CLN Daily

Changing Reimbursement Models Force Labs to Develop New Strategies

Nicole Tolan, PhD

Healthcare has shifted from a fee-for-service to a capitated reimbursement model that is now extending to clinical diagnostic testing. However, many labs are challenged with providing the clinical and economic evidence demonstrating how laboratory medicine supports this value-based endeavor.

This challenge was the focus of the Chair’s Invited Session on Monday, “Clinical Lab 2.0: How Laboratories Can Support Value Based Care, Optimize Patient Outcomes, and Reduce Total Cost of Care in Acute and Chronic Conditions.” Kathleen Swanson, MS, RPh, Michael Crossey, MD, PhD, and Richard VanNess, MS, of TriCore Reference Laboratories discussed how laboratories can provide targeted interventions in disease management programs, for use in clinical workflows.

The speakers described how population health management relies on aggregation of patient information such as longitudinal laboratory data, as well as innovative data analytics, patient-specific targeted interventions, and clinical decision support. Health systems are using these tools to improve patient outcomes and reduce total cost of care.

“Laboratory medicine is able to provide meaningful clinical diagnostic insights for population health initiatives that result in improved short- and long-term patient outcomes and drive cost-effective care,” Swanson said. However, laboratory professionals need to lead the efforts in creating new programs that can support value-based care in order to mitigate the effect of the new clinical laboratory fee schedule under the Protecting Access to Medicare Act of 2014 (PAMA).

“In this transition from Clin Lab 1.0 to 2.0, we need to get out of the lab and demonstrate our value beyond the 2%—the percentage diagnostic labs represent in the total Medicare budget,” Crossey emphasized.

For attendees interested in hearing more about how clinical laboratories can support sustainable, cost-effective care, Octavia Peck-Palmer, PhD, and Eugenio Zabaleta, PhD, will hold an interactive session on Thursday titled “Harnessing the Power of Evidence Based Medicine to Maximize Laboratory Cost Savings and Effective Test Utilization,” where they will demonstrate their own utilization strategies.

“It is our professional responsibility to lead and manage key areas of clinical testing, including appropriate test menu offerings, effective clinical consultation, and cost-savings for the hospital, that promote positive patient outcomes,” Peck-Palmer said. Patient-centered care that is more efficient and standardized—leveraging evidence-based medicine—is the most compelling, but it can be difficult to implement in practice. To help clinical laboratorians be effective in this endeavor, the speakers will explore how laboratorians must not only mine the literature of evidence-based medicine, but also proactively create the evidence to support best practices.

Both Peck-Palmer and Zabaleta will also emphasize the role of the clinical laboratorian as an accountable healthcare team member in stewarding lab test utilization, specifically through disease-specific protocols and evidence-based test order sets. “We can do a lot more for our patients, but to do so, we need to change our own preconceived notions about lab medicine practice,” Zabaleta noted. “We need to promote ourselves as consultants/resources for the diagnostic test results we provide.”

In this session, the speakers will share examples using the electronic medical record to provide test guidelines and interpretative comments, develop sepsis alerts, optimize cardiac troponin testing, and guide proper tumor marker testing. Attendees also will have the opportunity to share their own experiences with implementing effective test utilization.


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