But insurers are complying under the Transparency in Coverage regulations and that is where discrepancies in the disclosure of prices to the public have been found
Despite federal regulations requiring hospitals to publicly post their prices in advance of patient services, some large health systems still do not follow the law. That’s according to a new Transparency in Coverage Report from PatientRightsAdvocate.org (PRA), which found that some hospitals are “flouting” the federal Hospital Price Transparency Rule.
By cross-referencing price disclosures by hospitals and insurance companies, which are required to publish the amounts they pay for hospital services under federal Transparency in Coverage regulations, PRA, a 501(c)(3) nonprofit, nonpartisan organization, discovered the healthcare providers’ noncompliance with federal transparency regulation.
“Prices revealed in newly released health insurance company data files show some major American hospitals are omitting prices from their required price disclosures in violation of the federal hospital price transparency rule,” according to the PRA report.
Hospitals conceal their prices because they don’t want people to know how much rates for the same procedure vary,” Sally C. Pipes (above), President and CEO of Pacific Research Institute, wrote in the Washington Examiner. “A lack of price transparency benefits hospitals but not patients or payers. The federal government should not let providers get away with flouting the law,” she added. Clinical laboratories are also required under federal law to publish their prices. (Photo copyright: The Heartland Institute.)
“PatientRightsAdvocate.org discovered several instances in which prices were omitted from the hospital files but appeared in the insurance company files,” noted the PRA report. “These discrepancies indicate that some large hospitals are not posting their complete price lists as required by the hospital price transparency rule.”
The federal Centers for Medicare and Medicaid Services (CMS) says hospitals must post standard charges in a single machine-readable digital file, and display in a consumer-friendly way, “300 shoppable services with discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.”
But according to the PRA report and news release, the study team discovered that this was not always the case. Below are examples from the report of some of the discrepancies between prices on a hospital’s website and what payers’ websites showed as prices involving those same hospitals:
PRA’s report casts light on inconsistencies between what insurers and providers share with the public on prices.
“Today’s report confirms that hospitals are hiding prices from patients and [this] calls into question their public assertions that individual prices don’t exist for many of the services they provide,” said PRA Founder and Chairman Cynthia Fisher in the news release.
“The data made possible by the [federal] Transparency in Coverage (TiC) rule reveals prices negotiated with insurers that hospitals did not disclose in the machine-readable files required by law. Our report is just the tip of the iceberg of what the staggering amount of data in TiC disclosures will reveal,” she added.
Ascension, HCA Note Compliance with CMS Rule
For its part, Ascension, in a statement to Healthcare Dive, confirmed it is complying with the CMS rule and offers consumers tools to estimate costs.
“We’re proud to be a leader in price transparency,” Ascension said.
HCA told Healthcare Dive it has “implemented federal transparency requirements in January 2021 and provides a patient payment estimator in addition to posting third-party contracted rates.”
Advice for Clinical Laboratories Sharing Test Prices
Hospitals flouting the federal transparency rule is not new. Dark Daily has covered other similar incidences.
Clinical laboratory leaders who oversee multiple labs in healthcare systems may benefit from advice about CMS rule compliance shared in HealthLeaders.
Post a separate file for each provider.
Be “cognizant” of different sets of standard charges for multiple hospitals under one license.
“Today’s healthcare consumer wants to know prices in advance of service. That’s because many have high deductible health insurance plans of, say, $5,000 for an individual or $10,000 for a family as the annual deductible,” said Robert Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report.
Clinical laboratory tests may not be the most expensive healthcare service. But they are critical for high-quality hospital care and outcomes. Increasingly, patients want to know in advance how much they will cost. This is true of patients of all generations, from Baby Boomers to Generations X, Y, and Z.
Though burnout due to COVID-19 pandemic plays a role, the future is bright for pathology assistants
Anatomic pathology laboratories are expanding the role of Pathologist Assistants (PathAs) beyond the traditional duties. What does that mean for the future of this critical position? In an article she penned for the College of American Pathologists (CAP), certified pathologists’ assistant Heather Gaburo, MHS, PA(ASCP)cm, explains how PathA responsibilities are evolving to meet the needs of today’s surgical pathology suite and anatomic pathology service.
The PNPL in Woodbridge, Connecticut, funded the study and worked with various pathology laboratories to gather the information presented.
In her paper published in the Archives of Pathology and Laboratory Medicine, certified pathologists’ assistant Heather Gaburo (above), wrote “PathAs can fill a wide variety of nontraditional roles in hospital-based and private practice laboratory settings. In the current state of pathology, PathAs are underused in these roles.” (Photo copyright: American Association of Pathologists’ Assistants.)
