ePolicy News June 2014
Monday, June 2, 2014
Better Utilization of Laboratory Services a Focus for Many Choosing Wisely Partners
A recent ASCP analysis of the Choosing Wisely Recommendation Lists for more than 50 medical special societies found that half featured one or more recommendations on appropriate use of laboratory or pathology services. Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation to reduce overuse of tests and procedures. ASCP is the sole representative of the field of pathology invited by the ABIM to join the campaign to help reduce testing that may be medically unnecessary or potentially harmful.
The pathology-related recommendations put forth by the specialty societies fit into three categories: (1) those directed specifically at test ordering; (2) those directed at a therapy or treatment as determined by laboratory testing; and (3) those addressing patient self-monitoring testing. Among the laboratory tests appearing in multiple recommendations were coagulation studies, Lyme disease serology, PSA, vitamin D, cervical cancer screening/testing including PAP smears and HPV tests, and pre-operative panels, indicating significant confusion among clinicians regarding the most effective use of these tests.
Last month at the Choosing Wisely Summit held in Washington, D.C., the ABIM shed some light on this issue with the release of its national survey of physicians' attitudes regarding the overuse of medical services in the United States. Nearly three out of four U.S. physicians say the frequency with which doctors order unnecessary medical tests and procedures is a serious problem for America's healthcare system. However, just as many respondents say the average physician orders unnecessary medical tests and procedures at least once a week.
"Old habits are hard to break, but this research suggests that America's physicians are slowly making progress in efforts to reduce unnecessary care," said Richard J. Baron, MD, President and CEO of the ABIM Foundation. "Avoiding unnecessary medical care is important because care that is not needed can be harmful to patients; unnecessary care raises healthcare costs for everyone."
One in five physicians (21 percent) surveyed say they are aware of the Choosing Wisely campaign. Of those, 62 percent say they are more likely to have reduced the number of times they recommended a test or procedure because they learned it was unnecessary. This compares to 45 percent for those who are unaware of the effort, suggesting that Choosing Wisely is making progress.
By striving to increase awareness, while developing opportunities to educate, some health systems are seeking to change outdated or ineffective test ordering practices of their clinicians. For example, Intermountain Healthcare of Salt Lake City, Utah, developed a Choosing Wisely Guide for their clinicians. The Cedars-Sinai Medical Group in Los Angeles has "hard-wired" Choosing Wisely into health care there by embedding the 100-plus Choosing Wisely recommendations in their EMRs.
As a patient-centered organization, ASCP is committed to supporting initiatives that promote appropriate utilization of laboratory tests. ASCP believes pathologists and laboratory professionals are uniquely positioned to play a key role in promoting and managing the delivery and use of healthcare resources—and creating awareness about appropriate care with clinicians and patients. As a major proponent of patient-centered care and evidence-based medicine, ASCP supports Choosing Wisely's mission to do the right thing for patients and avoid unnecessary and possibly harmful care.
ASCP is currently developing additional Choosing Wisely recommendations to be released later in the year. If you would like to nominate a particular pathology or clinical laboratory test for consideration, please forward your nomination to firstname.lastname@example.org.
ASCP Pushes Reform of Physician Self-Referral Law
ASCP is continuing its advocacy to reform the Stark Law (also known as the Physician Self-Referral Law). The Society has been targeting key members of Congress as part of a drive to increase support for HR 2914, the Promoting Integrity in Medicare Act of 2013, introduced by Representative Jackie Speier (D-Calif.).
The Stark Law generally prohibits physicians from referring patients for services in which they have a financial interest. Unfortunately, a part of that law, known as the In-Office Ancillary Services (IOAS) Exception, has become twisted to allow clinicians to bill for certain complex medical services, such as anatomic pathology services, that they have attempted to bring "in-house."
ASCP has advocated for the reform of the Stark Law because physician self-referral arrangements can negatively affect patient care as it typically increases utilization of invasive laboratory services, such as biopsies, which can result in harm to patients.
AAMC Health Workforce Conference Spotlights ASCP Laboratory Workforce Data
The AAMC recently put the laboratory workforce center stage at its recent Health Workforce Conference in Washington, D.C., at the Tenth Annual Association of American Medical Colleges' (AAMC) Health Workforce Research Conference, May 1-2, 2014. ASCP was asked to present its abstracts on the Future of the Medical Laboratory Workforce Under Health Reform. Edna Garcia, MPH, ASCP Senior Manager, Scientific Engagement and Research, presented on behalf of ASCP and was joined by four other panel members who discussed roles of care coordinators, the long term care workforce, public health, and pharmacy in the Health Professions Spotlight panel.
