Jan 31, 2007 | Laboratory Management and Operations, Laboratory Pathology
Here’s another use of the Internet to lower the cost of laboratory operations. Now hospital laboratories can have blood utilization reviews performed via a Web-based service. The goal of the new company is to provide laboratories with dramatically lower blood supply costs by providing hospital laboratory clients the information they need to improve blood transfusion services.
David Jadwin, a pathologist at Kern Medical Center in Bakersfield, CA, recently launched a new business venture performing blood transfusion utilization review over the Web. The name of the company is Columbia Healthcare Analytics. Columbia Healthcare Analytics uses the Web to deliver its primary service and also uses the Web to market itself by making an informational video available at its Web site. Columbia Healthcare Analytics has also applied for a patent to cover its unique technology and intellectual property.
Columbia Healthcare Analytics can benchmark physician and institutional performance against regional, national, and international standards through the use of objective, rules-based techniques. Traditional compliance review models require external reviewers to travel to the laboratory site to access data. Columbia Healthcare Analytics will use new informatics technology to dynamically deliver electronic patient care data to qualified reviewers outside the institution. All HIPAA-sensitive patient information is carefully redacted to provide only clinically pertinent data. The hospital lab client transmits this data to off-site data servers. There it is reformatted and processed through algorithms that assess the appropriateness and effectiveness of patient care. This enables the reviewer to make a rapid qualitative and quantitative analysis and report the utilization review results immediately back to the client.
Columbia Healthcare Analytics provides case study examples that demonstrate the potential savings from an effective review of blood transfusion utilization. In one case, the review process triggered a reduction of packed red blood cell transfusions by more than 30%, a reduction in PRBC blood usage of 1,146 units with a corresponding savings of $223,000 in blood supply costs. Fresh frozen plasma use dropped 45%. Substantial reductions in nursing time and costs for treating adverse reactions to unnecessary blood transfusions were also realized as a consequence of implementing the review recommendations. By contrast, during this same time, other hospitals in the same community saw their blood utilization increase by 21% for packed red blood cells and 79% for fresh frozen plasma.
According to Jadwin, “At most hospitals, traditional blood usage committees are inefficient. There is often poor medical staff participation and members are reluctant to criticize a colleague’s performance. Consequently, many medically unnecessary or ineffective transfusions go without notice. Review comments, when made, are often so far after the fact that little improvement of physician performance occurs. These are important reasons why current hospital utilization review processes rarely result in better transfusion practices or lower costs. Additionally, hospitals may also lack staff trained or interested in current transfusion practices.”
Blood costs are a major expense, often exceeding $1 million per year in moderately-sized hospitals and costing millions of dollars per year in large health systems. That is motivation for hospital laboratories to identify ways to reduce unnecessary blood usage and improve the expense and quality of blood transfusion services. For that reason, Columbia Healthcare Analytics has a major business opportunity once it demonstrates to hospitals that it can deliver effective utilization reviews of blood transfusion services over the Web -and that its recommendations consistently unlock improvements in quality and worthwhile reductions unnecessary use of blood units and the costs related to this service. Dark Daily observes that laboratories are likely to see other compliance services offered via Web-based arrangements. Such services, which lower a laboratory’s cost of compliance while improving compliance effectiveness, are likely to be successful.
Dec 6, 2006 | Laboratory Management and Operations, Laboratory Pathology
Only one in four physicians, or 24.9%, currently uses some sort of electronic health record (EHR) under the loosest possible definition of the term. That’s the finding in a recent study entitled Health Information Technology in the United States: The Information Base for Progress performed by the Robert Wood Johnson Foundation and the federal government’s health information technology office. Of greater interest, only about 10% of physicians use a “fully operational” system, or a system that collects patient information, shows test results, and allows providers to enter medical orders and prescriptions.
The report’s findings are useful for laboratory administrators and pathologists because they demonstrate that implementation and use of EHRs by office-based physicians remains in its early stages. That gives laboratories and pathology group practices more time to craft an effective EHR strategy
We are pitifully behind where we should be,” said David Bumenthal, a co-author of the report. His words have certainly impacted the medical community. Google “EHR Adoption Pitifully Behind” , and you will discover that Bumenthal’s comment has been picked up by numerous media outlets. Most everyone finds this study newsworthy and discouraging. The government realizes that, with doctors continuing to use EHRs at their current rate, they will not hit President Bush’s goal to ensure that most Americans have their medical information collected, stored, and organized electronically by 2014. Healthcare-savvy patients will also be frustrated to know that doctors are so slow to adopt EHRs, as they certainly realize that electronic medical records lead to fewer handwriting errors and fewer resulting medical diagnosis and prescription errors.
