Timing, as they say, is everything.
As organizations struggle to meet the constantly shifting demands of today’s healthcare environment, labs and clinicians are finding themselves tasked with the growing responsibility of finding new ways to deliver value.
Enter the Diagnostic Management Team concept.
In 1995, Dr. Michael Laposata, Professor and Chairman of the Department of Pathology at the University of Texas Medical Branch in Galveston, initiated his idea to create a Diagnostic Management Team at Massachusetts General Hospital in Boston. In this scenario, the DMT was defined as a group of multidisciplinary coagulation experts who met on a regular basis to evaluate individual patient histories and interpret clinical data. These experts then generated a written narrative that became part of each patient’s medical record to advise on lab test selections and interpret test results with the goals of improving care, reducing waste and lowering the possibility of medical error. The innovative concept proved beneficial, and the Mass General coagulation DMT is still in operation today, now led by Dr. Betsy Van Cott.
Thanks in large part to Dr. Laposata’s passion and advocacy, other organizations across the country have also warmed to the DMT approach, creating their own groups to study a variety of medical conditions across fields and specialties.
“The areas of transfusion medicine, liver disease, autoimmunity, hematopathology, toxicology, anemia, microbiology and potential cases of child abuse all either have a DMT or are close to implementing one,” Dr. Laposata says. “The other major expansion that’s occurring is in the number of medical centers with Diagnostic Management Teams. In a recent webinar, I asked how many audience members had an active DMT on site. The answer was 23.”
Interest in the Diagnostic Management Team concept has steadily gained traction since Dr. Laposata’s initial introduction nearly 25 years ago, but some organizations have been reluctant to embrace it for lack of consistently measurable results. However, as more DMTs have emerged and been able to demonstrate proven value, that mindset is changing.
“Most doctors are aware they need help selecting the correct lab tests to avoid overutilization and underutilization,” Dr. Laposata explains. “They also realize that the high complexity of results, especially genetic results, requires an expert who can translate the diagnostic information into something that can be readily understood by all providers.”
The concept got a boost of credibility in 2015 when the National Academy of Medicine endorsed DMT consultative services as a means of reducing medical errors in the American healthcare industry. It’s also gained momentum and visibility over the past three years through a national DMT conference Dr. Laposata has coordinated each spring in Galveston, TX.
“I recognized the value of Dr. Laposata’s DMT idea after hearing him speak at a CLMA conference back in 1997; we’ve witnessed its growth and written about it as he’s refined the concept,” says Robert Michel, editor in chief of The Dark Report. “When the DMT conference began in 2016, it created a public forum that allowed early DMT practitioners to present their findings and exchange evidence with other scientists. It’s been a real catalyst for expansion.”
These early DMT adopters have provided a blueprint model for others to follow, and as awareness of the concept increases, so should the number of groups nationwide.
“I believe most of the guidance for new groups is occurring at the national conferences,” Dr. Laposata explains. “The leaders of the DMTs that were formed early on have served as speakers at the meetings. In this way, these early pioneers have been given an opportunity to share how they started their own expert consultative services.”
The paradigm shift from reactive toward personalized, proactive care puts new emphasis on more efficient utilization of lab tests to accurately diagnose disease and manage chronic conditions, allowing pathologists to step into a larger leadership role via Diagnostic Management Teams.
“There’s more encouragement now for clinicians to participate in patient care in new ways,” Michel describes. “Traditionally, clinical labs have focused solely on analytical accuracy and meeting turnaround times to deliver patient care on a timely, reliable basis. The DMT provides a format for these professionals to get out of the lab, collaborate with their medical colleagues and share their expertise to establish a new dimension of value.”
By providing molecular and genetic knowledge, labs are in a unique position to explore early detection mechanisms that can help providers treat and/or manage patient disease states more quickly and effectively. DMT-generated data also provides support for providers who can then encourage patients to follow healthier lifestyle recommendations based on the results of appropriate lab test selections, ultimately helping inform healthcare big data and support population health management.
“The need for consultative advice on test selection and results interpretation has dramatically increased as the laboratory test menu has expanded in complexity and cost,” Dr. Laposata points out. “Because there’s so much at stake with lab test overutilization and underutilization, the environment is ripe for Diagnostic Management Teams.”
“With the shift from fee-for-service toward more value-based reimbursement, organizations don’t want to order a bunch of unnecessary tests that waste money,” Michel adds. “It pays to order the most specific tests that can inform and manage proactive care. A lab that can generate that kind of valuable advice saves organizations money.”
In a word, opportunity. Diagnostic Management Teams, especially pathology participants, are poised to play significant roles in driving improved patient care, lowering costs and reducing the chances of medical errors.
“Pathologists are often called the doctor’s doctors for good reason,” Michel says. “They’re highly trained on lab test selections and assay limitations, so they’re in a valuable position to advise doctors as to which are the best lab tests to order, and to help physicians interpret the lab test results to determine the best therapies for their patients."
If they’re able to harness the power of the shifts currently taking place, Diagnostic Management Teams can continue to grow exponentially by proving the value of the lab’s relevant contributions within the greater health care continuum.
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