Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Lab Experts Help Providers Reduce Low-Value Resource Use, Costs

The AACC urged healthcare stakeholders to better use laboratory medicine experts to improve resource use and lower costs in value-based purchasing models.

The AACC called on healthcare stakeholders to incorporate laboratory medicine experts on care teams to reduce low-value resource use and healthcare costs

Source: Thinkstock

By Jacqueline LaPointe

- Collaboration between laboratory medicine experts and clinicians is critical to reducing unnecessary and low-value resource use for value-based purchasing success, the American Association For Clinical Chemistry (AACC) recently stated.

“The changing Medicare payment paradigm creates new opportunities for health systems to advance patient care while more efficiently and effectively utilizing their resources,” stated Janet B. Kreizman, AACC CEO. “Laboratory medicine experts are uniquely positioned to ensure this is achieved by working with physicians to devise optimal diagnostic and therapeutic protocols, leading to better health outcomes and reduced costs.”

Value-based purchasing models require providers to improve patient outcomes and healthcare spending while minimizing resource use. However, test utilization continues to challenge providers.

About 15 percent of providers stated that they were uncertain about what tests to order for their patients, a 2014 study. As a result, research showed that almost 21 percent of all laboratory tests ordered were unnecessary or not needed based on the patient’s case.

Hospitals could potentially save $5 billion per year by reducing low-value and unnecessary resource use, a 2009 Health Affairs study showed.

The AACC noted that hospitals and providers can achieve healthcare cost savings via appropriate resource use by emphasizing the laboratory medicine expert’s role in value-based purchasing models.

“The clinical laboratory provides the majority of the objective data available to clinicians,” they stated. “If used properly, this information can help produce the desired effects of enhancing quality and improving cost-effectiveness.”

Using clinical laboratory data, providers can work with laboratory experts to improve test utilization. Experts can advise providers on appropriate resource use, especially since a number of providers expressed uncertainty with ordering the right tests.

Laboratory experts understand the myriad of tests available. For example, if a physician wants to order a Vitamin D test, they have 12 options for selecting the same, similar, or related tests. Providers cannot be expected to know the cost or outcome differences for all the options. Therefore, laboratory medicine experts should be added to care teams.

Experts can also be helpful for recommending appropriate tests to diagnose conditions early, rather than waiting for symptoms to worsen and care becomes more expensive.

For appropriate resource use under value-based purchasing models, laboratory medicine experts can create educational tools for clinicians, develop disease-specific test-ordering guidelines, and help implement computerized clinical decision support interventions.

The AACC added that laboratory medicine expert and clinician collaboration can also improve test interpretation. Laboratory medicine experts can help providers understand test results. Primary care providers were uncertain how to interpret the diagnostic test results in 8.3 percent of their patients, representing about 13 million patients per year.

Providers could benefit from access to laboratory professionals who can include interpretative comments on results or advise all providers attached to the patient by joining the care team.

Additionally, the AACC pointed out that laboratory medicine experts can inform medical school courses because most schools separate clinical and laboratory education.

The professionals can also work with other healthcare stakeholders, including payers, to improve quality assessments of resource use for provider reimbursement and test innovation.

To incorporate laboratory professionals for value-based purchasing success, the AACC recommended that CMS promote collaborative caregiver group models, such as diagnostic management teams.

Some value-based purchasing models already include laboratory medicine experts as part of their value-based care teams. For example, many accountable care organizations include clinical laboratories in their provider networks to better control the quality and costs of tests for their patient populations.

However, a value-based purchasing pilot program for more general collaborative caregiver models would help to make the staffing model more accessible to all providers.

The AACC also suggested that CMS develop and implement evidence-based quality measures that can be used to appropriately reimburse providers for their laboratory test utilization, such as over- or under-utilization, misuse of tests, and accurate interpretation of results.

The Agency for Healthcare Research and Quality should also work with the private sector to create clinical decision support tools to help clinicians with appropriate resource use, the organization added.

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