CEO SUMMARY: A 22-physician pathology group in Tampa has complied with rules for lab test ordering that UnitedHealthcare and BeaconLBS established, yet has experienced a steep decline in the volume of specimens it receives. Physicians told the pathologists that other labs were not using the BeaconLBS system or were not asking their clients to use
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Pathology groups face a number of challenging pathology trends in the era of radical healthcare reform.
One of the primary trends is that like clinical laboratories, these businesses are carrying significant and potentially unsustainable levels of unreimbursed services. Although bad debt and uncompensated care in the healthcare industry are not new, they have been increasing at the same time that downward pressure is being applied to pathology reimbursement.
Medical laboratories and pathology groups are also facing enormous levels of change in their clinical, regulatory and financial environments. As the Affordable Care Act is implemented, laboratories see downward pressure on reimbursement at both the federal and payer level, coupled with increased emphasis on efficiency and quality.
Labs and health care providers need to seriously consider moving toward a retail business model. Changes in the health insurance market are now requiring patients to pay more out of pocket, and the perfect storm of bad debt and decreased requirement is pressuring laboratories.
Other pathology trends include:
- Growing emphasis on the continuum of care
- Increasing patient interaction directly with the lab organization
- Mounting demands of interoperability across a proliferation of disparate information technology systems to achieve meaningful use
- Evolving requirements for communication and data sharing with payers, accountable care organizations (ACOs), health information exchanges (HIEs) and other trading partners
Industry observers say that responding to each of these trends requires access to the most complete set of patient data possible. Accurate patient identification and record consolidation is central to achieving these goals.
In addition, labs and pathologists are increasingly urged to add value to the testing services they perform by leveraging information technology. For instance, advanced health information technology can be deployed within clinical labs and pathology groups specifically to meet changing patient expectations, while supporting the needs of client physicians for optimal workflow.
CEO SUMMARY: Once again, entrepreneur and pathologist David G. Bostwick, MD, is starting up a new lab company. Granger Diagnostics is now open and is located in North Chesterfield, Virginia. It is designed to be an anatomic, clinical, and molecular pathology reference laboratory. In an exclusive interview, Bostwick identified three substantial changes that have happened
CEO SUMMARY: It is one of those clinical laboratory deals that was announced before the end of 2015. Laboratory Corporation of America said it will acquire most of the operating assets of Pathology Inc., of Torrance, California, and that the acquired lab “will cease operations” upon the closing of the transaction. It has been six
CEO SUMMARY: Consultants in Laboratory Medicine of Greater Toledo was sold to Aurora Diagnostics last month. CLM’s president said that, as an ancillary service, pathology has little appeal to hospital administrators who want to cut costs as quickly as possible, and all hospital-based services are targets for cost reduction. Therefore, CLM sought a partner that
CEO SUMMARY: In a surprise move that further consolidates national anatomic pathology services, NeoGenomics will acquire Clarient Inc., from General Electric Healthcare. General Electric is getting cash, and preferred and common stock. The two companies announced plans to pursue integrated diagnostic services that would combine lab testing and diagnostic imaging data. The deal is subject
CEO SUMMARY: From the launch in 2013 of a big accountable care organization in Wisconsin, the North Shore Pathologists at Columbia-St. Mary’s Hospital have been involved. Among the lessons learned are the importance of structuring the pathology contract with the hospital to anticipate value-based reimbursement and having full access to the ACO’s data. The pathologists are using this data to develop test utilization programs that help physicians order the right lab test for the right patient.
CEO SUMMARY: To date, many of the nation’s 500 accountable care organizations have launched with little involvement by independent pathology groups and clinical laboratories. That was not the case with an ACO in Alabama, however. From its inception in 2012, the ACO has contracted with CytoPath, P.C., a five-pathologist group in Alabaster, Alabama. CytoPath’s pathologists are currently paid on a fee-for-service basis and must provide detailed and timely data to the ACO.
CEO SUMMARY: To simplify diagnostic reporting, the pathology and radiology departments at the David Geffen School of Medicine/UCLA Medical Center are working together to deliver integrated diagnostic information to treating oncologists. This innovative strategy is designed to improve patient care and quality while saving time and cutting costs. For five months, diagnosticians have worked together on more than 50 lung cancer cases while gathering the evidence to show this interdisciplinary approach can improve decision making and reduce downstream treatment costs.
CEO SUMMARY: In the search for ways to add more value to lab testing services, pathologists and lab administrators are considering organizing diagnostic management teams within their hospitals. Such teams focus on complex cases and include both diagnosticians and pathologists. In his pioneering work to develop the diagnostic management team concept, pathologist Michael Laposata, M.D., Ph.D., spoke recently about how such teams improve patient outcomes while reducing the cost of care.
CONSOLIDATION OF PRIVATE PRACTICE PATHOLOGY GROUPS in Washington State has been ongoing. Because of their acquisitions, CellNetix and Incyte Diagnostics are now the state’s two largest pathology groups.
The next challenge for these two pathology super-groups will be developing new ways to add value to a healthcare system moving away from fee-for-service reimbursement and to integrated