Utilization management of clinical laboratory testing is a big trend in laboratory medicine at the moment as innovative labs strive to add more value
DATELINE: DENVER, COLORADO—Interest in improving the utilization of clinical laboratory tests is at an all-time high among medical laboratories throughout the United States. Last week a national gathering of pathologists and laboratory professionals gathered in the Mile High City to share success stories and identify the best approaches to helping physicians better utilize lab tests.
This one-day conference on laboratory test utilization was organized by Mayo Medical Laboratories and the Mayo Clinic as part of its 27th Annual Conference on Laboratory Outreach. The keynote speaker was Michael G. Rock, MD, Chief Medical Officer at Mayo Clinic Hospitals/Mayo Foundation and an at-large member of the Board of Trustees of the American Hospital Association (AHA) and its Executive Committee.
Analysis of Key Trends in Healthcare
In recent years, Rock has been involved at the highest levels of healthcare strategy development, both at the Mayo Clinic and with several national hospital associations, including the American Hospital Association. He provided attendees at this conference with a razor-sharp analysis of key trends in healthcare. Rock then identified and explained the essential steps that innovative hospitals and health systems are taking to reshape their organization in order to provide the range of clinical services needed to support integrated healthcare and personalized medicine. (more…)
The Clinical Laboratory Management Association is encouraging medical laboratories to submit abstracts about their programs to deliver more value to patients and physicians through the use of clinical pathology laboratory tests
Now, more than ever, the house of laboratory medicine needs to be publishing clinic studies and evidence that the money spent on appropriate medical laboratory testing is returned tenfold from improved patient outcomes and substantial reductions in the cost per episode of care that can be associated with the use of those lab tests.
It is this credible evidence that can help shape healthcare policy in positive ways, while encouraging government and private payers to recognize the true value of clinical laboratory tests and thus establish adequate reimbursement to insure the continuation of high-quality lab testing services in the United States. (more…)
Alternative payment models and value-based payment schemes create financial unknowns for clinical laboratories and anatomic pathology groups
What happens to pathologists and clinical laboratories when fee-for-service reimbursement ceases to be the primary payment method for anatomic pathology services and medical laboratory tests?
After all, fee-for-service reimbursement for lab tests is what underpins today’s financial model for lab test services. Under this transaction-based business arrangement, a clinical laboratory that can increase its specimen volume will realize a lower average cost-per-test because of economies of scale within the lab. At the same time, the lower costs mean a bigger net margin available from profit, given the fixed price of the reimbursement for lab tests.
So what is a medical laboratory to do as healthcare shifts to a value-based reimbursement (VBR) model, formerly known as pay-for-performance? The answer to that question won’t take long to answer because of a recent announcement by the Department of Health and Human Services (HHS). (more…)
To help medical laboratories understand how to deliver patient-centric lab testing services, the Clinical Laboratory Management Association (CLMA) has launched its “Increasing Clinical Effectiveness” (ICE) program. CLMA President Paul Epner (pictured above) will be conducting a free webinar about the ICE program on August 12 and the details of ICE and the webinar can be found at the CLMA website. (Photo copyright CLMA.)
Increasing Clinical Effectiveness’ is the name of new initiative that CLMA is making available to all medical laboratories and anatomic pathology groups
There is now little disagreement that the U.S. healthcare system is in the midst of a transformation away from reactive and acute care and to proactive, integrated clinical care. This is why clinical laboratories and anatomic pathology groups across the nation now find themselves at a critical crossroads.
This trend presents medical laboratory managers, pathologists, and clinical chemists who lead the nation’s labs with an important question: When is it time to shift the lab’s focus away from its traditional “lab-centric” emphasis and position the lab as a “patient-centric” clinical service?
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…)