Traditional Duties of PathAs
The job of the PathA was developed in the 1970s to fill a gap in the pathology workforce. Traditional duties for PathAs include, but are not limited to, tasks such as:
Macroscopic examination (grossing process) and dissection of surgical specimens,
Assisting with intraoperative frozen sections and autopsies.
However, this role is expanding. According Gaburo, the 2021 AAPA membership survey showed that PathAs duties have grown to include tasks such as:
Why have the duties of PathAs broadened so much? According to Gaburo, the COVID-19 pandemic had much to do with it.
COVID-19 Pandemic Leads to New Duties/Burnout for PathAs
“The pandemic increased public awareness of the clinical laboratory by highlighting essential clinical workers with frequent spotlights on COVID-19 testing and staffing shortages, as well as understaffing in the anatomic space,” Gaburo said in an exclusive interview with Dark Daily.
“COVID-19 caused delays in cancer screening and non-emergency surgery, which led to a backlog of cases and delayed cancer presentations. Some studies have shown an increase in late-stage cancer presentations, which can be more time-consuming to diagnose in pathology. Both factors are contributing to higher traditional workloads for PathAs,” she added.
The pandemic, according to Gaburo, also led to increased duties for PathAs. “The pandemic also provided PathAs with opportunities to assist in developing new protocols such as: handling surgical specimens from COVID-19 patients, enhanced safety procedures in the laboratory, and autopsies on SARS-CoV-2 patients.”
But, with this expansion of duties also comes with the threat of burnout. “I believe the pandemic contributed to the burnout of PathAs in several ways. Many labs faced staffing challenges as employees contracted COVID-19, straining the existing workforce,” she noted.
“Some personnel struggled to balance their jobs as essential workers with providing virtual schooling for their children. Workloads increased when surgical cases resumed to catch up with the patient backlog. The incoming specimens were more complex due to delays in screening and advanced disease at presentation,” Gaburo added.
Job retention is an issue also explored by Gaburo in her Archives of Pathology and Laboratory Medicine paper. “Almost half of the laboratory professionals (including PathAs) surveyed by the ASCP addressed being underappreciated, especially compared with nursing and other allied health professionals.” She goes on to cite the risks of worker burnout, including adverse errors that could lead to liability of healthcare organizations.
Gaburo notes that burnout was an issue for PathAs before the COVID-19 pandemic “possibly due to a lack of job diversity and opportunities for growth,” she said. But the COVID-19 pandemic provided a unique opportunity for many PathAs, as well.
“The pandemic, while it brought challenges, also provided opportunities for PathAs to step into new, temporary roles early on when surgeries were limited, and clinics were closed. This job diversification may have helped develop resiliency and decrease burnout.”
PathA Shortage and Educational Opportunities
The COVID-19 pandemic required the entire healthcare industry to be flexible and expand in a short time. This, according to Gaburo, contributed to the growth of PathAs’ duties and could have helped with job retention as well.
When asked whether there was a shortage of PathAs in clinical laboratories and anatomic pathology groups, Gaburo said, “Though there are many open jobs for PathAs, our profession is fortunate in that we are not experiencing the same type of shortage as other laboratory professions. Instead of struggling to fill vacant positions, it seems many of the PathA openings are newly created positions. In fact, the new graduate employment rate of most, if not all, PathA programs is 100%.”
However, pandemic-related stresses and burnout have led to a shortage of anatomic pathologists, Gaburo notes. But in this she also sees new opportunities for PathAs.
“This is an area where the utilization of pathologists’ assistants has value for pathologists. PathAs, with support and mentorship, can provide assistance in many areas at a lower cost than pathologists, freeing up the pathologists to devote more time to patient care activities.”
As Gaburo concludes in her paper, “PathAs are qualified allied health professionals capable of handling a wide range of nontraditional roles in the pathology laboratory.” She goes on to note how practices can choose to mentor and support their PathAs by offering them mentorship and diverse educational opportunities.
“Over the last 15 years, the number of training programs for PathAs has more than doubled, from seven to 15. Class sizes have also increased to meet the growing demand for admission, which has become more and more competitive.
“The curricula include basic laboratory management classes, and some programs are considering incorporating ‘Business of Pathology’ courses as well. Many programs have expanded their clinical rotation sites, leading to opportunities for experienced PathAs to move into nontraditional teaching roles by becoming preceptors. However, there is still a need for more high-level administrative training opportunities,” Gaburo wrote.
Job satisfaction and retention increases quality for everyone involved. As clinical laboratories and anatomic pathology groups continue to support COVID-19 testing on top of traditional laboratory requirements, pathologist assistants have proven—and will continue to prove—what a valuable asset they are to clinical pathology practices.
