1887

Chapter 7 : The Changing Healthcare Environment

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $30.00

Preview this chapter:
Zoom in
Zoomout

The Changing Healthcare Environment, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817695/9781555812799_Chap07-1.gif /docserver/preview/fulltext/10.1128/9781555817695/9781555812799_Chap07-2.gif

Abstract:

This chapter provides a historical overview of reimbursement for laboratory services from 1969 to the present. Traditional indemnity insurance pays claims for beneficiaries to healthcare providers on a fee-for-service (FFS) basis. In the laboratory, test efficacy is measured based on whether a patient’s management is influenced by the test result. Test effectiveness is a measure of whether it changes the patient’s outcome. The new focus of healthcare will be on the five generations of consumers from the last century. Each generation has distinctively different ethics, values, beliefs, and needs. Now, the laboratory’s role is expanding to promote prevention. Genetic testing, point-of care testing (POCT), home testing, and direct public access to preventative testing and screening are increasing. The primary objective for regionalization is to develop a system of laboratories capable of providing services to a larger geographic area and positioning the laboratory system to compete for managed-care contracts. Strategic redesign is emerging as the tactical strategy of the new decade. The ability to constantly deliver value in an ever-changing healthcare environment can be cultivated only through effective listening and learning. Healthcare is changing throughout the world, with screening, diagnosis, and chronic disease management being redirected from the hospital environment to the physician providers. The prospective payment system for inpatient reimbursement and managed-care capitation in the outpatient market led to a commodity pricing strategy, with commercial laboratories using loss leaders to gain managed-care contracts.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7

Key Concept Ranking

Hepatitis C virus
0.5294118
Ligase Chain Reaction
0.4781065
Disease Management
0.4719767
Urinary Tract Infections
0.46615386
0.5294118
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of Figure 7.1
Figure 7.1

Evolution towards regional laboratory system. In a network model, independent laboratories affiliate under a network organization without any consolidation. In a consolidation model, two or more laboratories consolidate core operations to one primary site operating rapid-access operations in remote sites. In a regional laboratory system, a hybrid operation is formed with participants from academic medical center laboratories, a commercial laboratory partner, and participating consolidated hospital laboratory models. (Reprinted with permission from reference .)

