AMGA 2014: Focused on Embracing Change & Leading Healthcare Transformation


Record Attendance
Healthcare reform, which is now well underway, needs compelling frontline leaders. This year, the American Medical Group Association (AMGA) conference hosted more than 2,100 medical leaders from the nation’s top healthcare organizations. These top medical leaders were eager to share their insight and tactics, learn successful processes from others, and play a role in leading the transformation of care delivery.

AMGA represents over 435 multispecialty medical groups with more than 150,000 physician members. The annual conference, hosted this year in Grapevine Texas, is attended by CEOs, CAOs, CIOs, medical directors, physician board members, etc. from large multispecialty medical groups, IPAs, integrated healthcare delivery systems, academic faculty practices, Accountable Care Organizations (ACOs), and high-performing health systems. These healthcare leaders are looking for collaborative opportunities to gain and share information to help them confront the challenges they face in today’s volatile healthcare environment. AMGA 2014 set a new attendance record, creating awareness that there are strong leaders “tuned in” and seeking the knowledge necessary to embrace change and implement new processes and skills.

Mood Swing: From Anxiety to Focus
With healthcare in a time of tremendous change, the AMGA conference is intended as an opportunity to network and share ideas and to broaden leaders’ strategic thinking, preparing them to meet the challenges of healthcare reform. Orchard Software exhibited at the AMGA conference in 2013 and 2014 and noticed a striking contrast in the general “feel” of the 2013 conference compared to 2014. Anxiety loomed over last year’s conference, with healthcare leaders still trying to wrap their minds around the transition and determine how to best maneuver their organizations for success, including what to do with their laboratories. In comparison, the 2014 attendees have gathered their wits and are actively implementing successful processes to adapt to the value-based models, sharing those ideas with others, and leading the transformation of healthcare.

Leadership in Tumultuous Times
Each of the keynote speakers, Jim Collins, Carly Fiorina, and Ben Carson, M.D. spoke of the difficulties we face as a nation and shared leadership tactics for tumultuous times. Jim Collins summarized it well: he said that now is the time for us to shape the future of healthcare and encouraged leaders to “reach for greatness,” because as healthcare changes continue at a breakneck speed, “the mediocre will be crushed.” He talked of leaders keeping their overall purpose close at heart to guide them, saying, “For leaders to make something great, their ambition has to be for the greatness of the work and the company, rather than for themselves,” while pointing out that in our business this means focusing on the patient.

What’s All the Buzz?
Prevalent topics in the breakout sessions centered on:
• Culture change (for physicians and overall organizations)
• Combined efforts to improve quality and lower costs
• Physician scorecards/transparency
• Care teams (nurse navigators)
• Population health management
• Maneuvers from an ACO standpoint
• Merger process navigation
• Challenges of transition period between two types of payment models

Changes Still to Come
Donald W. Fisher, Ph.D., CAE, AMGA’s President and CEO, explained that “uncontrolled variation is the enemy of quality,” giving credit to W. Edwards Deming. Dr. Fisher said that medical leaders will need discipline to follow best guidelines, and that if providers do not unite and determine these best practices, the government will.

Fisher, who has led the AMGA since 1980, paints it in a positive light, saying, “I can’t imagine a more exciting time to be working in healthcare.” Undoubtedly, the next five years promise a landslide of changes with practices tackling the challenges brought on by rapid practice transformation and expending efforts to learn new ways to cut costs and maintain quality. Healthcare leaders, including those in the laboratory, will need vision and a progressive outlook to face the future.

Changes in the Laboratory
From the perspective at the AMGA conference, it is clear that healthcare leaders are on a well-focused mission to develop and implement new processes and concepts that surround patient-centered care and population health management. Many of these developing processes depend on clinical data and analytics provided by the laboratory. As determinations are made regarding new clinical analytics needed to support these efforts, laboratorians can be an instrumental part of the team that is defining effective pathways to success. To support this effort, Orchard has written a series of white papers on the role of the laboratory and structured data in the future of healthcare.

Orchard’s Commitment
Orchard is committed to keeping you informed and being a trusted resource that you can turn to for industry-related education. And as always, we welcome your feedback. Follow us on Twitter at @OrchardSoftware, and feel free to respond to this post by clicking the “Comment” link at the bottom, or by emailing us at news@orchardsoft.com.

Kim Futrell, MT (ASCP)
Products Marketing Manager
Orchard Software Corporation

Comments (0) Apr 17 2014

Best Cervical Cancer Screen: Roche cobas® HPV or the Pap Smear?


Advisory Panel Recommends HPV as First-line Screen
An advisory panel for the Medical Devices Committee of the FDA voted unanimously to approve Roche’s cobas® HPV test as a first-line screening for cervical cancer in women age 25 and older. While the FDA will have the final say, advisory committee recommendations are typically followed.

Prior to this recommendation, for women between the ages of 30 to 65, the Roche HPV test was recommended as an adjunct test to the Pap smear or for women aged 21 and older who have had an abnormal Pap smear result. The HPV test had not been approved for stand-alone screening, until now.