Why do EHR adoption rates by physicians remain low? The study hypothesizes that financial, technical, and legal barriers are to blame. Furthermore, there is no standard definition of what constitutions an EHR. Modern Healthcare Magazine quotes Providence Health System doctor Dick Gibson as saying that “Most docs who do it [use EHRs] say they do it because it’s the right thing to do. We know that the patient gets most of the benefits, the health plans get the rest, and the doctor is the one who has to pay for it.”
Lab directors and pathologists should keep in mind that this report on EHR adoption fails to make a key point: The larger the physician group, the more likely it is to have already implemented an effective EHR or EMR (electronic medical records) system. Thus, it is these physician groups and clinics which are larger in size – and important laboratory customers – that are first to go electronic with their medical records. To build and maintain competitive advantage, progressive laboratories and pathology group practices should already have a strategy and a solution that allows their laboratory to interface with the physicians’ EHR system for electronic test orders and lab test reporting.
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Dec 4, 2006 | Laboratory Management and Operations, Laboratory Pathology
Dateline: Bogota, Columbia – In recent days, The Dark Report visited clinical laboratories in this high-altitude city, situated 8,560 feet above sea level. The state of the laboratory profession in Colombia is well developed and the country’s healthcare system is recognized as providing high quality services.
The first site visit was to IPS Laboratorio Clinico. It is owned an operated by Compensar. The best way to describe Compensar is to say that it operates like a Kaiser Permanente without hospital inpatient services. Compensar provides health care to ambulatory patients who are enrolled members.
The central laboratory is modern and services approximately 1,200 patients per day. There are six satellite blood draw sites. These are open Monday through Saturday, from 7 a.m. until 10:30 a.m. Couriers bring these specimens into the core laboratory where they are tested and results made available by day’s end. Three of the satellite sites have rapid response laboratories and blood draws for urgent testing are performed at the core main laboratory facility throughout the day. The on-site test menu for this laboratory numbers approximately 600 different assays.
Dr. Carmen Cecilia Trujillo is Chief of the Laboratory and hosted the site visit by The Dark Report. She is justifiably proud of an operation that has the quality and productivity to match many laboratories in the United States. Of particular note is a rapidly-developing Six Sigma quality management program at IPS Laboratorio Clinico. Dr. Alba Garzon spearheads this initiative, which was launched in microbiology. Her team has achieved 5.47 Sigma in certain microbiology work processes (which is TBFI errors per million events).
Next on The Dark Report’s tour of laboratories in Bogota was Laboratorio Medico Echavarria. It is located directly across the street from the Colombia headquarters of Roche Diagnostics, which was hosting The Dark Report’s visit to Colombia. Laboratorio Medico Echavarria is an example of an independent commercial laboratory which has grown by consolidation. It operates in TBFI cities around Colombia and has ambitions to expand into neighboring countries.
This laboratory facility was new, having opened just 18 months ago. It is an open plan laboratory. Our tour was hosted by Catalina Perez Koller, M.D., a board-certifed pathologist who is Directora Cientifica. She described a laboratory organized to provide primary testing for the patients of office-based physicians. Laboratorio Medico Echavarria also performs reference work, providing reference and esoteric testing to other laboratories and clinics. The on-site test menu is about 600 assays. This laboratory serves more than 1,000 patients per day.
For pathologists and laboratorians in the United States, Dark Daily can offer some interesting and useful insights from these site visits. First, the level of quality, productivity, and sophisticated testing done by these two laboratory organizations demonstrates how laboratory “best practices” are converging across the globe. Second, leadership in these laboratories is keenly motivated to respond to declines in reimbursement while still introducing new diagnostic technology to their clients. Thus, the management team in these laboratories are actively educating themselves about the latest innovations in laboratory management and operations. Third, they are alert to the emerging potential of “health tourism” to bring cash-paying patients into their country. In fact, a growing number of patients now travel from surrounding countries to get their healthcare in Colombia.
Dark Daily has a key observation to offer: North America and Europe do not have a monopoly on skilled experts in laboratory medicine. Site visits to laboratories in countries like Colombia consistently demonstrate that the level of quality and service is advancing steadily. Because of unique economic circumstances, necessity is motivating many of these laboratories to develop clever management solutions to problems common to laboratories in the United States.
Should you have questions or comments, simply email Robert at rmichel@darkdaily.com.
