Record crowd of pathologists and medical laboratory managers learned about the latest trends in clinical laboratory management

Dateline: New Orleans, Louisiana—Day two of the 16th annual Executive War College (EWC) gave clinical laboratory managers and pathologists an insider’s view on the “Holy Trinity” of the ObamaCare legislation. The focus was on accountable care organizations (ACO), medical homes, and value-based purchasing.

As happened on day one, yesterday it was a sizable group that included medical technologists (MT), in vitro diagnostics (IVD) manufacturers, pathologists and lab entrepreneurs.

Why Do Physicians Order Medical Laboratory Tests?

Dr George Lundberg

Dr. George Lundberg

George Lundberg M.D., Editor-in-Chief of Cancer Commons, and Editor-at-Large for MedPage Today, Los Gatos, California, delivered a lively presentation. Foregoing PowerPoint slides, Dr. Lundberg delivered incisive observations and recommendations on how clinical laboratories can serve the new integrated care delivery models and deliver greater clinical value. He bantered with the capacity audience in the hotel’s grand ballroom throughout his presentation.

“It is our opportunity and responsibility to preserve the best, and scuttle the worst, and build a new laboratory testing service,” he said.

Dr. Lundberg posed the question, “Why do Physicians order lab tests?” He then went on to list the results of several studies conducted by him and other organizations that polled physicians on their reasons for ordering lab tests. The results were illuminating. Dozens of reasons ranged from “to confirm a clinical opinion” and “legal and state requirements” to “I was just curious about the outcome of the test” and “I didn’t want to be sued by the patient’s family” with every conceivable reason in between.

“I’m so tired of “fraidy-cat docs,” said Dr. Lundberg to the audience, “who, if one lawyer walks into a room of 100,000 American physicians with a wave and a sneer, causes these doctors to say ‘We’ll order more MRIs on everybody and make money off that because we don’t want to be sued.’ What? Come on! Brains and balls is what you need in this kind of situation.”

Peppered with large doses of humor, Dr. Lundberg delivered a steady stream of comments and insights about the state of laboratory usage—or over-usage. “The simplest test is a home medical device—it’s called a bathroom scale,” he noted at one point, generating a collective laugh from the Executive War College audience.

Dr. Lundberg stressed that Ordering, Interpretation, and Action are from where Value will come. “Clinical laboratory tests that matter are those that lead to actionable information that helps physicians improve patient health,” he concluded.

More on Accountable Care Organizations and Clinical Laboratory Testing

In that same general session, Tom Williams, Ph.D, MBA, Executive Director at Oakland, California-based Integrated Healthcare Association, took the EWC attendees through a 30-year journey covering the lessons learned from California’s experience developing ACOs.

“A major challenge facing the ACO is how to balance payment with patient care,” he said. His major points explained how:

  • Capitation increased risk for ACOs in California,
  • In areas of low socio-economics it’s hard for ACOs to succeed,
  • Total cost of care is going to be a game changer,
  • Lab data is integral to performance measurements,
  • There needs to be a data exchange standard, and how,
  • ACOs are real, but it’s going to take time for them to grow.
Dr. James Crawford

Dr. James Crawford

James Crawford, M.D., Ph.D, Senior Vice President for Laboratory Services at North Shore-Long Island Jewish Health System, and the Chairman of Pathology and Laboratory Medicine, North Shore University Hospital (NSUH) and LIJ Medical Center, followed Williams and tackled the topic of the Medical Home care model. Dr. Crawford explained the role of medical homes in advancing integrated patient care. He also discussed how clinical laboratories can add value to physicians practicing in medical homes.

“Forces are now in motion that will determine the path pathologists must take in the future,” he said.

Dr. Crawford explained three medical home concepts:

  • Medical home = primary care practice
  • Advanced medical home = specialists primary care
  • Patient-centered medical neighborhood = all care providers delivering all necessary care

He stressed that it is critical for pathologists to get out of their laboratories and proactively seek to interact with the physician community and even with patients.

“As pathologists and laboratory scientists, our interaction with the data and EHRs is self-evident,” he said. “There are opportunities for pathologists to be in contact with the patient during the entire healthcare continuum. We can establish and run the screening programs. To date, pathologists have been silent. We haven’t spoken up at all. The voice of the pathologist is absent.

“Outreach to medical homes will identify the clinical laboratory as a provider who cares,” he continued. “This unto itself is a value.”

Dr. Crawford listed specific observations and actions that pathologists should consider to raise their profiles and increase their value to the medical community:

  • Healthcare reform will occur at the local level and then role out nationally,
  • You can’t retrofit labs to work with medical homes. Medical laboratories must be part of the design of a medical home,
  • Find those physicians who are doing medical homes in your local market and reach out to them,
  • Become an informant of “absolute” measurements of primary care,
  • Pathologists should actively seek participation in demonstration projects,
  • Pathologists have to step forward as leaders and be part of the future.

These are important highlights from the presentations that addressed ACOs, medical homes, and value-based reimbursement. As well, more than 80 speakers delivered a host of actionable strategies, management innovations, and practical experience to a very large and enthusiastic audience. Dark Daily readers can order the audio recordings of this conference from the Executive War College website when they become available. This information may be invaluable in helping you guide your clinical laboratory organization to sustained success during the coming wave of healthcare reform.

—Michael McBride

Related Information:

2011 Executive War College

The Dark Report lab intelligence