Views on point of care versus core and more

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You’re implying that over the horizon we have some relief coming through new technology that’s easier to use. Am I interpreting your comments correctly?
Brian Durkin: Yes. We’re focused on making products that are easier to use, more efficient. We know the labor shortage isn’t going to turn around. Fewer laboratorians, clinicians, and phlebotomists are graduating every year.

Stan, while we’re on the question of supplies, what’s the situation today with blue-top tubes?
Stan Schofield: It’s better than a year ago, better than six months ago. But we’re having other tube shortages—pink, gold, the rapid spin tubes are the most difficult, mint green. Those are all problematic because we use them in the emergency department for fast turnaround times. Coagulation tubes were problematic, and it’s still not guaranteed we’ll get them. Everything is allocated, and sometimes you don’t know what you’ll get until the first of the month, when the allocation list is released. What you received last month you may not get this month. Overall, it’s still problematic, a little shaky.

Brian, what is the tube situation from your perspective? You depend on supplies just like the laboratories do.
Brian Durkin: We are aware of it and help where we can. The supply chain, inflation, and health economics are strained. Throughout the pandemic, we haven’t missed a shipment. Two examples—from our hemostasis business, D-dimer demand, which was standard of care, almost doubled, and on the blood gas side, requests for respiratory cartridges increased exponentially. We were able to meet demand despite challenges in obtaining some key components.

Where products are made is another important factor. We make 95 percent of our products in our U.S. technology centers. We’re proud that we’re able to meet the higher demand.

Stan Schofield: To Brian and his colleagues’ credit, we never had a problem with the IL instrument or ACL Top materials we needed. They’re one of the vendors we could count on through the crisis.

Brian, can you comment on autoimmune testing? Where is that business now and where is demand for those tests?
Brian Durkin: The demand has surged. During the pandemic, we saw a sharp decline in the volume of autoimmune tests because people didn’t want to go to a hospital and hospital staff were focused on managing COVID. Now we’re back to normal or even growth levels in autoimmune testing.

Oftentimes it takes years for clinicians to diagnose an autoimmune disease, but our products make it faster and easier for clinicians to identify whether it’s, for example, rheumatoid arthritis or something else, and provide care as fast as possible.

Stan, is it your experience at NorDx that demand not only for this but other tests is getting back to normal in the immediate post-crisis?
Stan Schofield: Autoimmune is a growth area, and as more markers are developed and the instrumentation becomes better, using and identifying those markers is a growth area. But it’s still only a small percentage of the entire laboratory. For routine work in the laboratory, we’re at about 96 percent of where we were in October 2019. The reason is we can’t get patients’ blood drawn in the outpatient arena and run it. We have capacity, but total volume is still off about four or five percent. Autoimmune remains strong and is growing. But of all the tests we do, autoimmune is only one percent.

Is there a testing category, however big or small, that has a percentage that surprised you, either in how it has not resumed or has bounced back strongly?
Stan Schofield: No, not in any major categories. Routine, nonesoteric testing has remained consistent. The demand for next-generation sequencing and oncology markers is expanding to higher panels and more markers. But for autoimmune, allergy, infectious disease, it’s all about the same per patient ratios that we’ve experienced. Tickborne illnesses have always been strong here.

Brian, tell us about the situation in Western Europe. We hear about their economies, and they’ve had a tough year, the dollar is awfully strong. How has that affected the European laboratories in your experience?

Durkin

Brian Durkin: It is similar here—labor shortages, looking for more automation, health care economic challenges. We take the same approach with the same products and same message—we’re looking for a long-term solution. Now that I have a global perspective, our strategic plan is similar because the issues are aligned. Inflation is high everywhere, so we’re challenged with our value pricing. People push back and say, well, there’s inflation. But we have to understand inflation hits manufacturers as well as health care providers. If we agree to invest in high-quality products, the long-term costs will be mitigated, and that’s the mutual goal.

Stan, are you continuing to see a rise in the use of the new class of drugs for anticoagulation control, or is that a fairly steady but not dramatic increase? I’m talking about the direct oral anticoagulants that are replacing warfarin by and large.
Stan Schofield: Yes. We are busy with that in our special coagulation area. It has been a slow, steady increase the past five years. As those drugs come onto market, we have to adapt and adjust the various specialty factors and tests. We’ve been fortunate to work with Werfen and IL around many of those assays.

Can you comment on that class of tests, Brian?
Brian Durkin: Overall the growth is high. And while traditional prothrombin time testing is declining, our direct oral anticoagulant testing and the specialty testing Stan mentioned continue to grow.

Stan, laboratories dodged the worst of it with the suspension of the PAMA cuts for the year, but are there other financial issues you’d like to bring up?
Stan Schofield: All laboratories are going to be stressed this year due to health care system finances. Nursing contract labor is breaking the bank everywhere, and many big health care systems are running seven to 10 digits into the red and it can’t be sustained. The lab is going to be impacted financially for capital equipment, operating support, improvements, and staffing. Lab staffing is a problem, but the economics of the parent corporations are deteriorating rapidly. It’s something we have to watch for and try to balance out in almost everything we’re doing. That has to be a major consideration going forward.

Brian, do you have a closing comment about finances or anything else?
Brian Durkin: Stan said it well. Health care institutions are stressed every day. From central labs to the point of care, the importance of diagnostics results was validated during the pandemic. So the hospital C-suites understand that we can’t shortcut lab quality and they’re willing to invest in high-quality products in the central lab and at the point of care.