News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups
Hosted by Robert Michel
Effective January 1, 2009, Physicians can get extra 2% for paperless prescribing
February 27, 2009
Medicare’s newest cash incentive program for physicians who use e-prescribing services has caught the attention of the medical community. In the months leading up to the January 1, 2009 implementation date for the physician e-prescribing bonus, the number of doctors using paperless prescribing services doubled.
February 25, 2009
Providers might blame soaring healthcare costs in part on caring for uninsured patients, but a new study published by the journal Health Affairs suggests this argument may not hold much water. (more…)
February 24, 2009
Are you curious about how molecular imaging and molecular diagnostics are being integrated into a single clinical service? If so, you may want to go to the Siemens Corporation Web site. On the home page, it prominently features video of events at the Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics, conducted in Philadelphia earlier this month!
Throughout the two-day Molecular Summit event, Siemens conducted video interviews with selected speakers. These interviews, and video of selected presentations, are easily accessible on the Siemens Web site. In fact, you can even see a video interview with Dark Daily Editor Robert Michel, who produces the Molecular Summit each year! Just hit the link with his picture .
Siemens’ interest in the Molecular Summit is directly linked to one of its primary global strategies. In recent years, Siemens placed a $14 billion bet on the integration of molecular imaging and molecular diagnostics by acquiring, in order, Diagnostic Products Corporation (DPC), Bayer Diagnostics, and Dade Behring Corporation. By 2007, Siemens had become the world’s second largest in vitro diagnostics (IVD) manufacturer, as well as the world’s largest integrated diagnostics company.
Pathologists and laboratory managers will want to pay closer attention to how radiology and pathology are evolving toward a single clinical service. This is a trend which is in its infancy. It won’t be disruptive in the short term. On the other hand, presentations at Molecular Summit by radiologists and pathologists who have begun to collaborate on an integrated clinical diagnostic service reveal that such efforts easily generate additional value to clinicians and improve outcomes for patients. Two examples of in vivo and in vitro integration can by found at the University of Kansas and at UCLA Medical Center. Pathologists and radiologists from both sites made presentations on their collaborative diagnostic services at the Molecular Summit.
Of course, the glue that will increasingly bind radiologists and pathologists together is personalized medicine. Molecular Summit speakers ranging from George Poste, DVM, PhD, to Mara Aspinall, PhD, told attendees that personalized medicine is no longer a concept, but is an active and expanding influence in healthcare today. Personalized medicine requires pathologists and radiologists to adopt molecular technologies and to evaluate disease processes at a cellular level, increasingly in a multiplex, multi-modality process.
The second annual Molecular Summit, produced by The Dark Report, was conducted in Philadelphia on February 10-11, 2009. An enthusiastic audience of almost 200 pathologists, radiologists, and other experts focused on this new vision for molecular imaging and molecular diagnostics. For two years, Siemens has been a corporate benefactor of Molecular Summit.
Dark Daily invites subscribers and readers to share their experiences at integrating imaging and molecular pathology. Planning for Molecular Summit 2010 is already under way and this is an opportunity for you to present your case study of in vivo/in vitro integration at next year’s event. Contact Editor Robert L. Michel at rmichel@darkreport.com.
One Medicare contractor is proposing a new policy that would effectively end payment to labs and physicians for routine testing for Vitamin D deficiency. In its proposed local coverage determination (LCD), the Medicare carrier indicates that it would cover Vitamin D testing only for patients with chronic kidney disease, osteomalacia, hypercalcemia, and rickets. The LCD states that other testing for Vitamin D would be denied.
The draft (or proposed) LCD is dated February 6 and was posted on the Web site of National Government Services (NGS), one of the nation’s largest Medicare contractors. Medicare has asked for comments through February 21. If accepted as proposed, the denials for routine Vitamin D testing would begin on June 1, according to the LCD. In the posted draft, Medicare added a disclaimer saying that LCDs are not necessarily a reflection of the current policies or practices.
National Government Services (NGS) serves 200,000 providers and suppliers, along with nearly 24.5 million Medicare beneficiaries in 25 states and five U.S. territories. Not all Medicare providers will be affected by the LCD that NGS posted. Other Medicare carriers may have posted a similar LCD.
