Medicare Laboratory Payment Policy Now and in the Future (2000) / Chapter Skim
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3 Technology Trends in the Clinical Laboratory Industry
3 Technology Trends in the Clinical Laboratory Industry
Pages 58-74
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From page 58... ...
has revolutionized the transfer of data by decreasing the time it takes to order and receive test results and by creating opportunities for research on large datasets. Many predict that clinical laboratory technology will play an even more important role in the future delivery of health care (Felder et al., 1999; Wilkinson, 1997~.
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From page 59... ...
~ 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~.
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From page 60... ...
A similar evolution occurred in the hematology laboratory, where the counting of different types of blood cells is consolidated and expanded to include automated differentials on the same in2While transport is still manual, the development of a global transportation system that facilitates rapid transport of people and goods has enabled independent laboratories to centralize their facilities and reduce costs through economies of scale (Burtis, 1996~. 3An aliquot is the small portion of a specimen taken for an assay or test.
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From page 61... ...
, "the vast majority of assays demonstrate technical variabilities that are well within medical needs." 6When considering the task conducted by individuals who do not have technical skills, it is important to note that many states have licensure laws that preclude the conduct of certain testing procedures by nontechnical staff. In addition, Clinical Laboratory Improvement Amendments of 1988 requirements, as they relate to moderate- and highcomplexity tests, do not allow the use of nontechnical staff for certain testing procedures.
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From page 62... ...
Other courses of action might include additional laboratory testing, hospitalization, changing a medication or the dose of a medication, initiating a new course of treatment, monitoring the patient more closely, or counseling a patient to conducted. Reflex tests are tests that are reordered by a physician after an abnormal test result.
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From page 63... ...
Test result reports will be linked to journal articles and other sophisticated multimedia information sources (Friedman, 1998~. This capability may become more important with the increased use of genetic testing by general practitioners since physicians often do not understand the meaning of genetic test results (Holtz~an, 1999~.
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From page 64... ...
Most of these types of tests are paid for by consumers, so they do not have the incentive of insurance coverage to obtain these tests through their health care provider. Collecting and analyzing patient outcome data may become more essential in the marketing of laboratory services as third-party payers increasingly demand evidence that new health care services are cost-effective and positively affect patient outcomes.
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From page 65... ...
As of August 2000, an Internet-based directory of genetics laboratories reports that 469 laboratories and 895 genetic clinics in the United States were performing tests for 753 genetic diseases, compared to only 110 laboratories that conducted genetic tests for 111 different diseases in 1993 (Children's Health i2Reference work includes testing that is sent to an outside laboratory for completion. Many hospital-based, independent, and physician office laboratories do not have adequate equipment and personnel to conduct their own esoteric testing.
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From page 66... ...
Early identification of immunologic markers that predict autoimmune diseases may facilitate early intervention with autoantigen-specific therapy, targeted directly at the component of the immune system that causes disease (Nakamura, 1999~. According to Nakamura, "This approach will require new information systems that will link large-scale databanks and special programs for data mining and retrieval in bioinformatics, cheminformatics, and population genetics.
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From page 67... ...
Experts disagree about whether this trend is the beginning of a dramatic shift in site of service for laboratory testing (Maibach et al., 1998; Woo and Henry, 1994~. Although trend data show that these markets are growing, concerns about costs, the potential for errors, difficulties in linking test results to other clinical processes and information systems, and coverage restrictions by third-party payers may limit the growth of these two expanding testing markets (Sainato, 1999~.
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From page 68... ...
Research from the early 1990s found that the cost per test using a POCT analyzer was significantly higher than central laboratory costs (Tsai et al., 1994~. Others have found that not all types of POCT decrease the TAT of the entire diagnostic process, save sufficient amounts of money to justify the additional expense (Van Heyningen et al., 1999)
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From page 69... ...
division of clinical laboratory devices points out that POCT devices may not have to meet the same quality standards as laboratory-based testing (Uehling, 2000~. Some devices, such as a video microscope used to visualize and count blood cells, may even be exempt from FDA review and subject to only minimal oversight under the Clinical Laboratory Improvement Amendments (CLIA)
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From page 70... ...
Home Testing Home testing is another growing market made possible by technological advances in laboratory testing. Unlike POCT, home testing is decentralized and physicians may not receive the test results unless they are provided manually by patients or entered into shared Internet-based data-monitoring systems.
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From page 71... ...
Reducing the need for labor could have profound effects on the cost of performing testing since labor constitutes approximately 60 percent of the total cost of laboratory services (Jacobs and Simson, 1999~. Kenneth Cruse argues that other benefits of redistributing work among technical and nontechnical personnel include enhanced productivity, increased testing accuracy and precision, significant reduction of TATs, increased physician satisfaction levels, and the potential to reduce the length of stay for hospitalized patients (Cruse, 1998~.
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MLO Med Lab Obs 30, No.
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MLO Med Lab Obs 29, No.
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From page 74... ...
1994. Point-of-care versus central laboratory testing: An economic analysis in an academic medical center.
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