Oct 28, 2008 | Laboratory Management and Operations, Laboratory Pathology
Federal officials underestimated the costs and time needed to implement the complex new codes for ICD-10, according to a new study released last week on October 14. As a result, laboratories and physician groups can expect to incur significantly higher costs to convert from the current International Classification of Diseases, Ninth Revision (ICD-9), to ICD-10.
The report by Nachimson Advisors, LLC, estimated that every provider will incur conversion costs in at least six ways. The report detailed and projected these costs for physician groups of small, medium, and large. It calculated that the typical small group of three physicians would incur costs of $83,290 to comply with ICD-10. A typical medium-sized group of 10 physicians would spend $285,195, and a typical large physician practice of 100 providers would spend $2,728,780. These costs include expenses for: 1) education; 2) process analysis; 3) changes to superbills; 4) information technology; 5) documentation; and, 6) cash flow disruption. Detailed coverage of the impending conversion to ICD0-10 is provided in the current issue of The Dark Report that was published on October 20, 2008.
One large laboratory with operations nationwide estimated that it will spend about $40 million to convert to ICD-10, including costs for information technology and staff education. This national lab further stated that implementation of ICD-10 code sets is projected to be twice as expensive as implementing the National Provider Identification (NPI) system that caused severe cash-flow problems for labs earlier this year.
A group of organizations representing physicians and laboratories, including the American Medical Association (AMA) and the American Clinical Laboratory Association (ACLA), commissioned the report. The deadline for compliance with ICD-10 is October 1, 2011, but physician trade groups are lobbying Congress to order the federal Department of Health and Human Services (HHS) to delay implementation. One reason the conversion is complicated is because ICD-10 uses 155,000 seven-digit codes, compared to the existing 17,000 codes in ICD0-9. Conversion will be particularly complex for laboratories because of the extensive system changes and the need to train not only staff, but the physicians who refer specimens to the laboratory.
“We have known this transition was going to be a big problem for a few years,” said ACLA President Alan Mertz. “The Nachimson study confirms that belief. ACLA has also consulted with our members and some of the larger labs tell us the costs for transitioning to the new codes and then the ongoing costs to use the new codes will be quite high. It will be costly for lab billing personnel to have to go back to the referring physicians to get the right diagnosis codes.”
Joseph M. Heyman, M.D., Board Chair of the AMA, said, “The AMA is deeply concerned that HHS is rushing head-first into the transition to a complex coding system without fully recognizing the impact on the health care system. Physicians, insurers, medical labs and others are raising the alarm that the costs, documentation and training required by ICD-10 will be significantly greater than HHS now recognizes.”
Medical laboratories and pathology group practices will need to develop a strategy for handling the transition from ICD-9 to ICD-10. Although providers are already pressuring federal health policymakers to delay the October 1, 2011 implementation date for ICD-10, there are many reasons why the United States must move to ICD-10. These reasons are detailed in current issue of The Dark Report.
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Oct 24, 2008 | Laboratory Management and Operations, Laboratory Pathology
Use of antibodies that detect biomarkers in as little as 15 minutes now allows researchers at the University of Leeds in the United Kingdom to identify such diseases as prostate and ovarian cancer, stroke, multiple sclerosis (MS), heart disease, and fungal infections. Using biosensors to identify the molecular markers for disease, the technology is much faster than current testing methods.
One goal of this research is to provide a way for hospitals to use this technology for rapid diagnosis. Another goal is to allow surgeons to use the technology to improve the speed and accuracy of referral to specialty physicians. Along with the ability to identify cancer, MS, heart disease, and infections, researchers say these biosensors may also be able to detect a wide range of analytes, including biomarkers in tuberculosis and HIV.
“We believe this to be the next generation diagnostic testing. We can now detect almost any analyte faster, cheaper, and more easily than the current accepted testing methodology,” said Paul Millner, M.D, a member of the faculty of Biological Sciences at the University of Leeds.
Researchers say that this technology could be developed into a device the size of a mobile phone, where different sensor chips could be inserted, depending on the disease being sought. “We’ve designed simple instrumentation to make the biosensors easy to use and understand,” Millner explained. “They’ll work in a format similar to the glucose biosensor testing kits that diabetics use.”
Currently blood and urine are tested for disease markers using test technologies such as ELISA (enzyme-linked immunosorbant assay). Developed in the 1970s, ELISA takes an average of two hours to complete, can be expensive, and can be performed only by highly trained staff.
