News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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While ACO Care Coordination Holds Promise for Improving Quality and Lowering Healthcare Costs, It’s Still a ‘Work in Progress’

Healthcare Experts Now Exploring New Care Coordination Strategies and Overcoming Gaps in Measuring Performance

For many healthcare professionals, the jury is still out as to whether accountable care organizations (ACOs) will prove effective at delivering the two important goals of improved patient outcomes at a lower overall cost of care over an extended period of time.

That is why close attention is being given to the experience of Medicare’s Pioneer ACOs, since they were among the first ACOs to begin delivering clinical services. In particular, physicians and hospital administrators want to learn useful lessons from the successes and setbacks of the different Pioneer ACOs.

By improving the coordination of care, accountable care organizations are expected to provide patients with better care while reducing healthcare costs. That’s why the Center for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program is structured to pay ACOs financial incentives or impose penalties, depending on whether performance quality measures and healthcare spending targets are met. (more…)

Experts Say Medicare Accountable Care Organizations (ACOs) Produced Mixed Results in 2014 Even as Enrollment Continues to Grow Significantly

Clinical laboratories and pathology groups can expect to see more growth in the number of patients served by ACOs and that will require labs to have a new pricing strategy

Will ACOs be the next big thing in American healthcare? Many people are betting that will be true as the number of ACOs continues to increase. Some reports indicate that as many as 750 Medicare and private ACOs were in operation as of early 2015, compared to about 250 ACOs in 2013.

Pathologists and clinical laboratory managers watching the ACO trend will find it significant that Medicare ACOs now serve about 5.6 million beneficiaries. According to a report issued by Oliver Wyman, that is about 11% of all Medicare beneficiaries. Providers in these ACOs are paid under a different arrangement than the long-established Part B fee-for-service price schedule.

The big question mark about ACOs is whether they can deliver significant cost savings while improving patient outcomes. This summer, officials at the federal Centers for Medicare & Medicaid Services (CMS) reported on the savings generated by the agency’s pilot ACO programs. The two main accountable care organization programs are the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. (more…)

CLMA Is Launching New Program to Help Clinical Laboratories Develop Patient-Centric Services and Deliver More Value to ACOs and Medical Homes

To help medical laboratories understand how to deliver patient-centric lab testing services, the Clinical Laboratory Management Association (CLMA) has launched its “Increasing Clinical Effectiveness” (ICE) program. CLMA President Paul Epner (pictured above) will be conducting a free webinar about the ICE program on August 12 and the details of ICE and the webinar can be found at the CLMA website. (Photo copyright CLMA.)

Increasing Clinical Effectiveness’ is the name of new initiative that CLMA is making available to all medical laboratories and anatomic pathology groups

There is now little disagreement that the U.S. healthcare system is in the midst of a transformation away from reactive and acute care and to proactive, integrated clinical care. This is why clinical laboratories and anatomic pathology groups across the nation now find themselves at a critical crossroads.

This trend presents medical laboratory managers, pathologists, and clinical chemists who lead the nation’s labs with an important question: When is it time to shift the lab’s focus away from its traditional “lab-centric” emphasis and position the lab as a “patient-centric” clinical service?
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Falling Inpatient Revenues at Many Hospitals Is Sign of Healthcare’s Transition to New Models of Integrated Clinical Care and Changes in Medical Laboratory Test Utilization

Statistics indicate that inpatient admissions and revenues are falling nationally, a development that affects clinical laboratories in hospitals and health systems

One important trend that directly impacts the medical laboratories of hospitals and health systems is the falling rate of inpatient registrations seen nationally in recent years. What exacerbates this trend is the fact that many payers are cutting the prices they pay for certain inpatient services.

Collectively, these two developments mean less inpatient revenue for many hospitals and that often translates into reduced budgets for the clinical laboratories.

But that is not the whole story concerning inpatient revenue. Spurred by the Affordable Care Act (ACA) and other market developments, payers now want to shift reimbursement away from fee-for-service to new models of reimbursement. This includes capitation or bundled payment models. (more…)

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