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 7.2
Figure 7.2

Bottom-up customer focus: the inverted paradigm. In the new business paradigm, the customer as king maintains the position of influence at the top of the chart. Employees are empowered and trained to provide exceptional customer service, exceeding the customer's expectation. The management teams within the organization must lead by example, building trust among the staff.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555817695.chap7
1. Allawi, S. J.,, B. T. Hill,, and N. R. Shah. 1998.New frontiers for diagnostic testing: taking advantage of force changing healthcare. Clin. Lab.Manag. Rev. 12:37.
2. Appold, K. 2002. Legislative update: law permits more self-referral tests in California. Vantage Point 6(9):13.
3. Appold, K. 2002. Laboratorians find the future on the information superhighway. Vantage Point 6(3):14.
4. Ayres, K. 2000. Genetic testing in the new millennium: government agencies and the public working together. Vantage Point 4(9):17.
5. Baldwin, M. 1986. HMOs’ special status an impediment to modernizing the industry, execs say. Mod. Healthc. 1986(1):26.
6. Beckham, D. 2001. What to watch for in the next three years as the Internet transforms the health-care landscape. Clin. Lab.Manag. Rev. 15:107111.
7. Berger, D. 1999. A brief history of medical diagnosis and the birth of the clinical laboratory. Part 4—Fraud and abuse, managed care, and lab consolidation. MLO Med. Lab. Obs. 31:3842.
8. Berwick, D. 2000. Knowledge always on-call: for docs, practicing medicine will be providing information more than providing care. Clin. Lab.Manag. Rev. 14:250252.
9. Bissell, M. 1996. Defining laboratory related outcomes measures—establishing a link to patient focused care. Clin. Lab. Manag. Rev. 10:9597.
10. Boland, P. 1993. Quality prerequisites for providers, purchasers, and payors. Manag. Care Q. 1(2):13. Aspen Publishers Inc., Gaithersburg,Md.
11. Boland, P. 1993. Role and purpose of performance standards. Manag. Care Q. 1(1):1.
12. Brailer, D. 2001. Peer-to-peer technology: connection tops collection. Health Manag. Technol. 22(8):2829.
13. Combs, K. 1995. Regional progress toward managed care. Va. Med. Q. 1995(3):159160.
14. Cooper, R., and McDonald, Hopkins, Burks and Haber Co., LPA. 1995. Principal elements of risk arrangements, p. 27-35. In Washington G-2 Reports and CLMA’s The Laboratory Guide to Negotiating Managed Care Contracts. Managed care series.Washington G-2 Reports in association with CLMA,Washington, D.C.
15.Coopers & Lybrand. 1993.Health care reform: new choices, new decisions, section II, p. 9. Presented at the Richmond Area Business Group on Health, Inc., 1993 Annual Health Care Conference and Exhibition, Health Care Reform: Adapting to Change, Richmond, Va.
16.Coopers & Lybrand. 1993. Health care reform: new choices, new decisions, section II, p. 11. Presented at the Richmond Area Business Group on Health, Inc., 1993 Annual Health Care Conference and Exhibition, Health Care Reform: Adapting to Change, Richmond,Va.
17.Coopers & Lybrand. 1993. Health care reform: new choices, new decisions, section IX, p. 7679. Presented at the Richmond Area Business Group on Health, Inc., 1993 Annual Health Care Conference and Exhibition, Health Care Reform: Adapting to Change, Richmond,Va.
18. Counts, J. M. 2001. Washington clinical laboratory initiative: a vision for collaboration and strategic planning for an integrated laboratory system. Clin. Lab.Manag. Rev. 15:97.
19. Davis, D.,, L. Connelly,, and V. Fuldauer. 1998. The total package for laboratorians: resource management, clinical guidelines, process improvement, outcomes management. Presented at the Clinical Laboratory Management Association Annual Conference, Philadelphia, Pa.
20. Dollemore, D. 2003. Secrets in your blood—skip the doc, order your own tests. Prevention 2003(4):42.
21. Ellrodt, G.,, and P. Keckley. 2001. Evidence based medicine, where medicine and technology meet. Health Manag. Technol. 22(8):4446.
22. Friedewald, V. E., Jr.,, and R. J. Pion. 2001. Telemedicine: home care returning home. Health Manag. Technol. 22(9):2226.
23. Goldsmith, J. 2000. How will the Internet change our health system? Health Tracking 19(1):148156.
24. Gollust, S. E.,, S. C. Hull,, and B. S. Wilfond. 2002. Limitations of direct-to-consumer advertising for clinical genetic testing. JAMA 288:17621767.
25. Gorman, E. 2000. The new futures of diagnostic testing. Clin. Lab.Manag. Rev. 14:2629.
26. Greene, J. 1997. Has managed care lost its soul? Hosp. Health Netw. 5:3642.
27. Haller, C. 1997. Managed care contracting from the insurer’s perspective, Finger Lakes Blue Cross Blue Shield. Presented at the Executive War College 1997, New Orleans, La.
28. Halsey, J. 2000. Direct access testing in the clinical laboratory: should laboratories offer testing services directly to the consumer? Clin. Leadersh.Manag. Rev. 14:261265.
28a.. Hammer, M.,, and J. Champy. 2001. Re-engineering the Corporation: a Manifesto for Business Revolution. Harper Business, New York, N.Y.
29. Harari, O. 1999. The trust factor. Clin. Lab.Manag. Rev. 13:2831.
30. Harty-Golder, B. 2003. Telemedicine: look before you leap. MLO Med. Lab. Obs. 35:40.
31. Hirschman, S. 1994. Merger mania strikes MCOs, but is bigger better, or will it be harmful to market competition? Manag. Healthc. 1994:5.
32. Holton, J. 2002. Viewpoint: meeting the needs of the pay-atthe- pump generation. Health Manag. Technol. 23(1):7879.
33. Kant, J. 2001. Molecular diagnostics: promise, pain for labs. Adv. Admin. Lab. 10:14.
34. Katz, F. 2002. Genetic testing in mainstream medicine. Lab. Med. 33:501504.
