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Medicare Laboratory Payment Policy: Now and in the Future
BOX 3.1The Future of Technology
Edwina Clark, a 42 year old woman with diabetes, no longer needs to test her blood sugar concentrations every day because she now has a glucose sensor implanted under the skin of her thigh. Her toilet at home provides a double check because it can analyze glucose, protein, and bacteria concentrations in her urine. Instead of giving herself daily injections of insulin, she now relies on an implanted insulin reservoir that automatically adjusts her insulin dose. Her blood sugar concentrations are so well controlled that she is unlikely ever to develop any of the vascular and neurological complications that used to be common.
This futuristic case was taken directly from a 1999 editorial in the British Medical Journal (Berger and Smith, 1999).
are reported. These innovations include automation, IT, and laboratory measurement or testing technology. The changes that these technological developments produce, especially how and where testing services are delivered and laboratory-staffing needs, are also discussed.
Automation has been, and promises to continue to be, an important force in the changing laboratory marketplace. Laboratory automated (and manual) processes occur in three stages:
Preanalytic stage: This includes, choosing the test, placing the order, preparing the patient, collecting the specimen, transporting the specimen, any specimen preparation work, and daily quality controls.
Analytic stage: This involves actual testing of the specimen and all routine procedures up to result reporting.
Postanalytic stage: This is concerned primarily with forwarding results to the appropriate hospital department or physician and routine daily maintenance and shutdown (Travers and Krochmal, 1988).1
The three stages of clinical laboratory testing, specifically within the laboratory, were defined in 1988 by Eleanor Travers and Charles Krochmal. Others categorize the computer entry of demographics, test request review, and specimen preparation, including specimen labeling and centrifugation, as a part of the analytic rather than the preanalytic phase of testing (Cruse, 1998). Still others would include steps that take place in the doctor’s office prior to placing the order and following delivery of the test results within these phases.