Clinical laboratories continue to test sample delivery by drone as a viable alternative to ground transport
In Switzerland, another clinical laboratory drone delivery service recently launched and it has several unique capabilities. This new pilot project to test the delivery of medical laboratory samples by UAV (unmanned aerial vehicle, aka drone) is being conducted by the Dr. Risch laboratory group and start-up drone company Jedsy.
What makes the Risch/Jedsy drone delivery service unique when compared to other drone delivery services is their drone’s capability to deliver directly to windows, regardless of where that window is. This, according to a Jedsy news release, “makes the transport of samples faster and more environmentally friendly.”
Dr. Risch group has 14 clinical laboratories and eight sample collection locations throughout Switzerland. The Swiss Federal Office of Civil Aviation (FOCA) approved Dr. Risch’s first flight between its lab in Vaduz, the capital of Liechtenstein, to its lab in Buchs St. Gallen, sUAS News reported. Risch began transporting lab samples between those locations on an experimental basis in December of 2022.
The Jedsy glider, as the drone is called, has a distinctive vertical takeoff, hover, and landing capability. Once it achieves a safe altitude, it transitions to forward flight and can travel at speeds up to 150 kilometers per hour or about 93 miles per hour.
All systems on the Jedsy drone are redundant and developed to be fail-safe. A human drone operator follows the flight visually via a livestream connection. Once the drone approaches a building for landing, with the exception of the docking station the entire surrounding area is blurred to ensure the privacy of nearby individuals.
The Jedsy Glider (above) is quieter than other multicopters, according to Jedsy, and is able to dock outside a window or balcony. This enables the convenient loading and unloading of clinical laboratory specimens in any type of weather. The docking station also serves as a charger for the drone’s battery to ensure the craft is available for use at any time. Similar medical laboratory sample drone delivery services have been tested in Switzerland but none with Dr. Risch Labs’ unique window delivery option. (Photo copyright: Jedsy.)
Why Transport Clinical Laboratory Samples by Drone?
“The last two years during the COVID-19 pandemic have shown convincingly how important this service is for the healthcare sector,” explained the medical laboratory group’s founder and CEO, Martin Risch, MD, in the Jedsy press release.
Risch envisions a need for drones in certain medical situations. Dr. Risch currently employs about 50 courier drivers who transport by ground medical samples to regional medical laboratories throughout Switzerland every day.
“If, however, the courier vehicles are stuck in traffic or if they are driving during rush hour, the planned daily routine regarding the analysis and the medical diagnosis is delayed. We hope that this will allow us to offer an even better service, which will ultimately benefit the patients,” Risch stated.
Jedsy has already utilized its glider drone successfully in Africa to deliver laboratory specimens and medicines to remote locations and looks forward to its continued benefits.
“With the new drone, we have already gained important flying experience in Malawi, where over 5,000 flights have been performed as part of the UNICEF drone corridor,” said aerospace engineer Herbert Weirather, founder and CEO of Jedsy, in the press release. “Health centers have already been supplied with critical medicines by Jedsy and the service is being expanded continuously,” he added.
Use of Drones to Deliver Clinical Laboratory Samples Growing Worldwide
Utilizing drones to deliver medical supplies and laboratory specimens is not a new concept and has been tested several times in the past. Dark Daily has previously reported on some of the projects that have been attempted.
The use of drones to deliver clinical laboratory specimens is a rising trend that could be extremely beneficial for healthcare systems, medical professionals, and patients. A number of clinical laboratories in the US and around the world have initiated drone pilot programs, however, there has been little follow-up press coverage about either the success of these efforts or whether they continue to operate.
Nevertheless, faster delivery of laboratory specimens can lead to more timely diagnoses which can potentially lead to better patient outcomes. In the future, it’s likely more clinical laboratories will receive specimens via drones.
NIH program could lead to new diagnostic biomarkers for clinical laboratory tests across a more diverse segment of US population
In another milestone in the US National Institutes of Health’s (NIH) plan to gather diverse genetic information from one million US citizens and then use that data to inform clinical care in ways consistent with Precision Medicine, the NIH’s All-of-Us Research Program announced in a news release it has “begun returning personalized health-related DNA results” to more than 155,000 study participants.
In addition, those participants who request them will receive genetic reports that detail whether they “have an increased risk for specific health conditions and how their body might process certain medications.”
The All-of-Us program, which began enrolling people in 2018, is one of the world’s largest—if not the largest—project of its kind. It could result in more than a million human whole genome sequences to drive medical research and speed discoveries. Study findings, for example, may produce new biomarkers for clinical laboratory tests and diagnostics.