35. Kennedy, M.,, and R. Pickett. 1997. Will your laboratory be ready for the future? Clin. Lab.Manag. Rev. 11:233.
36. Kost, G. 1998. Optimizing point of care testing in clinical systems management. Clin. Lab.Manag. Rev. 12:361362.
37. Kraft, C. 2001. Who’s managing whom? The silent generation, boomers, Xers, and the newly evolving millennials. Vantage Point 5(2):17.
38. Kuriyan, J. 2001. HIPAA and MCOs: administrative simplification or IT modernization? Health Manag. Technol. 22(10):4041.
38a.. Laboratory Industry Report. 2000.9(9):7. Washington G-2 Reports,Washington, D.C.
39. Lehmann, C. 2002. Management of point-of-care testing in home health care. Clin. Leadersh.Manag. Rev. 16:2730.
40.Lips, Bradley and Harris, Geoffrey, CFA. 1995. The clinical laboratory industry. New opportunities from a changing competitive environment, no. 12, p. 14. SmithBarney, Traveler’s Group, New York, N.Y.
41. Logue, J. 2002. Pharmacogenetic testing, coverage, and coding. Vantage Point 6(10/11):1, 68.
42. Louie, R. F.,, Z. Tang,, and G. J. Kost. 2001. Trends in POCT—a glimpse into the future of this new paradigm of distributed testing. Adv. Admin. Lab. 10:2632.
43. Lovic, R.,, and J. Gentry. 1984. Dimensions in Healthcare, p. 15. Peat,Marwick,Mitchell & Co., Philadelphia, Pa.
44. Marques, M.,, and J. McDonald. 2000. Defining, measuring the value of clinical information. Clin. Lab.Manag. Rev. 14:275278.
45. McClatchey, K. 2002. Perspectives in pathology—advances in molecular pathology. Adv. Admin. Lab. 11:14.
46. Michel, R. 2002. Disease management relies on lab testing. Dark Rep. 9(15):1617.
47. Michel, R. 1997. Regional lab systems beginning to emerge. Dark Rep. 4(7):514.
48. Michel, R. 2003.Hospital mergers down for fourth straight year. Dark Rep. 10(3):1011.
48a.. Miller, J. E. 2001. A Perfect Storm: the Confluence of Forces Affecting Health Care Coverage. National Coalition on Health Care, Washington, D.C.
49. Monahan, C. 1997. Special feature: is disease screening worth it? Vantage Point 1(8):13.
50.National Intelligence Report. 2002. Focus on: the healthcare crisis. Nat. Intel. Rep. 23(15):46.
51. Neuhauser, P.,, and R. Bender. 1998. Merging, partnering, and restructuring: coping with culture clashes. Clin. Lab. Manag. Rev. 12:405409.
52. O’Neal, W. 1998. Focus on genetic testing—the laboratory’s piece of the genetic testing puzzle. Vantage Point 2(15/16):13.
53. Parrot, J. 1998. Proactive management in the managed care era. Clin. Lab.Manag. Rev. 12:310312.
54.Professional and Economic Affairs Committee. 1999. Professional Relations Manual, 11th ed., p. 254263. College of American Pathologists, Northfield, Ill.
55. Rainer, R. 2000. Is telepathology right for your lab? Adv. Admin. Lab. 9:5357.
56. Reichheld, F. 1993. Loyalty-based management. Harv. Bus. Rev. 1993(3):6473.
57. Salk, J.,, and F. Ray. 1997. The buoyancy of laboratory networks. Adv. Admin. Lab. 6:7680.
58.Salomon, Smith Barney. 2002. Industry overview, Fig. 22. Salomon, Smith Barney Equity Research Report. Reprinted with permission for Lab Institute 2002 in Washington, D.C.
59. Skjei, E. 2002. Getting ready for the bioinformatics shakeup. CAP Today 16(8):16.
60. Soloway, H. B. 1995. Establishing a direct laboratory access program. Clin. Chem. 41:809812.
61. Solz, H. 2001. Disease management: getting better all the time. Health Manag. Technol. 22(9):4244.
62. South, S. 1999. Seeking the competitive advantage: it’s more than cost reduction. Clin. Lab.Manag. Rev. 13:173177.
63. Swisher, K.,, J. Begun,, and D. Ulmer. 1999. Hospital-physician relationships in the integrated delivery system: an ethical analysis. Clin. Lab.Manag. Rev. 13:311.
64. Titus, K. 1999. Future of self-test market not in the bag. CAP Today 13(6):110.
65.Trigon Blue Cross and Blue Shield. 1996. Trigon Blue Cross and Blue Shield Professional Provider Manual, p. 3941. Trigon Blue Cross and Blue Shield, Richmond,Va.
66.Trigon Blue Cross and Blue Shield. 1996. Trigon Blue Cross and Blue Shield Professional Provider Manual, p. 7475. Trigon Blue Cross and Blue Shield, Richmond,Va.
67. Walker, A.,, and B. Ziegler. 1997. Quality and outcomes management: what is the laboratory’s role. Probe, Module 9:Outcomes Management, p. 18. CLMA,Wayne, Pa.
68. Weber, L. J.,, and Bissell, M. G. 1998. Case studies in ethics— consent and confidentiality in genetic research. Clin. Lab. Manag. Rev. 12:435436.
69. Weber, L. J. 2000. Access to medical information: 10 ethical guidelines. Clin. Leadersh.Manag. Rev. 14:280283.
70. Wedlund, P. 2001. The cost of genetic testing. Adv. Admin. Lab. 10:20.
71. Wilkinson, D. S. 2000. Technology assessment: measuring the outcomes of laboratory practice. Clin. Lab.Manag. Rev. 14:267271.
72. Wills, S. 2000. The 21st century laboratory: information technology and healthcare. Clin. Lab.Manag. Rev. 14:289291.
73. Wilson, M. J. 1998. Enhancing managed care opportunities of group practices. Health Care Finance 24:6577.
74. Yablonsky, T. 2000. Bringing healthcare and education within reach—distance learning, telepathology transform laboratory medicine. Lab.Med. 31:198205.
75. Zeiger, B. 1997. Ethics: genes, clones, and other “neat stuff.” Special interview with Arthur Caplan. Vantage Point 1(14):16.
76. Zeiger, B. 1998. At the wheel of a point-of-care program. Probe, Module 14: Point of Care Testing, p. 16. CLMA,Wayne, Pa.
77. Zeiger, B. 1998. A closer look at alternative medicine: considering the alternative. Vantage Point 2(15/16):46.
78. Zeiger, B. 1998. Say hello to the future. Probe, Module 24:Laboratory Trends for 1999—A Look Ahead, p. 210. CLMA,Wayne, Pa.
79. Zneimer, S. 2002. The Human Genome Project: exploring its progress and successes and the ethical, legal, and social implications. Clin. Leadersh.Manag. Rev. 16:151157.

