News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Microhospital Trend is Gathering Momentum and Could Provide Revenue to Independent Clinical Laboratories

Though they mostly receive medical laboratory services from their parent health networks, microhospitals may, nevertheless, need services from independent clinical laboratories as well

For years, independent clinical laboratories and anatomic pathology groups have been adapting to healthcare networks undergoing changes based on increased demand for convenient, affordable medical services. One such innovation is the growing trend and popularity of microhospitals, which Dark Daily has reported on in multiple e-briefings.

These scaled-down healthcare facilities offer most critical medical services in smaller settings. They fill gaps between traditional hospitals and urgent-care facilities, are intended to be easier for patients to get to, and usually cost less than a typical community hospital of several hundred beds.

Although these microhospitals are typically owned by existing health networks and receive lab services from their parent health networks, for independent clinical laboratories, microhospitals could represent another potential customer in need of rapid test TATs in support of the facility’s emergency department and limited inpatient beds.

One-Stop Shops for Primary and Secondary Care

Microhospitals are typically between 20,000 and 60,000 square feet in size and offer a small number of inpatient short-stay beds—usually less than 15. They are licensed as hospitals and are usually low-trauma (levels 4/5) facilities that tend to focus on low-acuity patients.

Services at microhospitals vary from location to location, but generally include:

  • emergency departments;
  • imaging and diagnostic services;
  • surgery and procedure centers;
  • inpatient nursing facilities; and,
  • medical offices.

They are open 24-hours/day, seven days/week, and commonly located in small, underserved areas where there is not sufficient demand for healthcare to support a full-size hospital.

Microhospitals operate as comprehensive, one-stop shops, with both primary and secondary care available. Many microhospitals also have certified and accredited medical laboratories onsite that can provide immediate testing results.

Population Health and Precision Medicine Benefit from Microhospitals

Microhospitals have been in existence for more than 10 years and are growing in popularity among consumers as well as providers. Rising healthcare demands, lower costs, convenient locations, and more personalized care make them popular for patients.

From a business perspective, microhospitals have much lower construction and overhead costs when compared to large hospitals, making them an affordable market-growth opportunity for providers. The savings are passed on to the patients as services are offered at a lower rate than conventional hospitals.

Another advantage of microhospitals is that the services offered can be designed specifically for the demographics of their neighborhood. A guiding goal of both population health and precision medicine initiatives.

“That’s the beauty of it,” Robert Garcia, Vice President of Healthcare Advisory Services at Transwestern, told U.S. News and World Report (U.S. News). “You can tailor the hospital to the needs of the community, so if it’s an older community it may be more catheterization lab, and if it’s a younger community it may have more orthopedic procedures.”

Nineteen states now have at least one microhospital in operation with more in the works. They often offer more convenient, quicker access to healthcare than traditional full-size hospitals can deliver. Larger facilities tend to have longer wait times and typically cannot provide the same personalized care as microhospitals, due to a higher number of patients and many diverse problems.

“Our neighborhood [microhospitals] will bring to communities an innovative, patient-centered model that provides the best possible experience and outcomes for those requiring emergency care, short hospital stays, and other outpatient services,” Cynthia Hundorfean, Allegheny Health President and CEO, told Becker’s Hospital Review. Pittsburgh-based Allegheny Health is scheduled to open four new microhospitals in 2019, all located in the metropolitan Pittsburgh area. These facilities will each offer 10 inpatient beds and emergency and diagnostic services. (Photo copyright: Allegheny Health.)

Other Plans for Community Focused Microhospitals

Phoenix-based Abrazo Community Health Network, plans to open a microhospital in Mesa, AZ, in the spring of 2019. This facility will include an emergency department, an operating room, eight inpatient rooms, and will focus on lower acuity inpatient procedures.

“Medical care continues to evolve with a consumer focus, and this is a new model for bringing healthcare services into the community,” Frank Molinaro, CEO of Abrazo’s Phoenix Market, told Commercial Executive Magazine. “The Mesa microhospital will offer a patient-friendly design with emergency and acute care services in an efficient, convenient location. It’s designed to provide close integration with our other facilities for patients who may require more complex care.”

Emerus, a microhospital developer, operates more than 20 microhospitals nationwide. According to their website, the company has 24 additional microhospitals under development.

