge Expected For High-Priced Covid-19 Test Panels

by Jondavid Klipp | Nov 15, 2020 | Covid Testing, COVID-19, XIFIN

Volume Surge Expected For High-Priced Covid-19 Test Panels

With the flu season underway, more test panels are becoming available that test for Covid-19 plus other respiratory viruses, including influenza A/B and respiratory syncytial virus (RSV). Labs have begun to submit the combo PCR tests codes for Covid-19, although volume is nominal at this stage, notes Lale White, Chief Executive at XIFIN Inc. (San Diego, CA).

The AMA has issued new CPT codes for Covid-19 PCR-based test panels (87636 & 87637) and Medicare contractors have set rates for both of these codes at $142.63 by crosswalking to the existing code 87631 (respiratory virus detection, 3-5 targets).

In addition, several Proprietary Laboratory Analyses (PLA) codes (e.g., 0223U, 0202U and 0225U) have been issued for larger Covid-19 test panels that include up to 22 pathogen targets. Medicare contractors have set rates for these codes at $416.78 by crosswalking to the existing code
87507 (infectious agent detection, 12-25 targets).

There are currently an average of 1.5 million Covid-19 PCR tests being performed each day in the United States at cost of roughly $150 million per day, or $50+ billion annualized. A transition toward combo test panels reimbursed at $142-$417 per panel could potentially push the annualized market to more than $100 billion. That would exceed the total U.S. market for all non-Covid clinical lab and pathology testing.

In June 2020, the Office of Inspector General (OIG) communicated its fear that many labs are performing medically unnecessary add-on tests when responding to orders for Covid-19. The OIG has added an analysis for potential fraud and abuse with Covid-19 add-on testing to its work plan,
notes Charles Root, PhD, President of CodeMap LLC.

Top 25 Fastest-Growing Labs by Medicare Part B Volume of Services

Survey Reveals Huge Gap Between “Have” and “Have Not” Labs

by Jondavid Klipp | Oct 15, 2020 | Covid Testing, COVID-19, PCR Testing

Survey Reveals Huge Gap Between “Have” and “Have Not” Labs

The latest Laboratory Economics Covid-19 Survey of Labs showed that 71% of labs were currently performing Covid-19 PCR testing and another 3% planned to soon add this capability, while 26% were not doing this testing. Those labs that are performing Covid-19 PCR testing reported that they expect their overall test volume (including both Covid and non-Covid testing) this year to increase by an average of 59% with a median of 10%.

The benefits garnered by labs doing Covid-19 PCR testing will soon be enlarged as many labs are in the process of switching to combo tests that detect Covid-19 and influenza A/B from a single patient specimen (CPT 87636). New combo PCR tests for Covid-19, influenza A/B and respiratory syncytial virus (RSV) are also being introduced (CPT 87637).

Meanwhile, the “Have Nots” that do not perform Covid-19 PCR testing are expecting average volume growth of only 1% with a median of 0%. The “Have Nots” surveyed were comprised entirely of local pathology groups and physician-office-based labs.

“The downturn in patient office visits has decreased lab volumes and caused many to furlough or completely lay off certain areas of staff. The labs that are thriving are those that have been fast and flexible enough to add Covid testing,” said a surveyed lab executive from Florida.

“The Covid pandemic has introduced new healthcare delivery platforms, such as telemedicine, that do not enable the same amount of referral laboratory testing. Despite offering an electronic order and convenient online scheduling at local patient service centers, we are seeing an increase in patient no-shows and test orders are not being completed,” noted a lab executive from Texas.

National Covid-19 PCR test volumes have quadrupled since LE’s initial Covid-19 survey conducted back in early May. Volumes might be even higher if not for continued supply shortages. Our most recent survey
showed that 59% of labs had shortages in PCR-based Covid-19 test kits. Pipette tips (45%) and collection swabs/specimen transport media (41%) are also currently in short supply.

The Laboratory Economics Covid-19 Survey of Labs was emailed to approximately 6,000 pathologists, laboratory directors, managers and executives between September 30 and October 13. We received complete responses from 124 individuals, including 44% from local independent pathology groups/labs, 25% from national pathology/commercial lab companies, 23% from hospital-based labs and pathology groups, 6% from academic medical centers, and 2% from physician office labs.

Majority Of NYC Nursing Home Employees Have Had Covid-19

by Jondavid Klipp | Jul 15, 2020 | BioReference Labs, Covid Testing, COVID-19

Majority Of NYC Nursing Home Employees Have Had Covid-19

BioReference Labs reports that Covid-19 antibody testing it performed on nursing home employees throughout New York State in May-June showed a 29% positivity rate. New York City nursing home employees were found to have the highest positivity rate (55%).

During the same time period, BioReference performed PCR-based molecular tests for active Covid-19 infection and found a 2.9% positive rate throughout the state, including a 4.6% positive rate for New York City nursing home employees.

The testing was performed as a result of a New York State mandate (effective May 10) that all personnel at nursing home and adult care facilities be tested for active Covid-19 infection using PCR-based molecular testing, twice per week. In addition, at the start of the program, many nursing homes asked that employees be tested for antibodies at the same time.

BioReference uses the Roche Elecsys Anti-Sars CoV-2 assay for antibody testing. Overall, BioReference tested 3,488 nursing home employees in New York State (primarily in May) for antibodies and found 1,010 positive cases. “With 29% of employees testing positive for antibodies, an extrapolated estimate for the 140,000 total nursing home staff in New York State suggests as many as 41,760 nursing home staff members in the state could have had Covid-19 prior to early May,” according to Jon Cohen, MD, Executive Chairman at BioReference.

Sweden’s Controversial Covid-19 Strategy

by Jondavid Klipp | Jun 29, 2020 | COVID-19

Sweden’s Controversial Covid-19 Strategy

Sweden never imposed a strict lockdown to combat Covid-19, unlike most other countries. The only official rules put in place are a ban on gatherings of 50 people or more and a ban on visitors to nursing homes.

The nation’s Chief Epidemiologist, Anders Tegnell, MD, PhD, says Sweden’s strategy is based on the assumption that Covid-19 isn’t going away any time soon, and that severe lockdowns can’t be maintained for very long and will prove to be ineffective over the long run. Strict lockdowns may temporarily contain the virus, but won’t prevent it from returning, according to Tegnell.

In an interview with Swedish Public Radio on June 24, Tegnell said that Sweden has followed the “classic pandemic model” that he had been discussing with international colleagues for 20 years. Tegnell characterized lockdowns as flying in the face of what is known about handling viral outbreaks. “It was as if the world had gone mad, and everything we had discussed was forgotten….The cases became too many and the political pressure got too strong. And then Sweden stood there rather alone.”

Sweden, which has a population of 10.1 million, has recorded 65,137 cases, 2,407 intensive care admissions and 5,268 deaths from Covid-19 as of June 25, according to the Public Health Agency for Sweden. More than half of the Covid-19 deaths in Sweden have occurred among its nursing home residents.

Covid-19 deaths in Sweden are much higher per capita than its nearest neighbors (Finland, Norway and Denmark), which had strict lockdowns. However, its per capita death rate is lower than some other European countries that had strict lockdowns, such as Belgium, Britain, Spain and Italy.

Sweden New Covid-19 Cases 7 day moving avg

Source: Folkhälsomyndigheten