In the state of Virginia, there is no mandate to change to a six day operating week and the leadership of the public health agency is in charge of raising the NBS fee. Every couple of years, the laboratory reviews the strength of the current fee-for-service structure to meet budgetary needs and the memorandum of understanding (MOU) governing operation of NBS follow-up services. NBS fees go directly to the NBS lab, which pays the follow-up program quarterly per the terms of the MOU. More funding may have to be transferred to the follow-up program to hire the staff needed to cover the added workload generated by Saturday
To determine the fee increase for expanded operating hours, the laboratory first reviews expenses and revenue based on the past one to three years, and projects when additional funding will be needed. It then determines when the increase should begin to maintain program operations. This increase of the NBS fee would support overtime cost for Saturday lab and follow-up staff, hiring additional laboratory staff and IT and vendor support for Saturdays.
Once the fee increase is determined, the Director of the Department of General Services, the agency within which the laboratory resides, reviews the request and refers it to the Secretary of the administration. Once the laboratory receives approval, it presents the fee increase to the Commissioner of Health and to the Secretary of Health and Human Services. Because approval must be received at two secretarial levels, the process requires numerous presentations and reviews. Usually, it takes nearly six months to receive final approval from all decision makers. Once the increase is approved, the laboratory meets with stakeholders to inform fee payers (i.e., Hospital Healthcare Association, Medicare, Medicaid, Department of Medical Assistant Services, etc.) of the increase and its start date. This fee increase model has been in place since 1992 when Virginia first implemented the NBS fee.
In February 2018, the Virginia newborn screening (NBS) laboratory will implement full sample accessioning and testing processes on Saturdays in order to improve timeliness. Currently, Saturdays are spent reading results from Friday’s testing, receiving specimens and setting up testing for galactose and GALT on Monday. While a mandate from the state government is not necessary to change to a six-day operating week, staff and senior management buy-in are essential.
Since the staff was not hired with the expectation of weekend work, senior managers have provided multiple opportunities for input and ownership in the final decision. After considering the concerns raised by staff, the Division of Consolidated Laboratory Services (DCLS) decided not to use staff regularly scheduled for Monday-Friday as the primary coverage for Saturday work. Instead, the lab will utilize vacant positions to recruit for new bench scientists that will work an altered schedule to include Saturdays. In return, Saturday staff will have Sunday off and will receive an additional flex day for the following week. The NBS lab plans to hire a Senior Scientist to work Saturdays as well. Staff regularly scheduled to work Monday through Friday will serve as backups on Saturday if one of the primary Saturday team is not available; this will
be on a rotational basis.