“Emerus picks locations that have a need for additional emergency room beds,” Richard Bonnin, Senior Public Relations Consultant at Emerus, told U.S. News. “Increasing access to high-quality emergency care and focusing on the patient-physician relationship has provided a strong foundation for our growth.”

Not a Replacement for Traditional Hospitals

While microhospitals are equipped to handle a large range of healthcare issues, they are not able to deal with all medical situations. There are cases where patients may have to be referred to a larger facility.

“Not every [microhospital] is a Level 1 trauma center or cardiac center of excellence. It’s up to the smaller hospitals to diagnose, stabilize, and transfer patients as appropriate,” noted Bonnin in the U.S. News article. “They will send patients to the best trauma center, the best heart hospital, the best stroke center without a lengthy emergency room wait, depending on what the most immediate needs may be.”

Although most microhospitals are owned by existing health networks and most likely receive their medical laboratory services through their parent organization, independent clinical laboratories might find themselves being contacted when faster TATs or closer proximities are required to ensure positive healthcare outcomes.

—JP Schlingman

Related Information:

What You Need to Know about Microhospitals

5 Common Questions about Microhospitals, Answered

Microhospitals Market: Global Industry Analysis 2012-2016 and Opportunity Assessment

Microhospitals Provide Health Care Closer to Home

Microhospitals Are on the Rise

2018 Trends: Microhospitals to Gain Popularity

Allegheny Health Network to Open Four Microhospitals in 2019

Abrazo Entering East Valley with New Microhospital in Mesa

Telemedicine and Microhospitals Could Make Up for Reducing Numbers of Primary Care Physicians in US Urban and Metro Suburban Areas

‘Thinking Small’ May Be Next Big Innovation in Healthcare Delivery as Microhospitals Spring Up in Metropolitan Areas Across Multiple States

Telemedicine and Microhospitals Could Make Up for Reducing Numbers of Primary Care Physicians in US Urban and Metro Suburban Areas

Microhospitals already offer most of the critical features of traditional hospitals, and by featuring telemedicine technology at the point of care, they are becoming powerful tools for healthcare providers Dark Daily reported in January that microhospitals are opening nationwide, including in such innovative states as Texas, Colorado, Nevada, and Arizona. In addition to being open 24/7 and mostly located in high-density areas, these scaled down hospitals feature the most critical aspects of...

‘Thinking Small’ May Be Next Big Innovation in Healthcare Delivery as Microhospitals Spring Up in Metropolitan Areas Across Multiple States

Microhospitals may also be useful in providing patient access for the collection of clinical laboratory and anatomic pathology specimens

Thinking small may be key to the next big innovation in the delivery of healthcare. Microhospitals are taking hold in Texas, Colorado, Nevada, and Arizona—states known to be healthcare innovators. As well, microhospitals are popping up in metropolitan areas across the Midwest.

This trend could provide opportunities for clinical laboratories and pathology groups to cater to the needs of a new class of healthcare provider.

Microhospitals are small-scale inpatient facilities that provide emergency and ambulatory services. An article on Advisory Board’s website describes the new concept as ranging in size from 15,000 to 50,000 square feet, with fewer than a dozen inpatient beds. In addition to emergency departments, 24/7 core services include: (more…)

PwC Predicts Forces Shaping Healthcare in 2018; Some Could Impact Clinical Laboratories and Anatomic Pathology Groups

PwC’s list of 12 factors that will shape the healthcare landscape in 2018 calls attention to many new innovations Dark Daily has reported on that will impact how medical laboratories perform their tests

PwC’s Health Research Institute (HRI) issued its annual report, detailing the 12 factors expected to impact the healthcare industry the most in 2018. Dark Daily culled items from the list that will most likely impact clinical laboratories and anatomic pathology groups. They include:

How clinical laboratory leaders respond to these items could, in part, be determined by new technologies.

AI Is Everywhere, Including in the Medical Laboratory

Artificial intelligence is becoming highly popular in the healthcare industry. According to an article in Healthcare IT News, business executives who were polled want to “automate tasks such as routine paperwork (82%), scheduling (79%), timesheet entry (78%), and accounting (69%) with AI tools.” However, only about 20% of the executives surveyed have the technology in place to use AI effectively. The majority—about 75%—plan to invest in AI over the next three years—whether they are ready or not.

