The Ancillary Medical Sales Podcast is a weekly podcast that covers all things ancillary. We talk about sector trends, sales strategy and medical products from labs to equipment and more. This episode covers a new partner that provides a specialized laboratory service targeted to Women’s Health.

This episode, Mike and Viv talk to Mike Kalnoski about the lab.

“Well, Viv, I just wrote a blog article, what we called NBB, Nice Boring Business. We thought this would be a perfect time to bring on Dr. Mike Kalnoski who is the Chief Medical Director, CEO, and Co-Founder of Atlas Genomics, which is a terrific lab in Washington that focused on women’s health. When I talk about Nice Boring Business, this is stuff that’s not sexy. It’s not the stuff that’s running through a hospital and has super high billing for a couple months and then crashes and burns, nothing particularly fancy, other than good old fashioned, good customer service and reliability. That’s the kind of stuff that you can really build your business around. Dr. Mike, I want to thank you for getting on and joining us.

Thank you for having me.

Okay. Can you, first off, tell us a little bit about your lab and what sort of testing your lab offers?

Yes. Atlas Genomics was formed in 2014 and we are primarily a women’s health-focused laboratory. We started out doing the NIPT, which is the Non-Invasive Prenatal Test, for women that are pregnant and at high risk for Down Syndrome and some other abnormalities. From there, we also launched CARE screening testing, which tests for over 100 different diseases in pregnant women or women planning on becoming pregnant, such as Cystic Fibrosis, Tay-Sachs Disease and all the other diseases that can be given to a baby through the mom and dad each being a carrier of the disease, even though they’re not affected.

What are the advantages of having some of this testing done? Are patients actually coming to doctors looking for this kind of testing, or is it something that physicians need to offer their patients because some of this isn’t mainstream?

Well, the American College of OBGYNs, ACOG, has recently come out with some statements stating that carrier screenings should be offered to all women who are pregnant or considering pregnancy, just because the consequences of having a baby with Cystic Fibrosis or some of these other diseases that we test for, although relatively uncommon, the consequences of having a baby born with some of these are pretty devastating. It’s important to be aware and to avoid the consequences of having a baby with a genetic disease if the family chooses.

I know carrier screening is popular, but I’m sure the volume of your business is in the PCR arena, just because those are more ICU conditions that can occur with anybody.

Yes.

Can you speak to some of the latest PCR assays that are available and what your lab offers?

Yes – so after we launched the CARE screening stuff, because our clients were OBGYNs, we also launched into infectious disease testing based off PAP smears and swabs. We test for more than 40 different organisms, the common ones like HPV, Chlamydia, Gonorrhea, and Bacterial Vaginosis, and Candida, Vaginitis, and we also do the cytology. We get the full complement of testing with the PAP smear. That’s all mostly … That’s all PCR-based, some DNA application, but mostly PCR-based. Because we’re small and nimble and work seven days a week, our turnaround time is usually two or three days.

In addition to that, we also offer urinary tract infection testing, which is also very common in women. It’s seen a lot by OBGYNs. In fact, probably 10% of women come in with a UTI and I think more than half of women have a UTI at some point in their life. Many have recurrent UTIs. What we do is a PCR-based assay testing for more than 30 different bacterial organisms and we also test, in the same run, we test for fungus and viruses because some of the symptoms of a Candida infection or like a Herpes infection can mimic a UTI where the patients have dysuria and pain on urination. They send them for cultures and the cultures always come back negative, but the patients always come in complaining and it turns out that they’ll have something like a fungus or a viral infection that wasn’t picked up by culture that we would pick up right away and give the results to the doctor in 24 to 72 hours.

How commonly is PCR testing being utilized? Is it for every sample that goes in now, doesn’t matter what lab it goes to, they would use PCR or are still some using the culture bases that take, obviously, a lot longer and potentially don’t give as complete a diagnosis?

Correct. I think the majority of labs are still, and all the hospitals, still do culture as their main diagnostic test of choice.

Right. With the PCR, for one, the advantage is that it’s going to cover a much larger variety of organisms and plus, the second aspect, is that the results come back within two to three days. It’s much more sensitive, too?

Yeah, and much more sensitive.

We can pick up very small amounts of fungus and viruses and bacteria that typically wouldn’t picked up. We do quantitative so we give colonies forming units per mL Because we do quantitative PCR, rather than just qualitative yes and no, because some of the organisms it’s very important to … it’s not just the organism itself. It’s the amount of organism that’s present in the urine. We gave that in colony forming units per mL based.

Right.

On the DNA.

Right. There’s still a very large opportunity for sales reps to talk to physicians about PCR. It’s not like the market’s already flooded. That’s what I’m hearing. Would that be correct?

