Diagnostic facilities are the foundation for modern healthcare’s ambitious pursuit of longevity and better health for all.
They have also become significant profit centers that increasingly compete for market share. Here a reputation for vanguard diagnostic methods, expediency and accuracy can catapult a lab or imaging center into the leading market position—if not for a common barrier standing in the way. Most still see over 50 percent of their orders transmitted on handwritten or EMR-printed requisitions.
Based on my experience as a physician who has submitted countless orders of my own, I can tell you these methods take up too much time, invite dangerous errors, and have no built-in mechanism to collect the patient’s portion of the cost. In fact, the diagnostics industry is finally moving away from these archaic methods in favor of an approach that assures the right order with the right codes is submitted for the right patient—and collects patient co-pays right at the point of service. What’s more, the results come back for the correct patient, electronically filed in the right chart, establishing a “one patient, one record” paradigm.
Here are the four specific facets of this “perfect order”:
Electronic order capture. It may come as a surprise to some, but it’s not necessary to undergo a major technology overhaul to process 100 percent of orders electronically. There are diverse options to choose from, including standard EMR interfaces and using a vendor’s web-based portal. So, too, is outsourcing the entire process to a paper-to-digital conversion service.
Patient identity matching. Few measures will propel a lab more quickly into the future than an effective patient identity verification strategy. Duplicate records are still a source of medical errors, billing errors and inefficiencies. Absence of a unique patient ID hinders most labs from participating in population health initiatives, participating in local ACOs and obtaining payer contracts with payers who desperately need clean clinical data. Today’s state-of-the-art technology allows labs and imaging centers to implement a unique patient ID as part of their ordering and results integration efforts.
Maximize revenue. In the age of reduced reimbursements and higher patient deductibles, a laboratory must utilize the latest technologies to be fully accountable for its billing practices. Here a system for allowing real-time order editing before an order enters the laboratory is key. It should allow the lab to receive all orders electronically and fully validated for medical necessity; patient identity; insurance eligibility; and pre-authorization when required. Note that labs need not deploy technology to incorporate these value-added measures to the order process. An electronic ordering vendor should be able to provide these services instead.
Audit-proofing. Fraud is a huge drain on our national healthcare system, and all of us can play a role in reducing it. For labs, that includes diligent compliance, especially with Medicare and commercial payer audits on the rise. As such, more labs and imaging centers are employing novel techniques to assure compliance while keeping detailed digital records of their efforts. While achieving better reimbursement through compliant billing practices, such labs significantly minimize their audit exposure.
These are all innovative measures that can take lab and imaging operations to the next level, without racking up expensive technology costs and work disruptions. Rather, they are more likely to pay for themselves by reducing claims denials and giving facilities a competitive edge in an increasingly crowded market. Most importantly, they will help labs and imaging centers better serve the patients who depend on them for fast and accurate results.
Oleg Bess, M.D., is a founder and CEO of 4medica, the clinical data exchange company. With a quarter century of healthcare experience, Dr. Bess has spent the last 13 years honing his development and leadership expertise in informatics while maintaining his 20-year-old OB/GYN practice in Los Angeles. A board certified OB/GYN physician, he is a nationally recognized gynecological and laparoscopic surgeon.
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