Feb 8, 2012 | Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Many physicians say they lack specific details about the care model and how it will reimburse providers
In its own news service, the American Medical Association (AMA) reports lagging interest by physicians when they are asked about their participation in accountable care organizations (ACO). This survey of AMA members was conducted last fall.
According to an article at amednews.com (AMN), this survey found that—although many physicians are familiar with the concept—a significant number of them indicate they will either opt out of an ACO or unsure whether they will participate in an ACO.
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Jan 24, 2012 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Pathology
Clinical laboratory managers and pathologists can expect ACOs to impact competition for laboratory services
Six accountable care organizations (ACO) stepped up and applied for accreditation through the National Committee for Quality Assurance (NCQA). In many ways, this marks the beginning of the ACO era in American healthcare.
These six intrepid first-mover organizations will be familiar to most pathologists and clinical laboratory managers. In a recent press release, the NCQA announced their names. They are:
- Billings Clinic, Billings, Montana
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Crystal Run Healthcare, Middletown, New York
- Essentia Health, Duluth, Minnesota
- HealthPartners, Minneapolis, Minnesota
- Kelsey-Seybold Clinic, Houston, Texas.
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Apr 21, 2011 | Laboratory News, Laboratory Pathology
Pathologists may be asked to do more consults by oncologists practicing in a medical home
Recently a pioneering oncology practice in Philadelphia was recognized by the National Committee for Quality Assurance (NCQA) as a medical home practice. Though the NCQA medical home program focuses on primary care, a few specialty practices have gained medical home recognition.
This is a milestone on the road to expanded use of the medical home care model. It is also an early warning to pathologists and clinical laboratory managers that other medical specialties may take steps to implement a medical home practice. It is believed that physicians practicing in this care model are likely to be more careful users of medical laboratory tests.
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Apr 6, 2009 | Laboratory News, Laboratory Pathology
Meet the concept of the medical home. It is a managed-care delivery model that charges physicians with coordinating overall care for patients with chronic illnesses. Since its’ inception just a few years ago, it has spread nationwide. Medical home demonstration projects now operate in 22 states. Two states, Rhode Island and North Dakota, have implemented statewide programs.
By design, the medical home is a patient-centered, integrated care model. An important goal is to create a strong, long-term relationship between the physician and the patient. It does this by replacing episodic care based on illness with proactive, coordinated care provided by a physician-led team.
In 2008, the National Committee for Quality Assurance (NCQA) introduced standards to determine if a medical practice operates as a Patient-Centered Medical Home (PCMH). These standards meet the definition of a medical home as defined by a consortium that includes the American Academy of Pediatrics, American College of Physicians, American Academy of Family Physicians and American Osteopathic Association.
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Dec 29, 2006 | Laboratory News, Laboratory Pathology
When the NCQA reported significant improvements in healthcare last September, an Associated Press article on this topic was picked up by Yahoo News, CBS, Fox and many other news sources across the country. It was likely so widely reprinted because it was a rare piece of good news: The quality of the health care provided to millions of Americans improved last year across several dozen categories!
It is first evidence that efforts to improve patient safety and encourage providers to follow recommended health guidelines have made a difference. The laboratory industry has been front and center in this trend. For example, early in this decade payers began asking laboratories to report Health Plan Employer Data and Information Set or HEDIS-required measures such as Pap testing, Pap results, HbA1c testing, HbA1c results, among others. Improved use of laboratory testing as a result of HEDIS requirements has contributed to improved outcomes in several areas of the American healthcare system.
NCQA stated that, for patients covered by private insurance plans, there were significant improvements in 36 of 42 categories measured by HEDIS data sets. Improvements were noted in immunization rates among insured children, cervical cancer screening, colorectal cancer screening, and the controlling of high blood pressure in hypertension patients. While each of these areas may have only improved by a few percentage points last year, over a 10-year period, improvements are highly visible. For example, last year 96% of heart attack patients were given drugs to lower their blood pressure and slow heart rate to prevent a second attack. A decade ago, only 62% of patients suffering heart attacks were given those medications.
According to Margaret E. O’Kane, the president of the National Committee for Quality Assurance, “This past decade has demonstrated the benefits of measurement, reporting, and accountability, but three out of four people don’t enjoy those benefits today.” In fact, only 1 in 4 Americans are enrolled in a health plan that collects and reports data on the quality of care. O’Kane urges us to start asking why.
As Dark Daily reported in recent months, pay-for-performance programs are being instituted by the Medicare program and insurance companies across the US. The time is fast approaching when these programs and quality of care measurements for physicians, hospitals, and laboratories will become the norm. As the media gives greater exposure to the benefits of measuring quality of care, laboratories can be certain that they will see increased accountability and reporting on their quality by insurance companies.
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