We drive

With Labor Day upon us, it seems appropriate to share another playlist. This one is called “Automobile.” The driving theme seems appropriate because so many people take advantage of this three-day weekend to take driving trips. Unfortunately, the song that inspired the title — John’s Prine’s “Automobile” — is not available on Spotify. Here’s Prine playing it live in a 1980 televised concert. Song starts about 1 minute, 40 seconds in.

Anyhow, here’s the rest of the playlist. I had to make a couple of substitutions, again due to Spotify: a Bluegrass version of “Cut Every Corner” from The Simpsons, and John Hartford doing “Turn Your Radio On” instead of Grandpa Jones.

Labs grapple with handing results directly to patients

Time is running short for laboratories to figure out how they will comply with a federal regulation that for the first time requires all U.S. labs to give patients their test reports within 30 days of request.

With the Oct. 6 deadline for complying with the mandate fast approaching, leaders at two laboratories shared how they are wrestling with the regulation during a July 31 webinar hosted by G2 Intelligence.

A process that at first blush may seem fairly straightforward—patient requests test results, lab hands them over—gets complicated fast. How does a patient request the test reports? How does the lab that conducted the test verify the identity of a patient, or of a patient proxy, who may live in another state? And how should labs handle patients’ access to sensitive test results relating to sexually transmitted infections, or life-changing diagnoses?

My latest in CAP TODAY’s Put It on the Board section. Read the whole shebang.

Where smart labs go when the money’s gone

Payment rates declining. Bad debt rising. Test orders falling. Diagnostic equipment manufacturers checking in on test-volume commitments. A wrenching transition from fee-for-service care to population-based medicine. These are a few of the trends that laboratories across the country are seeing and that keep lab directors up at night, heavy lidded, checking their email, illuminated by the glow of their smartphones.

Strategies that once reliably yielded success in the laboratory business are no longer sufficient, says W. Stanley Schofield. He is president of NorDx, which operates 11 labs and 23 patient service centers and is owned by the MaineHealth system, also affiliated with four other health care organizations in the state. Schofield is cofounder and managing principal of the Compass Group, a 501(c)(6) business league whose 24 lab members represent more than 300 of the nation’s most prestigious hospitals and health systems.

Labs are being called upon to simultaneously add value, cut costs, and improve the quality of the work they do, Schofield says. Moreover, the pressure is on for laboratories to show how their performance compares with that of their peers.

“Today, labs are known for, and their value is seen to be in, delivering accurate test results in a timely fashion,” Schofield tells CAP TODAY. “In the future, the value of the laboratory is that it will help manage that the right test was done on the right patient for the right reason, and that the right cost will be available. And that they manage the data, rather than just report the data. That is one of the huge transitions that labs have to go through right now, and that we are preparing for.”

My cover story in the August issue. Read the whole shebang.

Ethics of laboratory billing at stake in AMA’s code

Proposed revisions to the American Medical Association’s Code of Medical Ethics would remove language that supports direct billing and condemns clinicians who charge markups for laboratory or pathology services. The changes could weaken efforts to rein in billing practices that CAP leaders argue are not in the best interest of the patient and that the AMA currently defines as unethical.

“The importance of this is that many states utilize the AMA’s code of ethics as their code of ethics for things related to medicine. . . . So, if you change the AMA code of ethics that these laws are based on, then people can make the argument that since these ethics principles have changed, perhaps these laws need to be changed,” Daniel C. Zedek, MD, tells CAP TODAY. He is an alternate delegate to the AMA House of Delegates for the CAP and is director of dermatopathology at the University of North Carolina School of Medicine.

My latest in CAP TODAY’s Put it On the Board section. Read the whole shebang.

Lab gets a jump on pay-for-value world

Before the Affordable Care Act was passed, and before the notion of an ACO became a Medicare reality, Richard J. Cote, MD, was among those in medicine who saw the writing on the wall regarding health care payment.

Dr. Cote recalls his thinking as he joined the University of Miami Miller School of Medicine in 2009 to become chair of its Department of Pathology.

