The healthcare industry's shift toward improved care coordination and value-based reimbursement is putting demands on lab services to become better integrated with the rest of the care team, both within the hospital and across the health network. A fully integrated lab can go far beyond collecting samples and reporting results to be an active partner in improving care and reducing costs. Here, lab leaders from some of the nation's top institutions share innovative ways to bring lab services beyond its traditional boundaries and into the mainstream of care.
Vanderbilt University School of Medicine, Nashville, has diagnostic management teams (DMTs) that include lab staff who work with clinicians to identify a given diagnosis or track the effectiveness of a treatment. "We can provide value in the laboratory by going beyond just throwing [physicians] a result," said James Nichols, Medical Director, Clinical Chemistry and Point-of-Care testing, at Vanderbilt. "We can provide that interpretation and then help the physician better manage their patient." For example, the lab might perform multiple studies to determine not only whether a patient is anemic, but whether the symptoms are caused by hemoglobin abnormalities, sickle cell disease, or an iron deficiency, and give the care team a comprehensive analytical report.
"Laboratory leaders and staff can provide better service when they step out of the lab to understand better what their colleagues do all day, said Paula Santrach, M.D., Associate Professor of Laboratory Medicine and Pathology, and Chief Quality Officer at the Mayo Clinic in Rochester, Minn. "One of the most important things I did in my career was to partner with surgeons and anesthesiologist on a research study and spend three months in the operating room," she said. "It's amazing how that can really build relationships with people, and then they listen to you and request your input." Santrach also headed a task force on converting the clinic to digital radiology. "I was the only person around the table who had no vested interest in looking at images," she said. "I spent a lot of time watching their processes and how they do their work... That was an invaluable experience for me and opened up the door for a lot of other opportunities."
"The laboratory is producing vast quantities of data that go into a typical EMR or EHR, and with all that data, there's the need to be able to extract relevant parts of it in order to make data-driven decisions about care, about processes, about what you're going to do within your organization to manage the care of your patient population," said Steven Zibrat, Manager, Laboratories Quality Improvement at the University of Chicago Medicine. Those who don't work in a lab can have a difficult time interpreting lab data and seeing how it fits into the bigger picture. Zibrat recommends labs assign one of their own to work with IT to help build analytical models. "Without that person, without those tools, we're just sitting on top of a gold mine trying to chip away at it with a toothpick."
At Geisinger Health System in Danville, Pa., lab staff have been instrumental in helping reduce the likelihood that post-surgical patients will need blood transfusions, said Diana Kremitske, Vice President of Laboratory Operations. A lab-affiliated RN meets with both the patient and the surgeon prior to a surgery to work out a care plan that reduces the risk of post-operative anemia. This participation is built into Geisinger's "proven care" models for orthopedic surgeries, and has reduced patients' length of stay and their risk for complications from transfusions."It's a real value-added thing on the inpatient side, and we're starting to migrate that clinical know-how to the outpatient side," Kremitske said.
Value-based Reimbursement vs. Fee for Service: Has Your Laboratory Adopted This New Paradigm?
By Irwin Rothenberg MBA, MS, MLS(ASCP)
Making Predictive Analytics a Routine Part of Patient Care
By Ravi B. ParikhZiad Obermeyer and David Westfall Bates, MD