The new year is coming in hot! Terms such as value-based care, that seemed vague and far-off just a few years ago, are now in full swing and are impacting laboratories across the nation. To kick off 2020, we have a list of trends that will likely continue to be on the laboratory’s radar in the upcoming year.
1. Healthcare Consolidation
Consolidation continues in healthcare as organizations combine to achieve the economies of scale necessary to compete in value-based care, resulting in larger, more geographically dispersed healthcare networks. Healthcare consolidation presents new challenges for laboratories, with some being forced to close their doors when their services are taken over by an in-house hospital laboratory as part of a merger.
2. PAMA Reimbursement Cuts
For better or worse, the Protecting Access to Medicare Act of 2014 (PAMA) is still in the works, enacting significant changes to the Medicare clinical laboratory fee schedule (CLFS) and creating challenges for laboratories that are required to report their data. PAMA has already prompted a significant reduction in payment for approximately 75% of laboratory tests that are billed to the Centers for Medicare & Medicaid Services (CMS). CMS estimated the first-year reimbursement cuts to approximate $670 million, a 10% decrease from the previous fee schedule, with more cuts expected each year through 2021. PAMA may cause more industry consolidation as the larger reference laboratories continue to buy smaller laboratories.
3. Population Health Management (PHM)
To shift to a more proactive healthcare system, many healthcare facilities are implementing population health initiatives that address patient care at each level of need, keeping healthy people healthy and addressing the needs of patients with chronic disease. PHM involves categorizing a patient population into risk groups (risk stratification), and then using that information to improve the health of specific patient groups. Once the population is understood, care managers can interact and interject appropriate care plans. Because much of the data used to risk stratify patients comes from the laboratory, PHM is an area where labs can add value.
4. POCT/Molecular POCT
Point-of-care testing (POCT) continues to gain popularity as its rapid turnaround time (TAT) can facilitate faster treatment decisions and improve patient satisfaction. Molecular POCT is gaining acceptance as its greater sensitivity and specificity, added to the rapid TAT, further expand the diagnostic capabilities at the patient point of care. Detection of the molecular signature of a harmful organism is a very accurate and rapid way to identify infectious diseases and allow providers to quickly initiate the correct treatment, leading to patient care improvements.
5. Patient Engagement
Proactive patient engagement is also becoming important to move the needle toward value-based care. It is well recognized that engaged patients have better health outcomes and spend fewer healthcare dollars. Because of this understanding, the need for greater patient engagement is a prevailing theme among today’s healthcare organizations. Patient engagement strategies can improve patient experience by helping patients become more active participants in their care. Ideally, providers interacting with engaged patients can use shared decision-making to review available interventions and build patient preferences into treatment decisions. In addition, as patients continue to adopt “wearables,” such as glucose monitors or heart rate and respiratory rate monitors, these devices will connect via the Internet and begin to shape how care is provided.
6. Value-based care/Laboratory Stewardship
The idea of laboratory stewardship is gaining traction as laboratories begin to understand the role they play in value-based care. Laboratory stewardship moves beyond tracking laboratory utilization and puts the focus on making sure appropriate tests are ordered and properly interpreted—looking beyond reporting the test result to downstream healthcare processes. Laboratorians can help providers in determining best test selection, performance, and interpretation—taking responsibility for testing from beginning to end.
Another move to decrease costs and address the healthcare workforce shortage is implementation of laboratory automation lines. The idea is to replace tedious, manual processing tasks with robotics, and save the complex, evaluative tasks for the laboratory scientists. In addition to freeing staff for other duties, various forms of laboratory automation can decrease repetitive injuries, improve TATs, improve cost effectiveness, eliminate human error, improve tube tracking ability, and improve job satisfaction.
8. Personalized Medicine
Personalized medicine, the tailoring of medical treatment to the individual characteristics of a patient, also continues to grow and gain diagnostic value. Personalized medicine research is increasing our ability to predict which medical treatments will be safe and effective for each patient, and which will not. Equipped with tools that are more precise, physicians can select a therapy or treatment protocol based on a patient’s molecular profile that can minimize harmful side effects, ensure a more successful outcome, and help contain costs as compared with a “trial-and-error” approach to disease treatment.
9. Genetic Testing
Many experts predict that genetic testing is well on its way to becoming a routine part of clinical care. Increasing applications of genetic testing for prenatal testing and early detection and prevention of oncology and genetic diseases are accelerating market growth. Genetic testing is quickly growing in value, particularly in the diagnosis of cardiovascular diseases, to identify health risks, and for analyzing treatment response.
Standardizing laboratory practices using evidence-based guidelines, including uniformity in test methodologies and procedures, falls under good laboratory stewardship and can improve efficiency, patient satisfaction, and quality of care. When testing policies, procedures, and methodologies are standardized, manageability, quality, and efficiency improve due to decreased redundancy and errors. In addition, EHR and LIS setup becomes uniform across locations, reducing opportunities for misinterpretation.
Stay tuned for another blog post discussing how digitalization and AI are being incorporated into the laboratory as a tool to improve efficiency and data-driven treatment decisions.
Moving into 2020, it is becoming clear that the laboratory’s role is to find those places within the care continuum where laboratory data and knowledge can be used to help clinicians achieve better patient outcomes at reasonable costs.
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