ADVANCE for Executive Insight 1 ADVANCE for Executive Insight

Healthcare is evolving faster now than ever in response
to a number of powerful forces. These include HI-
TECH, Meaningful Use, big data, decreasing costs
and increasing availability of personalized medicine, and
EMR adoption. However, most significant is the creation
of Accountable Care Organizations (ACO) under the Affordable
Care Act, and the significant shift, practically and
culturally, from volume to value.
If the financial outcome under the fee for service model
keeps patients in the hospital, then they will be kept out
under the ACO model. While ACOs do not remove fees
for services, they do create savings incentives to motivate
volunteer organizations to meet specific quality benchmarks
which demonstrate that they have saved healthcare
dollars, and ultimately improved
patient care.
One problem, however, is that
while volume is easy to measure
(the more you do, the more you
get paid), proving value with
quality metrics is more difficult.
And when trying to predict outcomes
(e.g., keeping patients out
of the hospital) the difficulty only increases.
So how can the clinical laboratory contribute to this
new challenging environment? The fact that it is the production
engine and custodian of vast amounts of test
result data that is relied upon for over 70% of diagnoses
by some measures, is insufficient.
The key to the laboratory fulfilling
its potential, and enabling the ACO
to fulfill its potential, lies in understanding
how to interpret
and apply its
data in a strategically
meaningful way.
Three specific areas
The laboratory cannot become a
data enabler in a meaningful way
for the ACO unless it becomes a
data partner with all of the other relevant
and willing moving parts.
it can support to achieve this are test ordering guidance,
admissions and discharges and pharmacy.
Test Ordering Guidance
The test ordering process is one initial area upon which
the laboratory can have a significant impact. Under the
ACO model, we must unite a disparate network of physicians
on the one hand, and the need for first-time accuracy
of testing and rapid turn-around time on the other. With
rapidly expanding test menus, particularly in molecular
diagnostics, it is unrealistic for physicians to know all of
the recommended ordering practices. Inevitably, the ordering
of old tests when new ones are available, the ordering
of new tests to a “‘panel”’ without replacing one in
that panel or the ordering of tests
useful for research but not necessarily
in diagnosis, are all risks
to ACO success.
Just as pharmacists influence
physicians’ drug ordering, the lab
can make a difference in test ordering
to pre-empt such potential
issues. One currently uncommon
method is to create a lab test formulary. When offered tests
are presented to the physician as formulary products, some
may require pathology review, some infectious disease review,
and even for some, chief medical officer review, before
being approved. Such an approach also aligns well with
broader industry efforts such as the
American Board of Internal Medicine’s
“Choose Wisely” campaign
which that focuses on encouraging
stakeholders to address
tests and procedures
that may be
unnecessary. 1 Even
without required
By Jonathon Northover, JD, BVC (ICSL), and
James Carson, PhD, MBA, MLS(ASCP)
scott frymoyer
ADVANCE for Executive Insight
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