Specialist physicians will benefit from enriched medical laboratory consultations involving pathologists and other clinical laboratory scientists
Increasing numbers of medical specialists are launching patient-centered specialty practices (PCSP). This trend has implications for clinical laboratories and pathology groups because these office-based physicians will want tighter clinical and operational integration with other healthcare providers who treat the same patients.
Specialist physicians are watching the growth of patient-centered medical homes (PCMHs) and how PCMHs are organized to provide proactive clinical services and maintain access to patients. In adopting this care model for specialty medical practices, these specialists will typically utilize a more extensive menu of medical laboratory tests and anatomic pathology professional support from their laboratory providers. (more…)
In Massachusetts, a 1,000-physician group gets 70% of revenue from capitated payments, motivating the physicians to reduce unnecessary utilization of medical laboratory tests
Accumulating market evidence indicates that unnecessary utilization of medical laboratory tests—a problem bemoaned by pathologists for decades—may finally be addressed by an unlikely source: ordering physicians! Such a trend would have both positive and negative consequences for clinical laboratories throughout the United States.
What motivates physicians, on their own initiative, to reduce the unnecessary utilization of medical laboratory tests are changes in how they are paid. Many private health plans are reimbursing office-based physicians using global payment arrangements, such as capitation. (more…)
The Increase in Certifications is the Result of New Reimbursement Models for Patient-Centered Medical Homes by Third-Party Payers
There is much activity in the patient-centered medical homes (PCMH) sector of the U.S. healthcare system. A host of certification and accreditation bodies have set up shop and they report a rapid increase in the number of organizations they are recognizing as medical homes.
That fact alone is significant news. It is evidence that physicians are spending substantial time and money to convert their medical practices into medical homes. In turn, this trend represents an opportunity for clinical laboratories and anatomic pathology groups, since medical homes need to order clinical laboratory tests on behalf of their patients. (more…)
Growth in the number of medical homes could make winners of those pathology groups and medical laboratories that learn how to best meet the needs of these providers
Physician executives at TransforMED, a wholly-owned subsidiary of the American Academy of Family Physicians, are blogging with their opinions about which providers will be winners and losers in healthcare. Although most pathologists may not agree with these opinions, there are useful insights to be gleaned from the reasoning behind these opinions.
According to TransforMed’s physician-leaders, healthcare is not about to transform—it already has! The healthcare world is no longer changing, it has changed, and “there will be winners and losers,” stated Terry McGeeney, M.D., MBA, FAAFP, in a blog published on the TransforMed Website.
NCQA published annual report showing increased rates of screening for most of its HEDIS quality measures and medical laboratory testing often plays a role in these screening activities
For almost a decade now, clinical laboratories and pathology groups have been asked by many private payers to provide laboratory test data for a number of clinical services. In turn, these private health insurers annually submit this data to the Healthcare Effectiveness Data and Information Set (HEDIS) program managed by the National Committee for Quality Assurance (NCQA).
Although their medical laboratories regularly feed this data to payers, few pathologists or lab administrators track how HEDIS data is used by NCQA. Thus, it is useful to know that, over the years, HEDIS data provides evidence that better utilization of certain clinical laboratory tests by physicians directly contributes to measurable improvements in patient outcomes across the United States.