PS: You may wonder how The Dark Report ends up in a country like Colombia. Upcoming in the next few days will be an assessment of a multi-nation laboratory meeting hosted by Roche Diagnostics and Sysmex in Cartagena, Columbia. Robert Michel was one of the featured speakers at DIAmante. Laboratory Site visits in Bogota were arranged by Ivan Ricardo Mendez R., who is Gerente de Mercadeo (country manager) and Alonso Emilio Torres, Gerente de Producto (product manager) of Roche Diagnostics in Colombia. Thanks are extended to both individuals for their contributions.
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Oct 27, 2006 | Laboratory Management and Operations, Laboratory Pathology
DATELINE-BUENOS AIRES, ARGENTINA: Believe it or not, Argentina is a country where pathologists are not associated with clinical laboratory testing! I am Argentina this week to speak to a group of laboratory owners, speak to health insurance executives, and visit clinical laboratories. My hosts on this trip are Sysmex Corporation and Roche Diagnostics Argentina.
The most startling thing that I learned is that pathologists do not own clinical laboratories in Argentina, nor do they manage clinical laboratories in hospitals. That responsibility is handled by clinical biochemists. Further, interaction between anatomic pathologists and clinical laboratories is relatively limited. This is a much different situation than the common clinical models and business arrangements used in the United States, Canada, and similar nations.
Another interesting difference is that doctors give their patients the laboratory test requisition. Patients then show up at the laboratory of their choice, where specimens are collected. When the results are ready, the laboratory contacts the patient, who comes by the laboratory or patient service center, picks up a paper copy of his or her test report, and then personally delivers the lab test report to his or her physician. This arrangement is counterintuitive to the American system. On the other hand, it does provide a powerful example that patients can reliably play a role this aspect of their healthcare.
Competition is intense among private laboratories in Buenos Aires, Argentina. There are private health insurance companies. Labs that bid for provider status in these contracts tend to keep the prices for lab testing at unprofitably low levels. Another factor in the financial struggles of the entire health system in Argentina was the devaluation of the Argentinian Peso in 2001. The purchasing power of the Peso fell by 66% overnight! This has made the purchase of laboratory testing instruments, reagents, and other laboratory consumables prohibitively expensive for labs in Argentina. The effects of this devaluation are still dragging down the finances of this countries’ lab industry.
During this week, I gained many useful insights about laboratory management, different business models for laboratory testing, and the opportunities for laboratories in the United States to benefit from some of the experience provided by the laboratory testing marketplace in Argentina. These are examples of how innovations by laboratories in one country can be adopted by labs in other countries. I hope to share some of the more powerful innovations with you in coming weeks.
Reporting from Buenos Aires, your faithful Editor,
Robert L. Michel
(E-mail Robert at rmichel@darkdaily.com)
Oct 18, 2006 | Laboratory Management and Operations, Laboratory Pathology
We wanted to make sure to report on the success of the pay-for-performance program in Britain and give it adequate space in Dark Daily and it’s full due. However, we also wanted to note, in this separate piece, that the success of the program in Britain may be slightly exaggerated.
In the study Pay for-Performance Programs in Family Practices in the United Kingdom, targets were met for 83% of eligible patients and practices earned nearly 97% of possible points available. The National Health Service (NHS) anticipated that practitioners would earn only 75%. Why did so many practitioners perform so well? There are a couple of plausible explanations.
First, the targets for high performance may have been too easy for practitioners to achieve. Trial and error is the only effective way for the NHS to find out how ambitious the targets should be. To address the possible problem of targets being set too low, the NHS has altered the 2006-2007 scheme so that all minimum and some maximum payment thresholds have been raised, 30 indicators have been dropped or modified, and 18 new indicators have been introduced.
The second reason that so many practitioners did an exceptional job of meeting targets is that there may have been some misreporting by practitioners. Certain patients may have been omitted from documentation to make it easier to meet targets. To ensure that misreporting is more difficult to get away with, the NHS has established Primary Care Trusts. These Trusts are statutory bodies responsible for the delivery of health care in local areas. They will inspect local practices and perform audits and inspections both randomly and at practices suspected of incorrect or fraudulent returns.
It is highly likely that the pay-for-performance program in the US will have similar results with practitioners performing better than expected in its first year. Doctors, hospitals, and laboratories who pay attention to developing targets from The Centers for Medicare and Medicaid and who make incremental improvements in their practices and facilities before the US adopts a pay-for-performance program in 2007 will put themselves in an excellent position early success. These health care practitioners and facilities will ensure not only that they meet appropriate standards and provide patients with the best possible care, but also that they will reap the maximum benefits and incentives from the government for their meeting targets.