Tables

Generic image for table
Table 7.1

National limitation amounts

National limitation amounts became effective in 1986. Median payment caps for laboratory services continuously decreased from 1986 to the present. See D. Weissman, , p. 315–318. (Washington G-2 Reports, Washington, D. C., 2002).

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.2a

Legislation and regulation impacting healthcare and clinical laboratories

HCFA, Health Care Financing Administration; CMS, Centers for Medicare and Medicaid Services.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.2b

Legislation and regulation impacting healthcare and clinical laboratories

HCFA, Health Care Financing Administration; CMS, Centers for Medicare and Medicaid Services.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.3

Decline of health coverage

From Miller ( ); see also reference 50.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.4

Percentage of clinical laboratory industry market revenues by segment

In 2001, the clinical laboratory industry was worth $35 billion. Figures for 1995 and 1998 are from the Centers for Medicare and Medicaid Services Office of the Actuary. According to the SMG Marketing Group, the number of hospitals in integrated networks was 2,060 in 1995, 2,819 in 1998, and >3,100 in 2001, for a 6-year difference of about 1,000. See reference 58.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.5

Comparison of traditional indemnity and managed-care insurance ( )

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.6

Types of MCOs and services

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.7

HEDIS performance criteria developed by the NCQA for rating MCOs

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.8

Quality management tools used by MCOs

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.9

Evolution of the educated consumer

See reference 37.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.10

Internet stakeholders: barriers and benefits to healthcare

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.11

Advantages and disadvantages of POCT

See reference 42.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7
Generic image for table
Table 7.12

Genetic mapping techniques

See reference 79.

Citation: Harris A, Wilkinson D. 2004. The Changing Healthcare Environment, p 160-192. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch7

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error