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

Hosted by Robert Michel

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

Hosted by Robert Michel
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Clinical Laboratory Leaders Agree: Showing Value Is More Important than Ever as Healthcare Transitions Away from Fee-for Service Reimbursement

How medical laboratories can show value through process improvement methods and analytics will be among many key topics presented at the upcoming Lab Quality Confab conference

Quality management is the clinical laboratory’s best strategy for surviving and thriving in this era of shrinking lab budgets, PAMA price cuts, and value-based payment. In fact, the actions laboratories take in the next few months will set the course for their path to clinical success and financial sustainability in 2020 and beyond.

But how do medical laboratory managers and pathologists address these challenges while demonstrating their lab’s value? One way is through process improvement methods and another is through the use of analytics.

Clinical pathologists, hospital lab leaders, and independent lab executives have told Dark Daily that the trends demanding their focus include:

  • Ensuring needed resources and appropriate tests, while the lab is scrutinized by insurance companies and internally by hospital administration;
  • PAMA’s (Protecting Access to Medicare Act of 2014) effects on reimbursement;
  • Consumers’ demand for lower cost and better access to quality healthcare;
  • Serving patients in a wider continuum of care; and
  • Collaborating instead of competing with other labs in the market.

“The laboratory and resources we are given are being scrutinized in a different way than they have been historically,” said Christopher Doern, PhD, Director of Microbiology and Associate Professor of Pathology, Virginia Commonwealth University Health System (VCU Health) Medical College of Virginia, Richmond, in an exclusive interview with Dark Daily.

“Our impact on patient care, in many cases, is very indirect. So, it is difficult to point to outcomes that occur. We know things we do matter and change patient care, but objectively showing that is a real struggle. And we are being asked to do more than we ever had before, and those are the two big things that keep me up at night these days,” he added.

This is where process improvement methods and analytics are helping clinical laboratories understand critical issues and find opportunities for positive change.

“You need to have a strategy that you can adapt to a changing landscape in healthcare. You have to use analytics to guide your progress and measure your success,” Patricia Nortmann, System Director of Laboratory Services at St. Elizabeth Healthcare, Erlanger, Ky., told Dark Daily.

Clinical Laboratories Can Collaborate Instead of Compete

Prior to a joint venture with TriHealth in Cincinnati, St. Elizabeth lab leaders used data to inform their decision-making. Over about 12 years preceding the consolidation of labs they:

  • Centralized the outreach core lab;
  • Installed front-end automation in chemistry;
  • Standardized the laboratory information system (LIS) and analyzer platforms across five affiliate hospitals; and
  • Implemented front-end automation outside the core area and in the microbiology lab.

“We are now considered a regional reference lab in the state of Kentucky for two healthcare organizations—St. Elizabeth and TriHealth,” Nortmann said. 

Thanks to these changes, the lab more than doubled its workload, growing from 2.1 million to 4.3 million outreach tests in the core laboratory, she added.

Christopher Doern, PhD (left), Director of Microbiology and Associate Professor of Pathology at Virginia Commonwealth University Health System; Patricia Nortmann (center), System Director of Laboratory Services at St. Elizabeth Healthcare; and Joseph Cugini (right), Manager Client Solutions at Health Network Laboratories, will present practical solutions and case studies in quality improvement and analytics for clinical laboratory professionals at the 13th Annual Lab Quality Confab, October 15-16, 2019, at the Hyatt Regency in Atlanta, Ga. (Photo copyright: The Dark Report.)

Using Analytics to Test the Tests

Clinical laboratories also are using analytics and information technology (IT) to improve test utilization.

At VCH Health, Doern said an analytics solution interfaces with their LIS, providing insights into test orders and informing decisions about workflow. “I use this analytics system in different ways to answer different questions, such as:

  • How are clinicians using our tests?
  • When do things come to the lab?
  • When should we be working on them? 

“This is important for microbiology, which is a very delayed discipline because of the incubation and growth required for the tests we do,” he said.

Using analytics, the lab solved an issue with Clostridium difficile (C diff) testing turnaround-time (TAT) after associating it with specimen transportation.

Inappropriate or duplicate testing also can be revealed through analytics. A physician may reconsider a test after discovering another doctor recently ordered the same test. And the technology can guide doctors in choosing tests in areas where the related diseases are obscure, such as serology.  

Avoiding Duplicate Records While Improving Payment

Another example of process improvement is Health Network Laboratories (HNL) in Allentown, Pa. A team there established an enterprise master patient index (EMPI) and implemented digital tools to find and eliminate duplicate patient information and improve lab financial indicators.

