by Manish Muzumdar | May 10, 2018 | Blog
Your clinical laboratory may struggle with lower test volume and reimbursements due to value-based care and other healthcare reform initiatives, facing stiff diagnostic price cuts this year. The Centers for Medicare and Medicaid Services (CMS) is proposing payment cuts to 75% of all lab tests on the clinical laboratory fee schedule in 2018, according to Clinical Laboratory News. More than half of the cuts are so large that CMS is phasing in the reductions over three years due to the limits of the Protecting Access to Medicare Act (PAMA).
During a recent HealthLeaders sponsored webinar, “The Strategic Impact of Laboratory Services in a Value-Based Environment,” pathology and lab-informatics experts advised lab leaders to adopt strategic responses as healthcare transitions and government regulations take hold.
“I don’t think any lab can survive in a pure cost-per-test world. You are going to have to move to a cost per diagnosis, a cost per episode of care or a cost per covered life. And laboratorians are not really great at working at that value-based purchasing nomenclature,” said panelist Michael Crossey, MD, PhD, Chief Medical Officer and Interim CEO, TriCore Reference Laboratories.
Labs are also affected by a healthcare system’s culture, according to panelist Bruce Friedman, MD, Emeritus Professor of Pathology, University of Michigan Medical School and President of Pathology Education Consortium. “Some do not view lab testing as strategic and view it as a distraction from the primary mission of direct care to patients. Others may have one hospital in the group as a center for excellence for molecular testing and esoteric testing, so they view testing as strategic.”
Indeed, precision medicine may enable physicians to make highly specific diagnoses for patients to participate in extremely targeted treatments. To make it all happen, labs need to offer highly focused diagnostics and actionable reporting to specialists, many of whom are already overwhelmed with data.
“If you are going to do molecular testing, you had better have the wherewithal to put out a cogent and integrated report,” Dr. Crossey highlighted.
About the author
Sr. Vice President, Product Development
Manish brings more than 20 years of experience in technology leadership, management, innovation, and the delivery of mission-critical, enterprise-class products and platforms.