One such example of how AI could impact clinical laboratories was demonstrated by a recent advancement in microscope imaging. Researchers at the University of Waterloo (UW) developed a new spectral light fusion microscope that captures images in full color and is far less expensive than microscopes currently on the market.

“In medicine, we know that pathology is the gold standard in helping to analyze and diagnose patients, but that standard is difficult to come by in areas that can’t afford it,” Alexander Wong, PhD, one of the UW researchers, told CLP.

“The newly developed microscope has no lens and uses artificial intelligence and mathematical models of light to develop 3D images at a large scale. To get the same effect using current technologies—using a machine that costs several hundred thousand dollars—a technician is required to ‘stitch together’ multiple images from traditional microscopes,” CLP noted.

Healthcare Intermediaries Could Become Involved with Clinical Laboratory Data

Pricing is one of the biggest concerns for patients and government entities. This is a particular concern for the pharmaceutical sector. PwC’s report notes that “stock values for five of the largest intermediaries in the pharmacy supply chain have slumped in the last two years as demands for lower costs and better outcomes have intensified.”

Thus, according to PwC, pressure may come to bear on intermediaries such as Pharmacy Benefit Managers (PBMs) and wholesalers, to “prove value and success in creating efficiencies or risk losing their place in the supply chain.”

Similar pressures to lower costs and improve efficiency are at work in the clinical laboratory industry as well. Dark Daily reported on one such cost-cutting measure that involves shifting healthcare payments toward digital assets using blockchains. The technology digitally links trusted payers and providers with patient data, including medical laboratory test results. (See, “Blockchain Technology Could Impact How Clinical Laboratories and Pathology Groups Exchange Lab Test Data,” September 29, 2017.)

PwC 2018 Annual Report

PwC’s latest report predicts 12 forces that will continue to impact healthcare, including clinical laboratories and anatomic pathology groups, in 2018. Click on the image of the cover above to access an online version of the report. (Photo copyright: PwC/Issuu.)

The Opioid Crisis Remains at the Forefront

Healthcare will continue to feel the impact of the opioid crisis, according to the PwC report. Medical laboratories will continue to be involved in the diagnosis and treatment of opioid addition, which has garnered the full attention of the federal government and has become a multi-million-dollar industry.

Security Remains a Concern

Cybersecurity will continue to impact every facet of healthcare in 2018. Healthcare IT News reported, “While 95% of provider executives believe their organization is protected against cybersecurity attacks, only 36% have access management policies and just 34% have a cybersecurity audit process.”

Patients are aware of the risks and are often skeptical of health information technology (HIT), Dark Daily reported in June of last year. Clinical laboratories must work together with providers and healthcare organizations to audit their security measures. Recognizing the importance of the topic, the National Independent Laboratory Association (NILA) has named cybersecurity for laboratory information systems (LIS) a focus area.

Patient Experience a Priority

Although there have been significant improvements in the area of administrative tasks, there is still an enormous demand for a better patient experience, including in clinical laboratories. Healthcare providers want patients to make changes for the better that ultimately improve outcomes and the patient experience is one path toward that goal.

“Provider reimbursements will be based in part on patient engagement efforts such as promoting self-management and coaching patients between visits,” PwC noted in its report, a fact that Dark Daily has continually reported on for years. (See, “Pathologists and Clinical Lab Executives Take Note: Medicare Has New Goals and Deadlines for Transitioning from Fee-For-Service Healthcare Models to Value-Based Reimbursement,” April 1, 2015.)

Demands for Price Transparency Increase

As they follow healthcare reform guidelines to increase quality while lowering costs, state governments will continue to ramp up pressure on healthcare providers and third parties in the area of pricing. Rather than simply requiring organizations to report on pricing, states are moving towards legislating price controls, as Dark Daily reported in February.

Social Factors Affect Healthcare Access

The transition to value-based care makes the fact that patients’ socioeconomic statuses matter when it comes to their health. “The most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting,” David Berg, MD, co-founder of Redirect Health told PwC.

One such transition that is helping patients gain access to healthcare involves microhospitals and their adoption of telemedicine technologies, which Dark Daily reported on in March.

