The molecular pathology lab is in a moment of transition. Faced with numerous internal and external pressures, lab leaders are having to do more, with less–devising strategies to increase efficiency and throughput, minimizing costs and workload, and adapting their operations for the future of the lab.
At the same time, new technology is emerging to help make this transition possible. In this article, lab leaders discuss the pressures affecting labs today, as well as how technology solutions can help molecular labs to manage them. As lab staff look to the future, they should carefully consider their unique mix of testing demands, cost cycles, workforce considerations, and technology needs–helping them to understand how the can overcome current challenges and prepare for the next decade of testing.
Today, lab leaders are moving away from traditional lab strategies, driven by momentous changes in the healthcare environment. "We definitely are in what I would call a revenue transition period for lab testing," says Dr. Longshore, director of molecular pathology at Carolinas Pathology Group, Atrium Health, Carolinas HealthCare System. In this transition, pressures on the lab have come from multiple fronts: "We're seeing increasing send-out costs, decreasing reimbursement with PAMA fee schedules, decreasing budgets with increasing workloads, as well as personnel shortages."
These pressures will, no doubt, shape the future of the lab, as lab leaders learn to adapt. They fall, in general, into two categories: financial and workforce. Below, learn how new technologies may shape lab leaders' approaches to change.
With decreasing reimbursement–many critical tests will be cut by nearly 30 percent for Medicare beneficiaries, with new PAMA fee schedules and other planned reductions for 2019 and 2020–labs are facing tighter budgets. This fact alone is forcing labs to reduce costs, create new efficiencies, and streamline their operations.
At the same time, significant pressure comes from the difficulty in justifying the value of lab services to health systems–many important tests are simply unprofitable: "In a consolidated molecular pathology laboratory, high-volume infectious disease testing has been a financial engine that keeps things afloat. However, other tests, which are medically vital, are typically more difficult do to, while being low-volume. Their medical value may be high, but not necessarily their monetary value," says Dr. Nolte, professor and vice chair for Laboratory Medicine in the Department of Pathology and Laboratory Medicine, and director of Clinical Labs, director of Molecular Pathology, and director of POC Testing at the Medical University of South Carolina.
Such tests might include, for example, oncology testing, next-generation sequencing, or even healthcare-acquired infections, for which, in the latter case, labs are not reimbursed.
As a result, labs are searching to consolidate and automate processes for high-volume testing, and increasingly for moderate-complexity tests–helping to cut costs and free time to focus on labor–intensive testing.
Meanwhile, laboratorians are contending with higher testing volumes and greater workloads, without the human resources to keep pace. The sticking point is that hiring new FTE staff to account for volume is not only expensive–labor accounts for as much as 60 percent of clinical lab budgets–but it's increasingly hard to come by.
"Despite annual increases in test volume, securing hospital administration approval for more FTEs in the laboratory is increasingly difficult. But, even if we have approval, where do we find people to do the work?" says Dr. Nolte. "Medical technologists are, on average, in their mid- to upper-50s, and there are not many people going into the field. The workforce is shrinking,
As a result, molecular labs are searching for solutions that can accommodate larger testing volumes, without the need to hire new staff. "I think that's going to be the motivating factor for us as lab directors: to meet the medical demands being placed on us, with fewer human resources available. We have to make this whole process more efficient," says Dr. Nolte.
Fortunately for molecular laboratorians, technologies are emerging that can help ease the burden on both fronts–helping to lower costs and drive efficiencies, while accommodating larger testing values without the need for new hires. In most cases, this technology comes in the form of consolidated workhorse platforms that not only offer larger testing menus, but support automation and time-saving pre-analytic solutions.
“I think the real paradigm shift is that, now, many of our high-volume molecular instruments actually can be run on a track line, or there are pre-analytic solutions developed specifically for molecular platforms," says Dr. Longshore. "In the past, we had to have qualitative instruments and we had to have quantitative instruments. Now, we're able to perform all that testing on the same high-volume platform, that also can fit onto an automation line. Because of this, along with menu changes, we can consolidate potentially six instruments onto a single platform.
Aside from driving significant efficiencies, this technology may change the way traditional molecular testing is performed–many molecular tests may soon be able to run in high-volume, chemistry-like environments, if not performed on chemistry instruments themselves.
"I think the real question that we have to be asking ourselves is: what's the next decade going to hold?" says Dr. Longshore. "Traditionally, it has made a lot of sense to consolidate platforms and to consolidate molecular testing into a single lab for efficiency of operation. But many high-volume molecular tests are getting approved with moderate complexity – and at the end of the day, we are putting a sample in at the beginning, telling it the test to run, and it's reporting a result out to our electronic medical record at the end, after it's been reviewed by appropriate personnel. That is much more chemistry-like, compared to what we've done in the molecular lab for years and years.".
In any case, it seems certain that, with significant business pressures coming on two sides, lab leaders will opt to consolidate their energies and drive new workforce efficiencies. For many lab leaders, this future of the molecular pathology lab will involve automated testing – where workhorses with expanded menus offer the chance for lab leaders to drive value for the lab and free time in constrained settings.
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