“The system uses trusted sources of data to make sure data is clean and the lab has what it needs to send out a proper bill. That is necessary on the reimbursement side—from private insurance companies especially—to prevent denials,” Joseph Cugini, HNL’s Manager Client Solutions, told Dark Daily

HNL reduced duplicate records in its database from 23% to under one percent. “When you are talking about several million records, that is quite a significant improvement,” he said.

Processes have improved not only on the billing side, but in HNL’s patient service centers as well, he added. Staff there easily find patients’ electronic test orders, and the flow of consumers through their visits is enhanced.

Learn More at Lab Quality Confab Conference

Cugini, Doern, and Nortmann will speak on these topics and more during the 13th Annual Lab Quality Confab (LQC), October 15-16, 2019, at the Hyatt Regency in Atlanta, Ga. They will offer insights, practical knowledge, and case studies involving Lean, Six Sigma, and other process improvement methods during this important 2-day conference, a Dark Daily news release notes.

Register for LQC, which is produced by Dark Daily’s sister publication The Dark Report, online at, or by calling 512-264-7103.   

—Donna Marie Pocius

Related Information:

13th Annual Lab Quality Confab October 15-16, 2019. Hyatt Regency, Atlanta, Ga.

Clinical Laboratory Innovators in Lean, Six Sigma, and Process Improvement to Gather in Atlanta October 15-16, 2019

Pew and Massachusetts eHealth Collaborative Find the Frequency of Patient Mismatches Exceeds ‘Desirable Levels for Effective Data Exchange’

EMPIs may help clinical laboratories ensure their patients and medical records are properly matched with medical laboratory test results and specimens

Mix-ups between patients and their medical records, known in the healthcare industry as “patient mismatching,” happen far too frequently in hospitals and clinics worldwide. When surgery is involved, such mismatches can lead to deadly errors. However, clinical laboratories and pathology groups also must take steps to ensure patients, their medical records, and their biological specimens remain properly matched.

Once horrific incident in 2016 involved Saint Vincent Hospital in Worcester, Mass. Believing they were operating on a patient with a kidney tumor, surgeons mistakenly removed a healthy kidney from the wrong patient. The cause of the patient mismatch was a mix-up with CT scans. The two patients shared similar names, Managed Care reported.

Sadly, patient mismatching is not a new or rare problem. Patient mismatches often lead to delays, extra costs to fix duplicate information, and tragically, unnecessary surgery and inappropriate care, Healthcare Dive noted.

According to Managed Care, organizations working on solutions include:

Extent of Patient Mismatching Unknown

A recent study by Pew Charitable Trusts (Pew) in collaboration with the Massachusetts eHealth Collaborative (MAeHC) revealed that the rate of patient mismatching is difficult to measure.

“Incorrect matches could result in patients getting the wrong medicine, and failure to link records could lead to treatment decisions made without access to up-to-date laboratory test results,” Pew noted in an issues brief.

Pew and the MAeHC interviewed 18 hospital, medical practice, and health information technology exchange leaders. The respondents admitted that they are uncertain about the extent of the matching problem.

“They don’t know all the records that should be related and thus cannot understand what percentage of those are unlinked,” the researchers wrote.

Nonetheless, the researchers found that patient/record match rates fall “far below the desired level” for effective data exchange among organizations, Healthcare Dive reported. 

For pathologists and clinical laboratory managers, the Pew/MAeHC study had several key takeaways, such as:

  • “Match rates are far below the desired level for effective data exchange.
  • “An increased demand for interoperability—the exchange of electronic data among different systems—is fueling the desire for improvements.
  • “Match rates are difficult to measure.
  • “The methods in which records are received can affect match results.
  • “Different types of healthcare providers vary in their perspectives on the extent of the problem.
  • “Effective opportunities exist for organizations to more accurately link individuals’ health records.”

Other research studies suggest that patient match rates can fall to 50% or 60% when organizations share patients’ records between disparate healthcare network electronic health record (EHR) systems, the Office of the National Coordinator for Health Information Exchange (ONC) noted in a final report on the ONC’s Patient Identification and Matching Initiative. From experience, medical laboratories understand the challenges of matching information on a clinical laboratory test requisition to the right patient and can often see patient mismatches on a daily basis.

About $1,950 in medical care costs per patient during a hospital stay, and $1.5 million annually in denied claims per hospital, are associated with inaccurate patient identification, reported a survey conducted by Black Book Research.

“Patient matching is a fundamental function of being able to get the right records, for the right person, at the right time, so that timely decisions can be made about his or her health. There has to be a mechanism to ensure that you’re actually getting a copy of the records for the right person,” Mariann Yeager (above), CEO of the Sequoia Project told Modern Healthcare. The Sequoia Project advocates for nationwide health information exchange (HIE). (Photo copyright: Value-based Care Summit.)

