With inpatient admissions declining and many surgical procedures moving to outpatient settings, more patients are bypassing hospitals and being treated in the community. Consequently, is it time for hospital and health system labs to make more intentional moves into the community in order to preserve their relevance and help their organizations keep patients healthier?
Absolutely, says Dr. Robert Field, professor of law and public health at Drexel University in Philadelphia. But it won't be easy. “We've been talking for 20 years about care moving away from the hospitals, that they're extremely inefficient and no longer necessary," he says. “A lot of hospitals are talking about a transition to an outpatient emphasis. But they still can't give up their bread and butter, so they're torn between the two worlds, having to maintain inpatient facilities [and] inpatient care, while they're sensitive to where care is going more generally. I think labs are in that same situation. They can't suddenly pull up anchor and move away from what they've been doing for decades. And yet they have to be prepared for where things are going.
The first step is to explore ways to add value to the services that a lab already provides, says Steven Gudowski, administrator, Department of Pathology, Anatomy, and Cell Biology, at the Sidney Kimmel Medical College of Thomas Jefferson University, also in Philadelphia. Some pathology departments have instituted a consultation service to fill the gap while a patient is waiting from a referral from a primary care physician to a specialist, he notes. For example, a patient may have a panel of rheumatology tests. While the patient might wait weeks to see the rheumatologist, there's no reason to wait for test results, and an explanation of what they mean. A pathologist might offer to be the bridge between the referring physicians, providing the patient with a short, descriptive report.
The next step might be to become more active in helping physician assistants, nurse practitioners, and other non-physician clinicians, who will take over more primary care as the industry adopts more collaborative care models. “Those advanced providers, nurse practitioners and physician assistants, and maybe increasingly pharmacists, really need help with laboratory testing," says Donald Karcher, MD, professor and chair of pathology and director of laboratories at the George Washington University Medical Center in Washington, D.C. “They will need guidance in terms of what tests to order next or how to interpret a result from a test that they're not used to interpreting. We think that niche will widen as more and more advanced providers and maybe pharmacists will become primary care providers."
Field says that with pharmacists providing primary care services (and even angling for reimbursement for them), it's not such a stretch to imagine laboratorians in a similar role. “[Pharmacists] have been doing it for several years now, rounding with doctors in the hospital," he explains. “You'll see more and more of a movement this way in retail pharmacies."
And with healthy people sending their DNA to online companies to see what medical issues lurk in their genome, Field sees a prime opportunity for lab professionals to establish a role in direct patient counseling outside the hospital or health system setting. “23andMe is now getting into actual clinical assessment of genes that have health consequences," he says. “Coupled with that will come counseling as to what it actually means, and when you see a physician, and how you should incorporate [the findings] into your behavior."
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