CAP Today

AUG 2014

CAP TODAY magazine features advances in tests and laboratory equipment, trends in management and clinical operation, regulatory changes and finance, plus news about the laboratory improvement programs of the College of American Pathologists.

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Where smart labs go when the money's gone Kevin B. O'Reilly Payment rates declining. Bad debt rising. Test orders falling. Diagnostic equipment manufactur- ers 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 see- ing and that keep lab directors up at night, heavy lidded, checking their email, illuminated by the glow of their smartphones. Strategies that once reliably yield- ed success in the laboratory business are no longer sufficient, says W. Stanley Schofeld. He is president of NorDx, which operates 11 labs and 23 patient service centers and is owned by the MaineHealth system, also affliated with four other health care organizations in the state. Scho- field 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 si- multaneously add value, cut costs, and improve the quality of the work they do, Schofeld says. Moreover, the pressure is on for laboratories to show how their performance com- pares with that of their peers. "Today, labs are known for, and their value is seen to be in, deliver- ing accurate test results in a timely fashion," Schofeld tells CAP TODAY . "In the future, the value of the labo- ratory 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." To succeed, Schofeld told a crowd of more than 800 at this year's Executive War College, labora- tories must follow fve rules: add clients, keep clients, create revenue opportunities, get paid, and reduce expenses. An essential ingredient in fulflling these man- dates is having the information to help make tough calls on purchasing, staffng, and test menus while demonstrating value to clients, payers, and C-suite decision-makers. After many years of double-digit growth (for which Seamless automation: within reach for AP? Anne Paxton A familiar optical illusion uses a draw- ing of a vase that makes your eyes play tricks. First you see the vase, then two faces gazing at each other, then again, the vase…two faces … ad inf- nitum. It's a concept that comes to mind when thinking about "tracking" in the anatomic pathology laboratory. Does it refer to a physical track—a conveyor belt to automatically trans- port and sort specimens—or to a sys- tem for "tracking"—that is, electroni- cally keeping tabs on specimens? As the AP laboratory steadily closes the automation gap with the clinical laboratory, it's not clear whether ma- chine-age automation or digital-age information technology is more im- portant. But AP laboratory directors and others interviewed by CAP TODAY suggest that IT is increasingly an essential part Laboratories are facing tough times, says Stanley Schofeld of NorDx. "You need to use your imagination on how to do things differently, and you must have execution." Peter Wynn Thompson Study hints at new directions on LAMNs Karen Titus A slow leak in a tire may not be all that interesting—until one is cruis- ing down the highway at 75 m.p.h. Suddenly, that same leak becomes much more compelling. Joseph Misdraji, MD, recalls a conversation he had at a meeting about pseudomyxoma peritonei that skirted a similar curve in the road. Approached by a pathologist who expressed a desire to collaborate with him, Dr. Misdraji suggested a study he was working on, looking at the signifcance of proximal margin involvement in low-grade appendi- ceal mucinous neoplasms, or LAMN. The pathologist's response was as unequivocal as a negative node. "I'm paraphrasing, but it was basically, 'I'll wait until you're doing some- thing more important,'" recalls Dr. Misdraji, associate pathologist, Mas- sachusetts General Hospital, and associate professor of pathology, Harvard Medical School, Boston. Dr. Misdraji laughs about that conversation—he harbors more cu- riosity than ill will about the re- sponse. Any topic can seem small "if you're not dealing with it right now," he says. "But one day when you are dealing with it, or it's your appendix, then you'd like to know that there's some data upon which to base a recommendation." Now, there is. TM Vol. 28 No. 8 Moving? Fax a copy of the above address with corrections to CAP TODAY: 847-832-8153. —continued on 68 —continued on 44 —continued on 35 pathology ◆ laboratory medicine ◆ laboratory management august 2014 Scoring against MRSA Prevention strategies—and related antibiotic resistance, page 76 Mary Hayden, MD (center), and colleagues at Rush University Medical Center, a CDC Prevention Epicenter

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