Correct. The other thing that we also do is with the PCR assay, we also look for antibiotic-resistant genes, which confer resistance to most of the common antibiotics given for UTI. In the same test, we test for 16 different genetic resistant genes. If they’re positive then we also add onto their report whether there’s susceptibility and resistance to the organisms that were found.

I could see a huge benefit to the stewardship that you get from finding out which antibiotics they may be resistant to would ultimately cut down on the overuse of antibiotics, which we all know is a huge issue right now. That is, I would think would be a, key selling point to a physician. Now, you are in a physician office yourself. – How would you recommend a salesperson approach their physician and get a conversation started about this? What would you want to hear?

I think in the clinician’s view … turnaround time is always very important for the clinicians. I think in terms that we can beat the culture by at least a couple days is very important. Sometimes we can beat them up to three or four days. Typically patients are already … they’ve already gone home with their prescription and if it’s not right, they’ve already completed their course before they even have the answerback. This way, the doctor’s office could say, “Hey, your bacterial was … your UTI testing was negative. The antibiotics you were sent home with you can discontinue. If you’ve only taken a day or two worth, it’s probably no harm.” The other thing is that I think that they would like that … the fact that we give them upfront which antibiotic is best utilized. I’ve worked with myself and a pharm D to put together the reports for the antibiotic-resistant panels.

All right. I know, as a woman, you don’t want to be on antibiotics a day longer than what you need to be because of the side effects! I know OBGYNs seem like the most obvious call point, but are primary care offices, are they using your lab services as well and can they offer it to men?

Yes. Both men and family practices would be … and internal medicine doctors would. Actually, we have a few pediatric physicians also.

Okay. That adds another call point.

Young children can also come in with symptoms of UTI and it’s very important to rule that in and rule that out.

The third area where we see this is in nursing home patients. A lot of times there’s a lot of patients in there and they have fevers and they don’t know why. They work them up for UTIs and respiratory infection, rule out pneumonia and they’re doing all this testing. Whereas, if they used us, they would get their results back much faster and they would pinpoint the problems much better and be able to treat them much faster.

That’s super important for the elderly because they can get confused and all sorts of things with a UTI. It doesn’t just present with classic symptoms.

It typically does not present … You’re right. It presents with confusion and a lot of them have catheters and catheter-associated problems. Infections. It would be very beneficial for them to get our sort of testing.

Dr. K, When I opened this podcast talking about the blog I wrote about Nice Boring Business and what the opportunity looks like for a sales rep to build a nice, boring portfolio of services starting with Atlas. I hope you guys take that as a compliment, ’cause that’s what it’s intended to be. You guys are boring in a good way.

You’re not going to have a lot of fireworks. You’re not going to be having to put out fires left and right. You’re just going to have happy customers and get your paycheck on time, which is what people want. I don’t want to sell this short in terms of what this opportunity looks like for sales reps that really embrace this and have the right call points. Do you have any sales reps who are finding a lot of success? Can you give us an idea of what that looks like in terms of somebody who is finding a lot of success with working with you guys?

I think our sales director, Chris, maybe he would be better served to answer that question.

Yeah. Hi, Mike. Hi, Vivien. Yeah. We’ve launched this test and so far it’s exceeded our expectation for volume. As you had mentioned, Mike, this is a commonly ordered test in either primary care or the OBGYN office. The barriers to entry really are fairly low, meaning if you can provide a better solution for the physician, which is turnaround time as Dr. K pointed out, accuracy, then it’s a home run. We’re seeing that already, the effects of that with our sales team that are currently offering those two modalities. Again, it’s really exciting. As you had mentioned, when you said boring, yeah. It’s a pretty standard test, but this is an improvement over what has been done in the past. Yeah. It’s a home run for everybody. We’re finding great success so far.

Excellent. Excellent. Well, that’s music to the ears of our sales reps. That’s for sure. I know you mentioned some figures before we got on the podcast. Certainly, if you just did your business this particular lab, you wouldn’t need much other business to have a very solid portfolio, if any actually. I want to say thanks a lot for being on our podcast today. If you are interested in adding women’s lab services to your portfolio, just go to everyancillary.com. Look for women’s labs and add that to your bag.  Thanks a lot for being on the podcast today. Looking forward to a long, reliable and boring relationship. Had to throw that in. Thanks.

Thank you.

The only other thing I’d probably add is about that our samples are typically shipped in by FedEx and we have a proprietary FDA cleared tube that the urine is poured into. It’s really easy to send into the lab.

Okay. Okay. Great. Good to know for the reps as well. Okay. Thanks a lot.

Thank you.”

To find out more about this or any of our other services go to Everyancillary.com and ‘Get Started’. Physicians can go to www.ancillarymedsolutions.com