Noted Humorist Garrison Keillor Encounters the Truth of Inadequate Funding for Clinical Laboratory Testing Services

It is widely recognized by pathologists and clinical laboratory managers in the United States and abroad that medical laboratory testing is a “high touch” clinical service. Each day, lots of patients interact with laboratory professionals to provide specimens. Physicians know that their own successful medical practice is dependent on a smooth-functioning and high-quality pathology testing service that delivers accurate, reliable lab test results.

Another truth in today’s healthcare system is selective underfunding of certain clinical laboratory testing services in the United States. In this country, pathologists and clinical lab managers are all too familiar with this situation. What might be at the top of the list of inadequately-reimbursed laboratory procedures is venipuncture. It has been years since Medicare, Medicaid, and private payers have reimbursed the venipuncture procedure at a level that is close to the cost of providing that service to patients.

(Image courtesy of A Prairie Home Companion)

The next truth in laboratory testing is that clinical laboratories have a large number of “frequent customers.” These are patients who regularly undergo tests. Thus, they often visit patient service centers to provide blood and other specimens. It is this group of patients who can be most critical of laboratories that fail to meet their expectations. As pathologists and clinical lab managers know from long experience, if too many patients have a bad experience with the lab’s phlebotomist and complain to their doctor, that doctor is often motivated to switch his/her business to another laboratory.

Earlier this week, a disgruntled patient spoke out about his negative experiences with his laboratory and several regular Dark Daily readers e-mailed us with their comments. On December 3, noted humorist and story teller Garrison Keillor, of Prairie Home Companion fame, in his syndicated newspaper column, wrote about his recent experiences with phlebotomists at Quest Diagnostics Incorporated (NYSE:DGX) as part of a commentary on the faults of private healthcare in this nation: 

• My own experience is that when I go to get a new driver’s license in St. Paul, or deal with the city inspector when a sewage line breaks, or walk into a post office to mail letters, or talk to the police when our house alarm goes off, I find public employees to be cheerful and competent and highly professional, and when I go for blood draws at Quest Diagnostics, a national for-profit chain of medical labs, I find myself in tiny, dingy offices run by low-wage immigrant health workers who speak incomprehensible English and are rude to customers and take forever to do a routine procedure. An hour in a Quest office will ruin your whole day.

• If the government took over this miserable operation, paid the people decently and trained them to smile and speak softly, civilization would be advanced. If we simply extended Medicare to anyone who wished to sign up for it, the vast Kafkaesque bureaucracy of for-profit insurance would come crashing down, and the public would be healthier.

Keillor has correctly identified one ongoing issue that has plagued the clinical laboratory profession for decades. Because the meager reimbursement for phlebotomy procedures offered by Medicare, Medicaid, and private payers fails to cover the actual cost of performing a blood collection, the majority of laboratories in the United States can only afford to pay a minimal wage to phlebotomists and must tightly control the costs of maintaining a patient service center where patient specimens can be collected.

In this case, Keillor has made a wrong assumption about why the patient service center experience he encounters fails to meet his expectations. It is attributable to a systemic problem in how this country funds healthcare services. Keillor is making an inaccurate conclusion to assume that, the primary reason he is in a “tiny, dingy office run by low-wage immigrant health workers who speak incomprehensible English and are rude to customers and take forever to do a routine procedure” is because that patient service center is owned and operated by a private laboratory company.

Most pathologists and clinical laboratory managers will understand these aspects of Keillor’s commentary. However, Keillor’s description of his experience does offer some lessons for the laboratory testing profession. It was just this September when Keillor was admitted to a Minnesota hospital operated by the Mayo Clinic for treatment of a minor stroke. In earlier years, he has had heart valve surgery at the Mayo Clinic in Rochester, Minnesota.

The point here is that Keillor has experience at one of the world’s pre-eminent health systems. It has a reputation for well-designed facilities and first-class patient service. On the other hand, the reality of the laboratory testing marketplace is that many patient service centers are located in medical office buildings and other sites that can frequently show their age or economic obsolescence. Yet these same access points may represent a vital link to patients in the surrounding community.

Keillor’s comments are a reminder that it is important for medical laboratories to devote adequate extra resources to the “public face” of their laboratory, including all the places where patients, physicians, and medical staff interact with the laboratory’s employees. The best examples of this are phlebotomists who collect blood; couriers who visit the doctors’ office to pick up specimens; client service reps who handle phone calls from patients and physicians; along with the lab billing/collections staff, who regularly communicate with patients and physicians to ensure that claims are properly completed and accurately reimbursed. And don’t forget! Pathologists and Ph.D.s also frequently communicate with patients.

The nation’s best clinical laboratories, regardless of whether they are for-profit, not-for-profit, or government laboratories, are proud of the services they render daily to million of patients. Only if the health programs in the United States—including both public and private payers—provide adequate reimbursement can clinical laboratories consistently meet and exceed all the needs and expectations of patients and referring physicians.

PS: See below to learn how the CEO of Quest Diagnostics Incorporated responded to Keillor’s published commentary.

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POSTSCRIPT: In wide circulation is the message that Chairman and CEO Surya N. Mohapatra, Ph.D., wrote to the employees of Quest Diagnostics Incorporated on December 3, the day that Garrison Keillor’s column appeared in print. In part, his response included these comments:

Yesterday, syndicated columnist Garrison Keillor published a newspaper article in which he referenced his negative experiences at our Patient Service Centers. To see the article, visit (requires Internet access) – (Source: New York Times): http://www.nytimes.com/2009/12/03/opinion/03iht-edkeilor.html. Mr. Keillor has every right to express his opinions, including those that are unfavorable to our company. However, I strongly object to his characterization of our employees as “low-wage immigrant health workers who speak incomprehensible English and are rude to customers.” Not only are his comments insensitive and inappropriate, but also they are an inaccurate depiction of our many customer facing employees around the country. 

Unlike the company Mr. Keillor describes, Quest Diagnostics is an ethical and highly successful business that has been recognized as a great place to work around the U.S. and in England. We are one of Fortune Magazine’s World’s Most Admired Companies.

I am proud of Quest Diagnostics employees and your ongoing dedication and commitment to putting patients first. Though we always try our best, there are times when we may not meet everyone’s high expectations. In these instances, I have always said we should consider every complaint as a gift.

Our success depends on continuing to provide a consistently superior experience for patients and customers – every time. I’m counting on each of you.