The draft of the NGS LCD says, “Measurement of vitamin D levels is indicated for patients with chronic kidney disease, osteomalacia, hypercalcemia, and rickets. Measurement of vitamin D levels is not indicated for screening. Measurement of any other Vitamin D metabolites (CPT codes 82307 & 82652) is not indicated, and will be denied.”
The draft LCD further states, “An excess of Vitamin D is unusual, but may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders, the most infamous of which is rickets. Treatment of Vitamin D deficiency is relatively straightforward, negating the need for measuring Vitamin D levels in many cases. Evaluating patients’ Vitamin D levels is accomplished by measuring the level of 25-hydroxyvitamin D. Measurement of other metabolites is not medically necessary.”
The Vitamin D Council, a nonprofit organization in Atascadero, California, reported the news on February 13. “If this rule passes, the change will quickly extend to all Medicare districts,” predicted the newsletter. “Private insurers will then follow suit, denying payment for Vitamin D blood tests, even for the diagnoses of Vitamin D deficiency. This rule change flies in the face of an enormous amount of research, some of it published in the last few months. For example, several weeks ago, the British Journal of Cancer reported that in men with prostate cancer, those with highest Vitamin D blood levels were seven times more likely to survive than were men with the lowest levels.”
It may be that Medicare officials are reacting to the significant increase in the volume of Vitamin D testing seen during the past two years. Much of this increased test volume is a result of ongoing media coverage about the importance of Vitamin D and new stories encouraging people to visit their doctors and request that their Vitamin D levels be checked.
For the laboratory industry, this is not an auspicious development. In the past, Medicare has used restrictions on coverage as a way to constrain utilization of certain procedures, thus helping it to control costs. Some lab industry experts are already speculating that this may be the reason why, at this time, one of Medicare’s largest carriers has published a proposed LCD that would limit reimbursement for Vitamin D testing only to a limited number of clinical situations. The Dark Report and Dark Daily will follow this developing story closely in the coming weeks
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The Central Laboratory of the Centre for Infectious Disease Research in Zambia (CIDRZ) has developed a profitable business model that might offer wealthy nations a way to jumpstart similar programs worldwide, then create profit centers to help sustain them.
This business model, developed under the leadership of Executive Director Jeff Stringer, MD, and Laboratory Director Ron Brown in collaboration with the lab’s new Business Manager Henry Latner-formerly of PACLAB Network Laboratories in Washington’s Puget Sound region-creates a sustainable funding source to assist funding at 64 free AIDS clinics in urban Luska, Zambia. The clinics provide more than 140,000 HIV-infected adults and children Antiretroviral Therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) services.
With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) , the Central Laboratory experienced rapid scale-up of services over the last four years, growing at an annual rate of about 250%. Today, the lab performs more than one million tests annually.
The steep growth curve caused Brown to focus on workload forecasting and continual service demand projections to ensure adequate testing resources are in the pipeline as needed to meet demand for growing services. This prudent planning resulted in operational efficiencies that created consistent excess testing capacity in key analytic areas, allowing the laboratory to market testing services to private sector clinics, faith-based and other non-government organizations in the region. Offering this service added a revenue stream for sustainable growth that reduces dependency on foreign donor support for anti-retroviral treatment programs.
Latner’s business plan called for building the for-profit laboratory service on an existing, well-established services foundation, including current courier routing and result delivery systems, and focusing on creating efficiencies and standardizing work in pre- and post-analytical areas of the lab.
CIDRZ Medical Laboratory Ltd., a separate, not-for-profit company which falls under the parent company of CIDRZ, now provides daily, full-service laboratory support to several hospitals and care clinics throughout the greater Lusaka region. Key to the success of this service are the focus on consistent, predictable, high-quality laboratory testing, with excellent customer service and a fair market price.
This business model was evaluated by a team from the Global Health Delivery program at Massachusetts Institute of Technology’s Sloan School of Management to validate current financial forecasts and potential for additional revenue streams, based on demand for private healthcare growth and market research. The analysis indicated potential for continued growth in demand for laboratory services by private care facilities in this region, and if managed well, Central Laboratory can expect a strong, sustained revenue stream to support CIDRZ care and treatment programs well into the future.
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