In 2020, the All-of-Us program “had begun releasing genetic results for ancestry and a small number of nonclinical genetic traits,” according to GenomeWeb. Now, the program is taking on the greater challenge of sharing health-related genetic test results directly with its participants.
“We really wanted to make sure that we are providing a responsible return to our participants,” Anastasia Wise, PhD, All-of-Us Program Director for the Genetic Counseling Resource, told GenomeWeb. “They might get information that’s unexpected,” she explained.
So far, about 10,000 people received the NIH’s invitation and 56% have shown interest in receiving their genetic test results, GenomeWeb noted.
“Knowledge is powerful,” said Josh Denny, MD (above), Chief Executive Officer, NIH All-of-Us Research Program, in an NIH news release. “By returning health-related DNA information to participants, we are changing the research paradigm, turning it into a two-way street—fueling both scientific and personal discovery that could help individuals navigate their own health,” he added. The NIH’s research could lead to new clinical laboratory precision medicine diagnostics for chronic diseases across a more diverse segment of the US population. (Photo copyright: National Institutes of Health.)
Two Types of Genetic Health Reports
Study participants who provided a blood sample and gave their consent to receiving genomic information may also receive a Hereditary Disease Risk report that includes 59 genes and genetic variants linked to serious and “medically actionable” health conditions.
About 3% to 5% of participants will have findings suggesting a high risk for a genetic disease such as breast and ovarian cancers as indicated by BRCA1 and BRCA2 genes, Medical Xpress reported.
“I kind of shudder to think about what could happen if I hadn’t known this [finding that she has the BRCA2 gene],” said Rachele Peterson, All-of-Us Chief of Staff, who spoke to the Associated Press about her receiving own Hereditary Disease Risk report.
Participants can also choose to receive an All-of-Us Medicine and Your DNA report with insights on seven genes that affect how specific medications are metabolized. This pharmacogenetics report is important for those who could learn, for example, that they have a 50% to 60% greater risk of a second heart attack when they continue to take the standard medication, as opposed to a different medication, Medical Xpress noted.
“The information on metabolizing medication can be particularly important for people who need treatment after a heart attack,” Josh Denny, MD, Chief Executive Officer, NIH All-of-Us Research Program, told Medical Xpress.
“Such transparency of genetic information about a massive group—as well as the genetic information on individuals—can be used to improve patient care and clinical outcomes,” said Robert Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report.
“The program provides a roadmap for other healthcare organizations to follow. And this is useful strategic knowledge for clinical laboratory leaders to understand and incorporate into their plans to support precision medicine with genetic testing and whole human genome sequencing,” Michel added.
Rich Genetic Data Across a More Diverse Population
As to its goal to reflect national diversity, NIH reported about 80% of All-of-Us participants reside in communities that have been unrepresented in medical research, and that 50% are part of a racial or ethnic minority group.
By combining this information into a single database, the MVP promises to advance knowledge about the complex links between genes and health, according to an MVP news release.
Researchers tapping All-of-Us and MVP data may ultimately produce enlightening and impactful study findings, which could enable clinical laboratories to perform new diagnostic precision medicine tests that identify diseases early and save lives.
It’s not only medical laboratory technicians, healthcare workers across the board continue to deal with extreme pressures that preceded the pandemic
Burnout in healthcare is a constant problem, especially in overstressed clinical laboratories and anatomic pathology groups. To raise awareness about the plight of medical laboratory technicians (MLTs) and other frontline workers in the healthcare industry, a former lab tech recounted her experience during the COVID-19 pandemic that led to burnout and her departure from the lab profession during 2020-2021.
Suzanna Bator was formerly a laboratory technician with the Cleveland Clinic and with MetroHealth System in Cleveland, Ohio. Her essay in Daily Nurse, titled, “The Hidden Healthcare Heroes: A Lab Techs Journey Through the Pandemic,” is a personalized, human look at the strain clinical laboratory technicians were put under during the pandemic. Her story presents the quandary of how to keep these critical frontline healthcare workers from experiencing burnout and leaving the field.
“We techs were left unsupported and unmentored throughout the pandemic. No one cared if we were learning or growing in our job, and there was little encouragement for us to enter training or residency programs. We were just expendable foot soldiers: this is not a policy that leads to long-term job retention,” she wrote.
Clinical laboratory leaders and pathology group managers may find valuable insights in Bator’s essay that they can use when developing worker support programs for their own clinical laboratories and practices.