The new biomarker technology was developed through a European collaboration of researchers and commercial partners in a 2.7 million Euro ($3.6 million) project called ELISHA (Electronic Immuno-Interfaces and Surface Nanobiotechnology: A Heterodoxical Approach).
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Oct 15, 2008 | Laboratory Management and Operations, Laboratory Pathology
When it comes to hospital accreditation, the Centers for Medicare and Medicaid Services (CMS) recently disrupted the status quo in at least three ways. First, last month it approved Norway-based Det Norske Veritas (DNV) as a hospital accreditation program in the United States. Significantly, this is the first new hospital accreditation organization in the U.S. in 40 years.
Second, by taking this action, CMS is bringing the hospital industry closer to the use of ISO 9001 quality management systems. That’s because Det Norske Veritas, which already accredits hospitals in several countries worldwide, bases its accreditation process on use of ISO 9001. It has also created a program that combines the CMS “Conditions of Participation” with the ISO 9001 quality management system. DNV calls this program the “National Integrated Accreditation for Healthcare Organizations (NIAHO).” At least 22 hospitals in the United States have already earned accreditation using NIAHO.
Third, by granting deeming status to DNV, CMS has introduced a new competitor for accreditation business into the U.S. marketplace-one that incorporates its accreditation standards on the ISO 9001 quality management system (QMS). Dark Daily predicts that it won’t take long for the Joint Commission to respond to this new competition by introducing an accreditation program that is also based on a quality management system like ISO 9001.
One U.S. hospital that has worked with Det Norske Veritas since 2005 is Newport Hospital in Newport, Rhode Island. During this time, the 120-bed community hospital has been surveyed four times by teams from DNV under its NIAHO program. Early in 2008, Newport Hospital was also surveyed by the Joint Commission and CMS, giving it a unique perspective on the similarities and differences from each of these survey programs. According to Terry McWilliams, Vice President of Medical Affairs at Newport Hospital, “They [Det Norske Veritas] consistently look for system-related issues and overall process improvement.” He further stated that the DNV survey, as conducted in his hospital was “clearly never inferior to our experience with any other agency-and at times superior! They really objectively look at your processes and how you might be able to improve them to get to that next level.”
For regular subscribers and readers of Dark Daily, these new developments are consistent with the healthcare trend of incorporating quality management systems, such as ISO 9001 and ISO 15189 Medical Laboratories, into the operation of healthcare organizations. It was in September that Dark Daily reported that the first two American laboratories were closing in on their ISO 15189:2007 accreditation. Piedmont Medical Laboratory (PML) of Winchester, Virginia, and Avera Health Laboratories of Sioux Falls, South Dakota, are in the process of completing the final steps required to earn accreditation under ISO 15189:2007. Each laboratory is using the College of American Pathologists (CAP) as its ISO 15189 accrediting body. (See “Two Labs in Friendly Race to Win First ISO 15189 Accreditation in U.S.“)
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Oct 13, 2008 | Laboratory Management and Operations, Laboratory Pathology
It’s tough to get an accurate picture of EMR (electronic medical record) adoption by office-based physicians. That’s important information for clinical laboratories because they must often provide an electronic gateway interface with physicians’ EMR systems for laboratory test ordering and results reporting.
Now comes help for clinical laboratories and pathology groups seeking to understand the pace of EMR adoption by physicians. This summer, The Institute for Health Policy published the results of a six-month study on the use of electronic health records (EHRs) in physicians’ offices in the New England Journal of Medicine. “This is the best data that there has ever been on the adoption of electronic health records by physicians,” said William Jessee, M.D., the physician president and chief executive officer of the Medical Group Management Association.
According to the abstract of the NEJM article, 4% of physicians reported having an extensive, fully-functional electronic-records system, and 13% reported having a basic system. Another finding was that the physicians most likely to be currently using EMRs were: 1) primary care physicians; 2) those physicians practicing in large groups, in hospitals or medical centers; and, 3) physicians practicing in the western region of the United States. Physicians reported positive effects of these systems on several dimensions of quality of care, as well as high levels of satisfaction in how their system performed. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.
The survey was conducted between September 2007 and March 2008 at the 902-bed Massachusetts General Hospital, Boston; the Harvard School of Public Health; George Washington University; and RTI International, working under a contract with the Office of the National Coordinator for Health Information Technology at HHS and grants from the Robert Wood Johnson Foundation.
Despite the fact that the survey revealed that 83% of physicians don’t have an EHR, the NEJM authors pointed out some good news. They noted that 16% of physicians with no EHR responded that their medical practice had purchased an EHR at the time of the survey, but it had yet to be implemented. Another 26 % of surveyed physicians said their practice was planning on implementing an EMR system in the next two years.