Why Patient-Matching is Difficult

Respondents to the Pew study reported that challenges to correctly matching patients with their records include:

  • Receiving patient records that an organization did not expect;
  • Urban health systems serving patients through multiple sites;
  • High costs associated with matching solutions; and
  • Differences in how organizations capture, use, and link medical records.

When humans manually input patient data, Mary Elizabeth Smith could be listed as M.E. Smith or Mary E. Smith or even Liz Smith. Such data, when filed differently, can result in duplicate records for the same person, or, as St. Vincent’s found out, patient mismatches that have dire consequences, Managed Care noted.

“If there’s some kind of error in entering fields (name, address, date of birth), either when the patient’s coming in or in a previous entry, the matching can go awry,” Brendan Watkins, Administrative Director of Enterprise Analytics at Stanford Children’s Health, told Modern Healthcare.

Patient-Matching Solutions at Clinical Laboratories    

Clinical laboratories also have tackled patient-mismatching and have devised processing software solutions that ensure patients are correctly identified and matched with the appropriate records and specimens.

For example, Sonora Quest Laboratories (SQL), a subsidiary of Laboratory Sciences of Arizona, developed an enterprise-wide master patient index (EMPI). As reported by The Dark Report, Dark Daily’s sister publication, “The EMPI underpins all the patient-centric services that tomorrow’s clinical laboratory must support to be successful at meeting the needs of ACOs, PCMHs [patient-centered medical homes], and other emerging models of integrated clinical care.”

Other solutions suggested by respondents to a previous 2018 Pew survey include:

  • Unique patient identifier: Adoption of a patient identification number could help matching efforts, though patients have expressed privacy concerns. The idea is to use smartphones to validate patient data using digit codes. However, respondents told Pew, not everyone has a smartphone.
  • Data standardization: Respondents said standardization of data elements and formatting could impact match rates. But agreement on which elements to use for the match would be needed.
  • Referential matching: Healthcare providers could follow the banking industry and use outside sources, such as credit bureaus, to verify addresses and other data. Respondents to the Pew survey balked at the cost. 

One other technology not mentioned in the Pew survey but previously reported on by Dark Daily is biometric facial recognition, which would aid providers in identifying patients and matching them with their records. (See “Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device,” July 9, 2018.)

With advancements in technology and interoperability, medical laboratory leaders and other healthcare leaders may soon be expected to achieve patient and record match rates of 100%. Pathology laboratories with EMPIs and other solutions may be well prepared to meet those challenges.

—Donna Marie Pocius

Related Information:

A Mismatch Made in America

Provider Demand for Accurate Patient Matching is High, Pew Says

Enhanced Patient Matching Is Critical to Achieving Full Promise of Digital Health Records

Hospital and Clinical Executives See Rising Demand for Accurate Exchange of Patient Records

Patient Identification Matching Final Report

Improving Provider Interoperability Congruently Increasing Patient Record Error Rates: Black Book Survey

Care Continuum Expands and Patient Matching Remains Problem without Single Solution

Medicare and Medicaid Programs Patient Protection and Affordable Care Act Interoperability

Sonora Quest Builds EMPI to Serve Patients and ACOs

Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device

Because of Sizeable Deductibles, More Patients Owe More Money to Clinical Pathology Laboratories, Spurring Labs to Get Smarter about Collecting from Patients

One Arizona medical laboratory focused on collecting from patients who were overdue on amounts averaging just $40 and, in 18 months, collected $3.2 million!

In today’s clinical laboratory marketplace, competency in revenue management is becoming just as important as clinical excellence. Blame it on these multi-year trends: shrinking lab budgets, Medicare price cuts, and payers excluding labs from narrow networks.

At the dawn of this decade—just five years ago—few pathologists and clinical lab executives would have predicted that the financial survival of their lab organizations would depend upon becoming more proficient and more sophisticated with billing and collections. Yet this is now a necessary response to the year-over-year decline in lab prices and revenue experienced since 2010. (more…)

California Clinical Laboratory Association’s Annual Conference Showcases How Medical Labs Are Using EMPIs and Similar Technologies to Deliver More Value

Progressive pathologists and lab leaders are looking ahead to the day when fee-service reimbursement is replaced by budgeted payment and similar arrangements

SAN DIEGO, CALIFORNIA—More than 100 clinical laboratory owners and lab executives gathered here this week for the annual meeting of the California Clinical Laboratory Association (CCLA). Because the medical laboratory testing marketplace in California is often a bellwether for trends that go national, the presentations were timely and of universal interest to lab professionals working in other regions of the United States.

The membership of CCLA certainly reflects the broader changes happening in the clinical laboratory industry nationally. Whereas a decade or two ago, the majority of CCLA members were independent lab companies providing routine lab testing services to office-based physicians, today the larger share of CCLA members are associated with lab companies that offer patent-protected or proprietary specialty tests. (more…)