Creating Added Value from Clinical Pathology Laboratory Testing Produced Improved Outcomes at University of Mississippi Medical Center and Broward Health

Jun 22, 2015 | Coding, Billing, and Collections, Digital Pathology, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations

Innovative medical laboratories shared their successes in improving lab test utilization that included physician engagement and close monitoring of key metrics

DATELINE: ORLANDO, FLORIDA—One big challenge facing medical laboratories  and anatomic pathology groups in the United States today is the need to transition from a transaction-based business model (increasing specimen volume leads to increasing revenue) to a value-based business model (helping providers improve their use of clinical laboratory tests in ways that measurably improve patient outcomes while controlling or reducing the cost of care.)

Two trends reinforce the need for clinical laboratories to craft strategies to develop new ways to add value to lab testing services.

One trend is the move by Medicare and private health insurers to shift reimbursement for providers away from fee-for-service  and toward bundled reimbursement and budgeted reimbursement.

The second trend is the emergence of integrated clinical care organizations. The most visible of these are accountable care organizations (ACO) and patient-centered medical homes (PCMH). What these care delivery organizations have in common is that they require hospitals, physicians, clinical laboratories, imaging centers, nursing homes and other types of providers to work together more effectively so that patients receive healthcare in a seamless fashion because there is a continuum: primary care to specialty care to acute care and back again. (more…)