“The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error,” Suzanna Bator wrote in Daily Nurse. Burnout in clinical laboratories is an ongoing problem that increased during the COVID-19 pandemic. (Photo copyright: Daily Nurse.)
Hopeful Beginnings and Eager to Help
During the early days of the COVID-19 pandemic, folks in every industry stepped up. Fashion designers tasked their haute couture seamstresses with making personal protective equipment (PPE), neighbors brought food and supplies to their immunosuppressed or elderly neighbors, and healthcare workers took on enormous workloads outside of their own departments and traditional responsibilities, The New York Times reported.
When Bator joined the Cleveland Clinic’s COVID-19 team she had no clinical lab tech accreditations. Nevertheless, she and 12 other non-accredited hires were quickly put onto the second and third shifts to keep up with SARS-CoV-2 test demands.
“In the beginning, I was so happy to be helping and working during the pandemic. I felt proud to be on the front lines, honing my skills and discovering what it was like to work under intense pressure. My work was good even when the work was hard. There was no room for error and no time to waste.”
At the Cleveland Clinic, Bator and her colleagues did not experience the equipment and supply shortages other clinics faced, at least not in the beginning of the pandemic. That began to change in late 2020.
Unrelenting Pace and Supply Shortages as Pandemic Grew
Despite their state-of-the-art equipment at the Cleveland Clinic, problems began to arise as the pandemic wore on.
“The machines we worked on were never meant to be run at this intensity and would frequently break down during the second shift. Those of us on the third shift were then left to deal with these problems despite our lack of technical training. Even worse, there were no supervisors on staff to help us problem-solve or troubleshoot, which only added to the pressure,” Bator noted.
And the high demand for testing left little room for new lab techs to hone any other skills.
“The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error,” she added.
Eventually, Bator left the Cleveland Clinic for a county hospital to “get off the graveyard shift and begin working on more than just COVID testing,” she wrote. However, soon after her move the Omicron variant hit, and she was once again running COVID tests.
Six months later she had had enough. She burned out and “dropped out of the industry after only a few years,” she wrote. And she was not the only one.
“The [Cleveland] Clinic began to hemorrhage techs who left for better opportunities at different hospitals or in different fields. Of my original 15-or-so-member team two years ago, only four remain in the same department, and only about half remain in the clinical lab field at all,” Bator wrote.
Burnout in Clinical Laboratories
Worker burnout is a state of mental and/or physical exhaustion caused by a heavy workload. Those experiencing burnout may feel emotionally overwhelmed, anxious, and depressed. Burnout can manifest in physical, mental, and emotional symptoms.
Burnout in the wake of the COVID-19 pandemic is an issue affecting all facets of healthcare. According to Forbes, a 2022 report by Elsevier Health found that 47% of US healthcare workers plan to leave their current role in the next two to three years, in some measure due to the enormous pressures healthcare workers face.
And workers are not the only ones paying attention to burnout. On May 23, 2022, the United States Surgeon General, Vice Admiral Vivek Murthy, MD, issued a Surgeon General’s Advisory highlighting the need to address worker burnout.
“COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point,” Murthy noted. “Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”
Healthcare workers were facing high levels of burnout before 2020, the COVID-19 pandemic only made the issue worse. The National Academies of Medicine (NAM) reported in 2019 that worker burnout had reached a “crisis level,” and that during the pandemic, half of all healthcare workers reported symptoms of at least one mental health condition.
Training Programs Needed to Offset Worker Shortages and Retain Staff
As Bator reported in Daily Nurse, “The American Society of Clinical Pathology (ASCP)—the largest association for [medical] laboratory professionals—has stressed the importance of promoting MLS/MLT programs to produce certified, well-trained lab professionals, to fill major staffing shortages. However, filling the positions is only one piece of the puzzle.”
Bator points out that there wasn’t space nor time for guidance or advancement with the sheer volume of SARS-CoV-2 testing they had to complete.
“Late last year, during the worst of the Omicron variant surge, the only people I could commiserate with were the nurses who thanked us for running their pediatric ICU tests first,” she said. “They understood what we meant when we said we were drowning and stopped calling the lab to pester us for results because they knew that the positivity rate in Cuyahoga County was the third highest in the country and that the entire system was overwhelmed.”
Suzanna Bator is just one early-career worker among many healthcare professionals who have experienced this type of burnout due to the COVID-19 pandemic. As made evident by her piece, the pathology and clinical laboratory professions are losing workers who otherwise might have entered training programs to further their careers in those fields.
The issue of worker burnout is not just a temporary stressor on the clinical laboratory industry. Both worker burnout and staffing shortages in labs preceded the pandemic and will have continuing long-term effects unless steps are taken to reverse it.
