Getting the Key in Turnkey Allergy Programs
For a physician beginning to explore allergy as an additional service line, the term “turnkey” presents a pitfall. It helps to understand what it’s supposed to mean, where it is so often misused, and what a true turnkey program includes.
The Useful Definition: The Seller Sets It Up, You Turn the Key and Drive Away
Properly used, turnkey refers to goods or services that come complete and ready to be used by the purchaser right away and as-is, with no further ado. The Cambridge Dictionary is succinct, defining turnkey as “ready to be used immediately by the person who is buying or renting it.” Investopedia explains in more detail for the business context: “A turnkey business is an arrangement where the provider assumes responsibility for all required setup and ultimately provides the business to the new operator only upon completion of the aforementioned requirements.” The buyer “only needs to turn the key to unlock the doors to begin operations.”
In a different metaphor, a turnkey program is one in which the seller builds the car and shows the buyer how to drive it, then accepts the purchase payment and turns over the keys. If the owner is using it to make money, that money belongs to the owner. The seller is still around in case the new owner needs something, such as driving tips or help training additional drivers, but otherwise it’s the new owner’s car.
In the context of allergy for primary care, a turnkey program is provider-trained but self-staffed. The program seller provides all the necessary materials, makes sure everyone who needs to be trained is adequately trained in candidate detection, allergy testing, and treatment, does a few dry runs so the staff is knowledgeable and confident, then hands over the keys and stands ready to assist with more materials, training, and consultation.
Misuse of “Turnkey” Abounds
In the clinical context, the term is often abused by eliminating the crucial concept of buyer operation. A group purchasing organization called ProVista typifies the confusion. “Many companies offer ‘turnkey’ solutions,” they say, which can include everything from merely “selling allergy test kits to primary care doctors” to “establishing on-site allergy testing and treatment centers,” but they indicate neither option may be suitable for “physicians who wish to maintain control.”
That summation is confusing in two opposite directions at once. Just buying allergy kits is the commodity model, which provides none of the necessary setup, so it’s not even close to ready to go, and not turnkey for that reason. Conversely, a solution leaving the physician with no control means someone else is operating it, which also is not turnkey by any useful definition.
Multiple third-party staffing model providers perpetrate this same misuse of “turnkey.” Allergy Solutions in New York and Florida “provides the physician… with a fully staffed and operational allergy center” but describes that service as a “turn key program.” It’s not turnkey if it’s third-party staffed. BioTex Partners says “we provide fully staffed in office allergy testing and treatment” but goes on to say “our service is completely turnkey with little to no demand from your resources.” Either it’s fully staffed or completely turnkey. It can’t be both.
Bird Dog Pharma is even further afield from the traditional, useful definition of turnkey. Its “Turnkey Allergy Program” uses “prepaid shipping envelopes” to take blood and “send it to our… lab.” So they describe their third-party lab referral service as turnkey despite the fact that it doesn’t even occur on the clinic premises, let alone under the physician’s control.
A True Turnkey Allergy Program
MRS Allergy Solutions provides a true turnkey allergy program designed for primary care practices. Specialty clinics such as ENTs, ophthalmologists, and sleep centers also benefit equally from use of the program, often for elimination purposes in differential diagnosis.
To be truly turnkey, an allergy program must be comprehensive and include, as MRS Allergy’s program does, all of the following at a minimum. Equally important, it certainly will not include third-party staff occupying space or schedule time in the customer clinic. True to the definition, once set up and trained, the customer gets the keys and runs this program internally in order to maximize patient outcomes, revenues, and seamless integration into existing systems and processes.
- The necessary materials
- Candidate detection protocol
- Medical necessity forms
- Consent forms
- Allergens, ideally a wide range carefully selected for cross-reactivity
- Appropriately labeled trays and wells
- Applicators
- Skin markers
- Measuring tools
- Results recording forms
- Patient education materials
- Complete training
- Candidate detection process and workflow
- Establishment of medical necessity
- Obtaining consent
- Test protocol
- Indications
- Contraindications
- Drug interactions
- Test performance
- Results reading and interpretation
- Treatment options
- Reimbursement
- CPT codes
- Treatment billing protocols
- Treatment options
- SCIT
- SLIT
- Self-staffing support
- Repeat training as necessary, including refreshers, new personnel, and new developments
- Medical consults
- Ordering and customer service
Ideally, all of the foregoing will be included with the price of materials, with no long-term contracts or commitments. From MRS Allergy, it is.