“President Obama had just been elected. There was a great push for creating a comprehensive health care system across the country to insure uninsured people,” Dr. Cote tells CAP TODAY. “What was very clear to me, even before the ACA came into being, was that this push was going to accelerate the at-risk model of reimbursement and that there was also going to be very much a downward pressure on reimbursement for all medical services, including pathology, which we’ve clearly seen take place. And there was going to be a move to better coordinated management of care.”

Dr. Cote and his laboratory colleagues at UM are preparing for this transition away from the traditional, and still predominant, fee-for-service payment model. They say the health-system–owned laboratory must move beyond its established role to show how it will help cut costs while improving care and outcomes.

My latest feature article in CAP TODAY. Read the whole shebang.

For trainees, information ‘gaps are closing’

With the dismissal of residents from training programs having led to well-known tragedies, the most recent in pathology just a year ago, attention is being paid to the importance of ensuring residents’ well-being and properly handling remediation, probation, and dismissal.

The Accreditation Council for Graduate Medical Education has strengthened its requirements for what kind of information residency programs must share about residents’ performance. The ACGME’s common program requirements, last revised in June 2013, say “a program director must provide timely verification of residency education and summative performance evaluations for residents who may leave the program prior to completion.”

My latest in CAP TODAY’s Put it On the Board section. Read the whole shebang.

Making the most of big data no easy task

A trillion base pairs of sequence here, a trillion there. Pretty soon, you’re talking about a lot of information—and it all needs to be managed. That’s the dilemma facing Mayo Clinic and other health care organizations leading the personalized medicine revolution that relies on compiling and analyzing patients’ genetic code to better diagnose, predict, and treat disease.

“We generated 90 trillion base pairs of sequence last year,” says Eric Wieben, PhD, director of Mayo’s Medical Genome Facility in Rochester, Minn. “Gathering big piles of data is the easy part. It’s trying to transform the data into knowledge that’s the hard part.”

My latest in CAP TODAY’s Newsbytes section. Read the whole shebang.

Cancer biomarker use varies widely, needs a ‘broader view’

Despite an explosion of research into cancer biomarkers and professional guidelines that urge testing for certain genetic mutations that help detect disease, anticipate its course, or predict response to treatment, many cancer centers are out of sync with oncology testing recommendations.

Payment policies, regulatory oversight, clinician preferences, and varying access to testing technology are among the factors that contribute to discrepancies in cancer care.

So says Jan A. Nowak, MD, PhD. And he is worth hearing out on the subject, as did an audience of hundreds of pathologists, oncologists, and others at this year’s Cancer Biomarkers Conference in Houston.

“Adoption of biomarker cancer testing is not high among cancer centers,” Dr. Nowak told the crowd. “It seems high to us because . . . we go to the meetings and we talk to each other, and we’re doing this stuff. But then there are the people who are not going to the meetings, not talking about it, and not doing it.”

My latest feature article in CAP TODAY. Read the whole shebang.

Here’s the problem …

… If your drug cops conduct a raid that ends up putting a child in the hospital with critical burns, and they did nothing that violates your department’s policy, then there’s something wrong with your policy.

A flashbang is an explosive device that emits a deafening boom and a blinding flash of light. It’s designed to temporarily stun the occupants of a building so that the armed men who deployed it can “clear” the building. It is an instrument of war. And cops are tossing these things through doors and windows with no idea what’s on the other side. Indeed, that’s the whole point.

— Radley Balko, “Georgia toddler critically injured by police’s flash grenade

It’s worth remembering …

… that the inconvenience and injustice of the TSA’s activities exists for literally no reason. If the agency’s privacy violations and annoying carry-on regulations were merely the price we paid for reducing the incidence of terrorist attacks, that’d be one thing. But, as security expert Bruce Schneier likes to note, there’s no evidence that the TSA has ever prevented a terrorist attack, and there’s some research suggesting it could serve to increase non-airborne terrorist attacks. Airline security is, so far as we can tell, totally useless.

— Dylan Matthews, “The case for abolishing the TSA