The steady shift away from fee-for-service to value-based reimbursement models that is taking place within our healthcare system is influencing the what, where, and how of lab testing. Specifically, the changing healthcare dynamic influences what tests are offered on lab menus, where lab testing takes place, and how those tests are reimbursed.
Patients Becoming Better-informed Consumers
Part of the reason for this change is that unsustainable healthcare costs now place more payment responsibility on the patient through high-deductible health plans (HDHP). This, in turn, is prompting patients to become more savvy “shoppers” or better-informed consumers in regards to their healthcare choices. At the same time, technology advances are allowing more care to be performed on an outpatient basis, to include point-of-care testing (POCT), telemedicine visits, and remote home monitoring.
The Engaged Patient
Patients are being encouraged to take a more active role in their healthcare decisions. As a society, we have become accustomed to technology’s role in our everyday lives, so we begin to expect similar services and mobility within the healthcare system. Patients want mobile access, convenient locations, and cannot afford to wait hours for visits. Patients, whose satisfaction has finally become a factor, are demanding convenient, affordable, quality care, with flexibility in visit times. Engaged patients want access to their healthcare data and transparency in costs so they can understand their choices.
Hospitals Serving Outpatient Needs
As a result, hospitals, faced with declining numbers of inpatients, are expanding their reach through urgent care facilities; remote, freestanding emergency rooms; outpatient surgery centers; and other satellite care locations. Adding to the mix of this perfect storm of change are crowded emergency departments and shortages of primary care providers, particularly in rural locations. “Micro-hospitals” offering emergency services with fewer beds are also becoming more widely available.1
De-centralized Lab Testing at Retail Clinics
In addition, retail chains, such as CVS’ MinuteClinic and Walgreens’ Healthcare Clinic, are opening their doors for certain non-critical conditions, including POCT for labs. This is an example of how laboratory testing menus and locations are shifting with the times.
Increased Value in POCT
This rise in POCT makes sense in healthcare’s new paradigm of providing care near the patient. And POCT technology is rapidly advancing to meet this demand; for instance, there are already very accurate molecular POCT devices available. This shift aligns with other technology advances in our lives. It makes sense to be able to go to the drug store, have POCT, and get a diagnosis for simple conditions such as strep throat or ear infections. The pharmacist can fill the prescription immediately, as opposed to waiting in the primary care or pediatrician office for hours, then traveling to the pharmacy and waiting again.
Laboratories should be aware of this shift in services and in the patient’s perspective, and should keep this in mind when deciding when and where it is appropriate to offer POCT and what tests to keep on the core lab menu. Laboratory data is vital to rapid, accurate diagnosis, so it makes sense to get that information as quickly as possible and near the patient, as technology allows. We are in a time of change, and laboratorians must continue to demonstrate their value and support patient care initiatives that improve quality and access to care.
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- Warren, A. (2017, October 2). Five reasons why retail clinics are a “game-changing” threat to traditional healthcare providers that could strain clinical laboratories and pathologists. Dark Daily. Retrieved from https://www.darkdaily.com/five-reasons-why-retail-clinics-are-a-game-changing-threat-to-traditional-healthcare-providers-that-could-strain-clinical-laboratories-and-pathologists-1002