Iowa Nursing Homes Lose Phlebotomy Service Twice

Since April, nursing homes, LTC facilities, and home-bound patients have lost draw services twice

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CEO SUMMARY: It may be without precedent in the clinical lab industry that a laid-off lab manager launches a nonprofit mobile phlebotomy service in order to continue services to homebound patients, nursing homes, and long-term care facilities. The events in the Quad Cities of Moline, Ill. and Davenport, Iowa, are also the most recent example of how PAMA cuts to Medicare clinical laboratory test prices have a role in reducing the access of Medicare beneficiaries to local, quality lab testing services.

SOMETIMES PATIENTS IN SMALL COMMUNITIES LOSE ACCESS to quality lab testing services when a long-established independent laboratory closes or is acquired. Since April 1, that scenario has been playing out in the Quad Cities of Moline, Ill., and Davenport, Iowa.

On that date, Laboratory Corporation of America (LabCorp) acquired Metropolitan Medical Laboratory, a privately-held company that had served the Quad Cities area in Iowa and Illinois since 1914. At the time, a local newspaper reported that some 136 employees could lose their jobs. (See TDR, Mar. 18, 2019.) But this story has an interesting twist.

On the day LabCorp closed the MetroLab deal, one of the employees who lost her job there launched a nonprofit organization to replace a long-established mobile phlebotomy service that the lab’s new owner was not providing.

The nonprofit Heart and Hands Home Draw did home draws and mobile phlebotomy until May 24 when the business, which was running on donations, could no longer survive financially, said Carla Downing, who started the service and contributed her own funds and enough donations to run the operation for almost two months.

As of the end of May, patients at home, in nursing homes, and in longterm care facilities in the Quad Cities no longer have access to mobile phlebotomy, although Downing said she has been in contact with a national lab interested in reopening the service. She declined to name the national lab, saying the talks were only preliminary.

No Mobile Phlebotomy

“Since the mid-1980s, MetroLab operated a mobile blood-drawing service in the community to serve homebound and other patients unable to easily get to a patient service center,” Downing said in an interview with The Dark Report. “However, after hearing about the pending sale in January, lab employees learned that LabCorp would not retain this mobile blood-drawing service.”

From this department, MetroLab sent certified phlebotomists to nursing homes, long-term care facilities, and to home-bound patients in Illinois and Iowa, explained Downing. The patients were disabled or otherwise had trouble getting to a patient service center or doctor’s office. Downing worked for MetroLab for 11 years and was laid off at the end of March.

“As news of the acquisition and the termination of this service became known in the community, physicians and many of these patients were very concerned,” stated Downing. “These patients and their physicians began calling MetroLab’s Extended Care department asking what would happen after April 1. We didn’t have an answer for them. Some would cry over the phone.

55 Nursing Homes

Until MetroLab ended its service at the end of March, it had served about 200 to 300 patients each week. “In Iowa, we served about 25 large nursing homes and a few smaller nursing homes,” she said. “In Illinois, we probably had 30 or more nursing homes.” Phlebotomists would serve these patients and the larger facilities five days a week.

“Our patients would call the lab and ask, ‘What are we going to do?’” Downing recounted. “I didn’t know. But whenever Iwasintheoffice,Iwastheonewhogot many of those calls.

“Patients would ask, ‘Is there any other service like this out there?’” she added. “No, unfortunately. MetroLab was the only company drawing blood in patients’ homes in these communities.”

After working in the mobile-phlebotomy service since 2007, Downing knew many of these patients and their doctors by name, a factor that made it that much harder to deliver the bad news to patients.

“Whenever those patients would call about it, they would worry,” Downing commented. “Some would say they would pray about it. That’s when I started praying about it myself.”

She also explored the possibility of offering the service based on raising funds through donations, and she knew that Medicare paid little for a blood draw and it paid a small fraction of the cost for a phlebotomist to drive each mile to collect blood. Even combining these two fees was insufficient to cover the actual costs.

Any lab that serves nursing homes and long-term care facilities knows these facts well, as do the nation’s largest lab companies which do not provide such service because it is not cost-effective.

In attempt to fill this need, Downing organized Heart and Hands Home Draw and accepted donations from MetroLab of office space, blood-drawing supplies, and a computer and fax machine. She used the donated equipment to get the new service operational on April 1.

“Our challenge is that Medicare reimbursement for phlebotomy and travel to a patient fails to cover the cost of this service. That’s why we started a nonprofit organization,” explained Downing. Local news organizations covered the story about this new service and as of June 1, Downing was still seeking donations on the website she started, at

In the seven weeks or so of its operation, Heart and Hands served 20 to 30 patients per day, and Downing expected to average about 100 to 125 patients per week, depending on the season. More patients find it difficult to get out in the winter, for example.

Getting the donations was an answer to Downing’s prayers, she said. Once she told a few patients that the new service was available, she started hearing from physicians who wanted the service for their patients.

In addition, Downing used her own funds to pay the phlebotomists and to cover other costs. Some of those funds came from a retention bonus and payment for earned time that MetroLab owed her, she said.

She retains hope that some organization, perhaps the national lab company, will restart the service.

Contact Carla Downing at 309-519-0978 or


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