The conclusions of the report were that “Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.”
The pace and nature of physician adoption and use of EHRs are important issues for medical laboratories and pathology labs. Lab managers and pathologists will want to be ahead of physician EHR adoption curve by preparing their laboratory information system (LIS) to interface with these EHRS to accept electronic test orders and directly download lab test results into the physician’s HER system.
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Oct 7, 2008 | Laboratory Management and Operations, Laboratory Pathology
Today’s most innovative clinical laboratories and pathology labs are tapping a powerful resource to achieve world-class outcomes-their managers! In response to a variety of market forces, laboratory administrators and medical directors are turning their attention toward encouraging more productivity and achievement from managers at all levels in their laboratory.
“This is an emerging trend,” stated Jeff Smith, Vice-President of Leadership Development for Slone Partners of Miami, Florida. “The art and science of management in clinical laboratories is now reaching the point where, for a laboratory to be competitive and financially self-sustaining, it must get top productivity from its management team. In fact, this is how first mover and early adopter laboratories are responding to ongoing budget cuts and the acute shortage of trained medical technologists (MTs) and other technical staff that makes it near impossible to operate their laboratories at 100% of authorized staffing levels.”
In recent years, Smith has been personally involved with several prominent clinical laboratories to help them create and implement effective management development programs. “It is no accident that these clinical laboratories achieve world-class management outcomes,” noted Smith. “They have three attributes that can be duplicated by any laboratory-large or small-willing to pursue management excellence.
“First, top-performing laboratories are good at assessing the strengths, weaknesses, and undeveloped potential of their managers,” he said. “This means recognizing those managers with the potential to be a management super star, as well as those managers, who, because of their attitudes and long-established patterns, are likely to roadblock and oppose efforts to improve productivity and performance within the laboratory.
“Second, top-performing laboratories create an objective, concise career path for lab managers at all levels,” continued Smith. “These career paths help senior lab leaders identify promising manager candidates at the bench, and then provide these individuals with the training, knowledge, and mentoring that allows them to develop. The goal is to help the next generation of management talent acquire skills and experience in a safe setting, and build them step-by-step, level-by-level, into confident leaders and managers.”
“Third, in those clinical laboratories and pathology laboratories with the most energized management teams, I see a well-articulated vision, clear management objectives, and detailed measurement of progress toward goals,” commented Smith. “This is accomplished in two dimensions. One dimension is the global goals and measurements for the laboratory’s operational, service, and financial objectives. The other dimension involves regular and objective feedback to managers on how they are attaining their personal milestones while managing their staff in ways that sustain the desired working culture with the laboratory.”
For those laboratory administrators, lab directors, and lab managers interested in advancing their ability to create a high-performance management team, Jeff Smith has agreed to conduct a special audio conference on this topic for readers of Dark Daily and The Dark Report. Titled: “Improving Lab Management Productivity: How To Evaluate Your Team And Stimulate Increased Performance And Profitability,” this unique learning opportunity will take place on October 21, 2008 at 1:00 P.M. Eastern Time. This will be a fact-filled, 90-minute session. For information and to register, visit http://www.darkreport.com/Audio/10.21.08/Improving-Laboratory-Management-Productivity-Audio-Conference.htm.
This audio conference helps you understand how to identify the super-stars on your management team. You’ll learn how to re-recruit them so they don’t go off to work in another laboratory. There will be information on how to spot the non-achievers on your existing management team, along with proven methods you can use to help these disappointing managers either overcome their barriers to self growth and lab achievement or to help them recognize their deficiencies, setting up a mutual departure from the lab. Best of all, you’ll learn the proven secrets to creating an energized, enthusiastic, “can do” management culture in your lab-one that consistently exceeds expectations. Reserve your participation in this highly valuable audio conference by registering today at http://www.darkreport.com/Audio/10.21.08/audio-register.htm.
HOW TO REGISTER:
1. Register Online
2. Call toll free: 800-560-6363
Registrations accepted until Tuesday, October 21, 2008, noon EDT.
Cancellations before 5:00 p.m. EDT on Friday, October 17, 2008 may receive a full refund less a $25 service charge.
Your audio conference registration includes:
• A site license to attend the conference (invite as many people as you can fit around your speakerphone at no extra charge)
• Downloadable PowerPoint presentations from our speakers
• A full transcript emailed to you soon after the conference
• The opportunity to connect directly with our speakers during the audience Q&A session
