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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As Medical Laboratory Test Utilization Grows, Health Insurers Develop Programs to Manage Rising Costs

After seeing a rise in the volume of clinical lab tests physicians order, managed care plans are develop a variety of strategies to manage utilization and costs

Health insurers are taking more aggressive actions to control the cost of clinical laboratory testing. For many years, clinical laboratories and pathology groups have been concerned about the strategies used by Medicare to control the utilization and costs of medical laboratory tests. Private health insurers usually follow the actions of Medicare, the nation’s largest health insurer. But today, managed care plans are developing their own lab-test-utilization strategies in addition to following those of Medicare.

Recently, Managed Care magazine explained many of the steps health insurers take to keep the costs of clinical laboratory tests under control. The cover story in the October issue of the magazine, “Health Plans Deploy New Systems To Control Use of Lab Tests,” outlined how health insurers Cigna, Group Health Cooperative, Priority Health, and UnitedHealthcare (UHC) are managing lab test utilization. (more…)

Texas Section of the American Association of Clinical Chemistry Hosts All-Star Line-up of Clinical Laboratory Experts to Share Successes at Improving Lab Test Utilization

Innovative medical laboratories are developing ways to deliver more value to physicians ordering and using lab tests

TEMPLE, TEXAS—Changes now happening to healthcare and the practice of medical laboratory medicine were upfront and personal here during last Friday’s meeting of the Texas Section of the American Association of Clinical Chemistry (AACC).

An impressive crowd of more than 120 pathologists, Ph.D.s, and clinical laboratory professionals were present to learn from an all-star panel of lab industry innovators. Space does not allow a full report of all 10 speakers who addressed this conference, but a nugget or two from three of the morning speakers will illustrate some of the latest thinking on how medical laboratories and pathology groups can make the transition from a transactional business model (fee-for-service payment) to a value-added clinical model (bundled or shared per-patient-per-month fee).

After an opening presentation by your Dark Daily editor, Robert L. Michel, who identified the primary dynamics propelling healthcare’s transformation, the next speaker launched into the key issue associated with how clinical labs and pathology groups can deliver value. (more…)

Pathologist Michael LaPosata, M.D., Delivers the Message about Diagnostic Management Teams and Clinical Laboratory Testing to Attendees at Arizona Meeting

Conducted by Sunquest, the meeting introduced medical laboratory professionals to  ideas and improved patient outcomes that result when pathologists actively help physicians select the right lab tests and understand how to act upon the results

PHOENIX, ARIZONA—Most pathologists and clinical laboratory scientists are quick to agree that overutilization of medical laboratory tests is a major problem in healthcare. But underutilization of medical lab tests is an equally significant problem. That’s the message delivered here last Monday by pathologist Michael Laposata, M.D., Ph.D., during a presentation he delivered at the Sunquest Executive Summit.

Laposata, who recently assumed new duties as the Chair of Pathology at the University of Texas Medical Branch in Galveston, Texas, was speaking about the value of what he calls “diagnostic management teams,” or DMTs. In recent years, while at Vanderbilt University Medical Center, Laposata and his colleagues introduced DMTs in support of several medical specialties. These DMTs proved quite successful at improving patient outcomes, while reducing the overall cost per healthcare encounter for these patients.

Vanderbilt University Medical Center Forms Nation’s Largest Clinically Integrated Network that includes Its Own Health Insurance Offering

Clinically integrated networks is one market trend in response to shift away from fee-for-service payment and toward value-based provider reimbursement

One fast-developing trend is that of academic centers forming integrated networks with various providers within a community and a surrounding region. This is related to a movement to establish accountable care organizations (ACOs). But it is also a response to actions by payers to narrow their networks and exclude high-cost providers, such as academic centers.

This business model has a mutual goal. Each integrated network is anchored by an academic medical center and is designed to foster closer interaction between the academic subspecialists and the wider clinical community. For pathologists and clinical lab managers, such integrated provider networks may often encourage participating physicians to send their reference and esoteric medical laboratory test referrals to the academic center and not to the physicians’ primary laboratory provider. (more…)

Leapfrog Study Shows Hospital Use of CPOE Can Affect Clinical Pathology Laboratory Test Utilization

Study Finds Weaknesses in the Performance Of CPOE System in Daily Care Settings

Many experts believe that wider use of computerized physician order entry (CPOE) systems can contribute to the better utilization of clinical pathology laboratory tests. CPOE is considered one method for helping the physician order the right medical laboratory test for the patient at the right time—then use the clinical lab test results to implement the most appropriate therapy.

CPOE is an important decision-support tool for physicians at the point-of-care (POC). Regular use of a CPOE is also something that the federal government specifically identified as necessary to accomplish “meaningful use” link under the ARRA/HITECH Act legislation. (more…)