CEO SUMMARY: As the number of accountable care organizations and patient-centered medical homes grows monthly, a handful of innovative labs are seizing the opportunity to develop and deliver lab testing services that add more value to physicians and patients. These early-adopter labs recognize that fee-for-service reimbursement is on the way out. They want to get a head start on transforming their lab from a trans- action-based culture to one that contributes value.
IN THE NEXT HEALTHCARE MARKET CYCLE, ample reimbursement will flow to those providers who deliver measurable value and contribute to improved patient outcomes.
This includes clinical laboratories and anatomic pathology groups. In recognition of this fact, a handful of innovative labs are already pushing forward with value-based initiatives designed to help physicians deliver better quality care.
One common strategy used by many of these labs today is to improve how physicians utilize lab tests. This most frequently involves working with physicians to reduce the ordering of lab tests that are inappropriate or medically unnecessary.
Another strategy is for the labs’ pathologists and Ph.D.s to get outside the laboratory and consult with clinicians on how to interpret lab test data, then work as part of the care team to deliver more appropriate therapies to the patients. A high-payoff partner in this effort is often the pharmacy, since therapeutic drugs can cost tens of thousands of dollars for a single patient.
Both of these added-value strategies were part of the lab case studies presented at the eighth annual Lab Quality Confab, which took place in New Orleans, Louisiana, on October 21-22, 2014. A high- energy crowd of almost 300 attendees was on hand to hear the presentations, network, and share their lab’s successes in intelligent cost-cutting and delivering value in ways that improve revenue margins for their clinical labs and pathology groups.
One example of how the lab can contribute more value occurred at North Shore Long Island Jewish Health System (NSLIJ) in Lake Success, New York. This is the nation’s largest urban health system and the lab team took on the immense challenge of supporting a complete patient lab test record in the electronic health record system.
To achieve this, the lab team headed up a cross-discipline task force that set out to implement full-function validated interfaces. Their goal was to enable the accurate collection, in real-time, of core lab results, lab test data produced by point-of-care testing devices, and physician office lab instruments.
A complimentary goal was to establish and validate the interfaces needed to display this lab test data on the many types of mobile devices used by physicians and nurses affiliated with NSLIJ.
Reporting on this effort at Lab Quality Confab were Hannah Poczter, MPH, ASCP(DLM), Assistant Vice President Laboratory Services; Ed Giugliano, Ph.D., Six Sigma Black Belt, Project Manager; and, Carol J. Sien, MT, MS, ASCP, ASQ, Quality Management Manager, all from NSLIJ.
The team attacked this project in three waves. The first wave involved establishing and validating the interfaces between the labs of NSLIJ’s 12 hospitals, along with associated institutions. Using Lean methods, the team was able to reduce the time required to validate the interface between each lab’s IT hub from three months down to one month and the failure rate of test scripts during the validation process dropped from 35% to just 3%.
Validated EHR Interfaces
In the second wave, the team worked to validate the interfaces needed to deliver lab test data to the EHRs of hundreds of outreach clients and thousands of physicians served by NSLIJ. This required the engagement of the clients, their different EHR vendors, and the health system’s LIS outreach team. Again, Lean methods and the experience from wave one enabled the team to establish validated interfaces in a timely basis.
Wave three is where things got interesting. The need was to develop an app that passed lab test data accurately to the mobile devices and in a secure fashion. The resulting app serves both iPhones and Androids. It allows users to open an account and validates the password. A user is logged-out at three minutes.
Delivering Value at H. Ford
A contrasting case study of value was presented by Henry Ford Health System in Detroit, Michigan. The presenters were Richard J. Zarbo, M.D., DMD, Senior Vice President and Chair, Pathology and Laboratory Medicine; and, Guarav Sharma, M.D., Director, Regional Medical Laboratory, Associate Medical Director, Core Laboratory, Quality Systems and Regulatory Affairs.
In recent years, Zarbo and Sharma have infused a Lean culture in the lab division and achieved ISO 15189 accreditation across 36 lab sites within the health system. These were steps that positioned the clinical laboratory and anatomic pathology lab to work more closely together to deliver an integrated lab medicine service.
Installation of a MALDI-TOF mass spec instrument—with associated changes in clinical work flow—allowed the lab to cut turnaround time for blood cultures by 33% while improving diagnostic accuracy. The resulting reduction in patient length-of-stay generated annual savings of $1.1 million.
Collaborating on cancer care is a source of substantial savings to Henry Ford Health. In working with clinicians to improve cancer test utilization management, Zarbo and Sharma gave the example of KRAS testing, a companion diagnostics for Cetuximab ($125,000 per patient). In 2013, the health system saved an estimated $4.8 million because of better utilization of the KRAS test while delivering better out- comes to cancer patients.
These examples demonstrate the progress lab innovators are making in their efforts to add value to clinicians.