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
“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:
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,”
Using analytics, the lab solved an issue with Clostridium
difficile (C diff) testing turnaround-time (TAT) after associating it with
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
Avoiding Duplicate Records While
“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 Dailynews release notes.
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
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
According to Managed Care, organizations working on
“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
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
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
“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.”
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
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
High costs associated with matching solutions;
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.
Other solutions suggested by respondents to a previous 2018
Pew survey include:
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.
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.
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.
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.
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…)
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…)