Current Cervical Cancer Screening Guidelines
Cervical cancer screening, since the introduction of routine Pap smears in the ‘70s, has been one of public health’s true success stories—dramatically decreasing the incidence of a disease that at one time caused more deaths among American women than any other form of cancer.

Current U.S. guidelines for cervical cancer screening recommend that women between the ages of 30 to 65 have both the HPV test and the Pap smear every five years, or Pap testing alone every three years. Women between the ages of 21 and 30 are advised to have a Pap screen every three years. Following proper cervical cancer screening recommendation is important because The American Cancer Society estimates that 2014 will bring 12,360 newly diagnosed cases of cervical cancer and result in 4,020 deaths.

HPV Closely Linked to Cervical Cancer
HPV, a sexually transmitted virus that causes genital warts in men and women, is believed to cause the majority of cervical cancers. Certain strains (16 and 18) account for 70% of cervical cancer cases.

The Roche HPV test is able to detect a variety of high-risk HPV types, including 16, 18, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.  Women who test positive for the two high-risk HPV strains are advised to undergo colposcopy to allow the physician a clear view of the vulva, vagina and cervix and collection of additional samples for further testing.

Mixed Reviews

  • HPV Testing Shows Advantages Over the Pap
    Those in support of HPV testing as a cervical cancer screen feel that the testing is far more objective and consistent than the Pap smear because the Pap smear requires human interpretation, resulting in variation between laboratories. 

    Studies have shown that the HPV test is much more sensitive in detecting precancerous lesions.  Additionally, a negative result on the HPV test is a better predictor than a negative Pap test to indicate that a woman will remain free of lesions for the next three years. A negative HPV predicted a lower three-year risk of cervical intraepithelial neoplasia 3 (>CIN3) (which indicates advanced cervical dysplasia or cancer) than a negative Pap, lending credence to the conclusion that the HPV test alone is superior to the Pap smear.

  • The Cons
    Although, based on their recommendation, the advisory board clearly thought that the positives outweighed the negatives; there remain those who have concerns. An HPV infection can be transient and a positive HPV test does not always indicate cervical cancer or dysplasia. 

    A Quest Diagnostics Health Trends study indicated that screening using only HPV testing could potentially miss 13.5% of cervical cancer instances annually—cases that would have been caught with co-testing that included a Pap smear. The study also found that nearly 5% of women whose Pap test showed advanced cervical dysplasia or cancer (>CIN3) had a negative HPV test. So while the HPV test seems like an advance in technology, there are concerns.

  • So What Happens From Here?
    The FDA will make the final decision on whether to accept the panel’s recommendation. Based on this, professional medical societies will have to decide if this recommendation meets the needs of their patient population. Many providers will not change ordering patterns until the professional societies lend their support.

    Most likely, testing changes will not happen quickly. Yet, some clinician ordering patterns could conceivably change based on the recommendation, affecting cytology and molecular diagnostics departments. Even if the change is down the road, it is prudent for these types of laboratories to be aware of current guidelines and recommendations in order to make astute decisions regarding their future.

    Orchard’s Commitment
    Orchard is committed to keeping you informed and being a trusted resource that you can turn to for industry-related education. And as always, we welcome your feedback. Follow us on Twitter at @OrchardSoftware, and feel free to respond to this post by clicking the “Comment” link at the bottom, or by emailing us at news@orchardsoft.com.

    Kim Futrell, MT (ASCP)
    Products Marketing Manager
    Orchard Software Corporation

Comments (0) Apr 10 2014

ICD-10 Delay: What does it mean for my lab?


A recent bill passed by both the House and the Senate has pushed back the ICD-10 compliance date to October 1, 2015, in conjunction with the passing of legislation aimed at providing another patch for pending reimbursement cuts under Medicare’s sustainable growth rate (SGR) payment formula. As the bill heads to the President for a final signature, we will be monitoring the situation closely and will continue to keep you updated as information about ICD-10 becomes available. As of now, we recommend as of now that laboratories continue to prepare for ICD-10 so that they are in a position to move forward at the appropriate time.

As healthcare continues to evolve to value-based systems, diagnostic information becomes critical and discrete analytical data is paramount, making the conversion to ICD-10 beneficial in the effort to improve our healthcare system. The increased specificity and precision of ICD-10 will provide more detailed information for identifying diagnoses, trends, and public health needs. The conversion to ICD-10 can also enhance benchmarking of data and improve patient care management.

We highly recommend that clients continue to prepare for the ICD-10 conversion in advance. It remains prudent to plan ahead and include ICD-10 refresher courses as you get closer, even if the 2015 delay comes to fruition. Preparedness includes any upgrades that may still need to take place, as well as Orchard’s ICD-10 conversion package that covers detailed ICD-10 validation and testing. As a valued partner of yours, we will continue to monitor and keep you informed of ICD-10-related news.

Orchard is committed to keeping you informed and being a trusted resource that you can turn to for industry-related education. And as always, we welcome your feedback. Follow us on Twitter at @OrchardSoftware, and feel free to respond to this post by clicking the “Comment” link at the bottom, or by emailing us at news@orchardsoft.com.

Curt Johnson
Chief Operating Officer
Orchard Software Corporation

Comments (0) Apr 02 2014