“Right now, they seem to be popping up in large urban and suburban metro areas,” Priya Bathija, Vice President, Value Initiative American Hospital Association, told NPR. “We really think they have the potential to help in vulnerable communities that have a lack of access.”

Data Collection Challenges Pharma

The 21st Century Cures Act, along with the potential exploitation of Big Data, will make it possible for organizations to gain faster, less expensive approvals from the US Food and Drug Administration (FDA). As Dark Daily noted in April, the FDA “released guidelines on how the agency intends to regulate—or not regulate—digital health, clinical-decision-support (CDS), and patient-decision-support (PDS) software applications.

“Physician decision-support software utilizes medical laboratory test data as a significant part of a full dataset used to guide caregivers,” Dark Daily noted. “Thus, if the FDA makes it easier for developers to get regulatory clearance for these types of products, that could positively impact medical labs’ ability to service their client physicians.”

Healthcare Delivery During and Following Natural Disasters

PwC predicts the long-term physical results, financial limitations, and supply chain disruptions following natural disasters will continue to affect healthcare in 2018. The devastation can prevent many people from receiving adequate, timely healthcare.

However, new laboratory-on-a-chip (LOC) and other “lab-on-a-…” testing technologies, coupled with medical drone deliver services, can bring much need healthcare to remote, unreachable areas that lack electricity and other services. (See Dark Daily, “Lab-on-a-Fiber Technology Continues to Highlight Nano-Scale Clinical Laboratory Diagnostic Testing in Point-of-Care Environments,” April 2, 2018, and, “Johns Hopkins’ Test Drone Travels 161 Miles to Set Record for Delivery Distance of Clinical Laboratory Specimens,” November 15, 2017.)

PwC’s report is an important reminder of from where the clinical laboratory/anatomic pathology industry has come, and to where it is headed. Sharp industry leaders will pay attention to the predictions contained therein.

—Dava Stewart

Related Information:

Top Health Industry Issue of 2018

PwC Health Research Institute Top Health Industry Issues of 2018 Report: Issuu Slide Presentation

12 Defining Healthcare Issues of 2018

Is Laboratory Medicine Ready for Artificial Intelligence?

Artificial Intelligence Imaging Research Facilitates Disease Diagnosis

Blockchain Technology Could Impact How Clinical Laboratories and Pathology Groups Exchange Lab Test Data

Skepticism, Distrust of HIT by Healthcare Consumers Undermines Physician Adoption of Medical Reporting Technologies, But Is Opportunity for Pathology Groups, Clinical Laboratories

Pathologists and Clinical Lab Executives Take Note: Medicare Has New Goals and Deadlines for Transitioning from Fee-For-Service Healthcare Models to Value-Based Reimbursement

Researchers Point to Cost of Services, including Medical Laboratories, for Healthcare Spending Gap Between the US and Other Developed Countries

Telemedicine and Microhospitals Could Make Up for Reducing Numbers of Primary Care Physicians in US Urban and Metro Suburban Areas

New FDA Regulations of Clinical Decision-Support/Digital Health Applications and Medical Software Has Consequences for Medical Laboratories

Lab-on-a-Fiber Technology Continues to Highlight Nano-Scale Clinical Laboratory Diagnostic Testing in Point-of-Care Environments

Johns Hopkins’ Test Drone Travels 161 Miles to Set Record for Delivery Distance of Clinical Laboratory Specimens

From Micro-hospitals to Mobile ERs: New Models of Healthcare Create Challenges and Opportunities for Pathologists and Medical Laboratories

New low-cost alternatives to emergency department and hospital visits could require flexibility from pathology groups and clinical laboratories to provide the best quality care

In response to the rising cost of conventional hospital services, innovative healthcare models such as micro-hospitals, bedless hospitals, and mobile and freestanding emergency rooms (ERs), are attempting to lower costs while maintaining quality of care by providing alternatives to traditional ER visits and hospital stays.

This means new challenges and opportunities for pathology groups and medical laboratories that can adapt to the different needs of these new healthcare delivery models. Each different care model will want clinical lab testing services and the reporting of lab test results to be handled in ways that enable these providers to achieve improved patient outcomes.  (more…)