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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Pathologists may be asked to do more consults by oncologists practicing in a medical home

Recently a pioneering oncology practice in Philadelphia was recognized by the National Committee for Quality Assurance (NCQA) as a medical home practice. Though the NCQA medical home program focuses on primary care, a few specialty practices have gained medical home recognition.

This is a milestone on the road to expanded use of the medical home care model. It is also an early warning to pathologists and clinical laboratory managers that other medical specialties may take steps to implement a medical home practice. It is believed that physicians practicing in this care model are likely to be more careful users of medical laboratory tests.

One major characteristic of the medical home model is that it incorporates a standardized approach for treating and managing care for diseases. Thus, the fact that an oncology practice earned recognition as a medical home points to a future where diseases such as cancer will be treated with greater attention to a standardized care path based on evidence-based medicine (EBM) guidelines. Pathologists may welcome such a development in oncology. It may motivate oncologists to more closely consult with anatomic pathologists when diagnosing cancer patients and determining the most appropriate therapies.

Medical homes bring several aspects of what today is considered “high-value care” under one roof. Medical home practices focus—among other standards—on:

How Oncologists Reduced the Burden on Emergency Departments

Since Philadelphia-based Consultants in Medical Oncology and Hematology (CMOH) adopted the medical home care model, referrals to emergency departments (ED) have dropped significantly. In 2005, 12% of the practice’s chemotherapy patients were sent to EDs when they experienced severe side effects from their treatment. By 2009, that number had dropped to just 5%! Hospital admissions also dropped—down by 16% in 2009, and by another 10% in 2010.

Experts believe these improvements in patient outcomes are significant enough to validate the medical home model for both primary care and specialty practices.

More Private Payers Support for Medical Homes is Needed

The Philadelphia oncologists are learning that—at least at this time—the designation as a medical home does not guarantee profitability. Currently, CMOH holds only one Medicaid HMO. This brings into question whether payers are serious about paying for higher-quality care. More payers will be needed or the medical home model cannot be sustained, said Dr. John Sprandio, the oncology practice’s lead physician, in a Modern Healthcare article.

(John Sprandio, M.D., lead physician at Philadelphia-based Consultants in Medical Oncology and Hematology. Sourced from Modern Healthcare magazine.)

“Improving the level of care is great for patients, but hopefully it makes business sense too,” said Dr. Sprandio.

“If John Sprandio does not succeed in doing this, it is a terrible bellwether for what’s going to happen in healthcare in the next few years, because he’s doing everything right, and he is doing everything [the Patient Protection and Affordable Care Act] is calling for,” said Alice Gosfield in the same Modern Healthcare article. Gosfield is a Philadelphia-based healthcare lawyer. She also served as Chairman of the NCQA’s board for five terms.

Major Benefits from Use of Electronic Health Records

Dr. Sprandio credits the practice’s electronic health record (EHR) as one key to the practice’s success as a medical home. That’s because the EHR enables the physicians to monitor their own progress in real time. He also warns that physicians without an EHR lack an important source of accurate information.

“Many of my colleagues say, ‘I’m pretty sure we do what you’re doing,’” said Sprandio. “And my response is, ‘Respectfully, I was pretty sure we were too, but we weren’t. And you have no idea what you’re doing until you start measuring. Only then can you go back and improve your processes of care and thus your performance,’” he concluded.

To receive NCQA recognition as a medical home, a practice must meet six PCMH (Primary Care Medical Home) 2011 standards. The six standards are:

  • Enhanced Access and Continuity
  • Identify and Manage Patient Populations
  • Plan and Manage Care
  • Provide Self-Care and Community Support
  • Track and Coordinate Care
  • Measure and Improve Performance

There are 149 factors that make up the six standards. Among them are six that are “must pass” elements. They are:

  • Access During Office Hours
  • Using Data for Population Management
  • Manage Care
  • Self-care Process
  • Referral Tracking and Follow-up
  • Implements Continuous Quality Improvement

Pathologists and clinical laboratory managers will recognize that any focus by office-based physicians on quality measurements can encourage them to use medical laboratory tests with greater precision. As more physician groups adopt the medical home care model, it is uncertain how this will affect their overall utilization of medical laboratory testing.

That’s because, as physicians get better at following evidence-based medicine guidelines with a larger proportion of their patients, two things are likely to happen. First, it can be expected that the number of unnecessary or inappropriate clinical laboratory tests will decline. But, second, by following care guidelines more diligently, it could mean that the overall number of medical laboratory tests ordered by physicians will increase, as they ensure that each of their patients get the medical laboratory tests that are appropriate for their disease or health status. How these two factors offset each other will determine whether medical homes increase or decrease the overall volume of clinical laboratory tests ordered by physicians.

—Michael McBride

Related Information:

High standards: NCQA-approved practice a test for value-based care (Modern Healthcare)

NCQA Patient-Centered Medical Home

NCQA PCMH 2011 6 Standards, 27 Elements, 149 Factors

NCQA’s Patient-Centered Medical Home (PCMH) 2011 January 31, 2011 Overview 

Health Reform: What’s in it to Promote the Medical Home?