This is the first year that the AAMC has included allied health professions in its annual conference. This transition to a health workforce research conference responds to the shift in care delivery and payment models which require healthcare professions work together to enhance care coordination. Yet barriers to effective care coordination still exist, according to Jean Moore, DrPH, Director of Center for Health Workforce Studies at SUNY. Building the needed collaborations can be challenging, reimbursement may not fully cover cost of care, risk-sharing arrangement may be required, funding is scarce, and HIT/EHRs need to be developed. Care coordination studies are being conducted all over the country to determine the best model for implementing healthcare delivery.
Recruitment and retention of various allied health professionals was a common theme at the conference. Like the medical laboratory profession, the allied health profession is preparing for the upcoming changes in healthcare delivery. Population growth, social conditions, environmental factors, and policies are under scrutiny as experts seek to address the future healthcare needs of patients.
The conference, which brought together researchers, educators, and policymakers provided a forum for stimulating discussions on state and federal workforce issues. Topics included the implications of new care delivery models and health system redesign on the workforce, workforce supply and demand, innovations in technology (e.g. telehealth, virtual clinics, email and phone visits); rural and underserved communities, diversity and healthcare equity; social determinants of health; and inter-professional education; to name a few.
To read more about the conference, click here.
ASCP Joins CDC Clinician Outreach on MERS
ASCP was recently invited to attend the Clinician Outreach and Communication Activity (COCA) call: Interim Clinical Guidance and CDC Updates for Middle Ease Respiratory Syndrome Coronavirus.
CDC representatives stressed the importance of clinician communication with state and local health departments and urged providers to take an active role in the prevention and detection of MERS Co-V. Various issues, such as the procedure guidelines for the treatment and testing of infected individuals and criteria for testing suspected cases, were highlighted throughout the presentation. With the passage of Ramadan in the upcoming months, there will likely be more cases of MERS diagnosed in U.S. as individuals travel to the Arabian Peninsula during this Islamic holiday.
To access more information regarding this call or MERS-CoV, please visit: http://emergency.cdc.gov/coca/calls/2014/callinfo_052814.asp.
APHL to Offer MERS Webinar
The Association of Public Health Laboratories (APHL) announces an archived webinar entitled, "MERS: What Every Laboratory Needs to Know!" which was originally broadcast on May 27, 2014. This one-hour presentation covers the epidemiology, disease presentation, laboratory detection of MERS, and laboratory precautions when dealing with a suspect patient's samples. The presentation is presented by Judith Lovchik, PhD, D(ABMM), Assistant Commissioner, Public Health Protection and Laboratory Services, from the Indiana Department of Health, which dealt with the first U.S. case. Please register your laboratory for the archived version and pay $50 for your entire laboratory staff to have unlimited access to the program for up to 12 months. No CEUs will be offered. Your site representative can register here.
U.S. Hospitals Status Examined on Post-Recession and ACA Environments
Health Affairs held a briefing in Washington, D.C., last month to explore the concerns of U.S. hospitals in the new healthcare environment since the recession. Presentations and papers to analyze trends in U.S. healthcare spending were made available to attendees. The briefing also attempted to answer the question on what lies ahead for U.S. hospitals by showing, from selected sources, that:
- Per capita healthcare spending growth for males outpaced females, while the oldest population group (both male and female) continued to spend most from 2002-2010.
- Emergency departments are already money makers for hospitals, and the Accountable Care Act (ACA) could push profits even higher.
- An estimated $84.9 billion in uncompensated care—an overall measure of hospital care provided for which no payment was received from the patient or insurer—was provided in 2013.
- In key years between 1980 and 2006, growth in healthcare spending is linked to rising costs of treatment.
Implementation of the ACA has gradually influenced how hospitals operate. David Cook, MD, from the Center for the Science of Health Care Delivery at the Mayo Clinic College of Medicine, indicated that his hospital is transitioning from the “Solution Shop” to “Focused Factory” model. Under the Solution Shop model, care expectations are poorly defined and communicated, which leads to “overcare.” The quality of health care decreases and the cost increases as patients stay longer at hospitals for unnecessary treatments. For example, at ambulatory surgical centers, the procedures take less time, allowing providers there to meet demand up in addition to lowering the cost of outpatient care.
A study titled, “Hospital Financial Performance in the Recent Recession and Implications for Institutions that Remain Financially Weak,” conducted by Naleef Farred, PhD, Department of Health Policy and Administration, Pennsylvania State University, et al., indicates that the “recent recession did not compound an already difficult situation faced by financially weak or safety-net hospitals.” This is something to think about when conducting an analysis of the effects of recession on healthcare facilities to determine the best solution to budget issues and patient care.
ASCP supports initiatives that promote increasing the quality of healthcare delivery to patients. Laboratory medicine will be playing a key role in the advent of ACA and, therefore, ASCP continues to participate in briefings on health care.
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