CALPERS Saves $15 Million in Health Premiums Because Proactive Care Reduced Hospital Inpatient Admissions

Clinical laboratories and pathology groups may need to re-strategize should hospital inpatient admission rates begin declining as a result of proactive clinical care programs

More hospitals are ramping up their services in proactive outpatient care. The goal is to reduce hospital admissions and curb costs. The challenge is that fewer admissions and shorter stays mean a drop in hospital revenues. For the hospitals’ clinical laboratories, it also means less inpatient lab test volumes.

Hospitals are doing this in response to changes in reimbursement models specifically designed to incentivize providers to keep people out of hospitals. Of all sites that deliver patient care, hospitals account for the greatest share of the nation’s healthcare dollar. This makes them a prime target for cost cutting, noted a recent story in Modern Healthcare (MH).

Accountable Care Organizations (ACOs) Expected to Encourage Appropriate Use of Clinical Pathology Laboratory Tests

ACO model encourages clinical integration involving hospitals and office-based physicians

Here in Texas, the portion of the Obamacare Health Law that creates Accountable Care Organizations (ACOs) and an ACO payment mechanism has caught the full attention of the state’s largest multi-hospital health systems. Pathologists and clinical laboratory managers across the nation should take this activity in Texas as an early sign that ACOs are a care delivery model that must be taken seriously.

That’s because two things are happening in Texas. First, across the state, hospitals and health systems are actively developing ACOs. Second, anticipating restricted access to patients, physicians in smaller practices are starting to either sell their practices to the local hospital/health system, or are merging their group with larger medical practices.

Both activities are likely to fundamentally change the way clinical laboratories in Texas compete for the laboratory test referrals from office-based physicians. This could occur  once the ACOs now in organization initiate clinical services.