Is Your Lab on the Cutting
Edge of Diagnostic Testing?
Should it Be?
Maria Hardy, IMA (ASCP)
Technical Writer, CRI (COLA Resources, Inc.)
M
any Physician’s Office
Laboratories (POLs) were
opened to provide quick and
accurate diagnostic results to
clinicians by keeping testing
in house. In 2012, this model was in place for
116,634 of the 232,996 laboratories in the U.S.1
Many of these labs are in the office practices of
primary care physicians, and some are in
specialty practices that made the decision to
have an in-house laboratory based on the
necessity or desire of having certain tests at
their fingertips.
According to an article in the Journal of
General Internal Medicine, “physicians who own
diagnostic testing equipment are more likely to
order tests and highlight the important role that
self-referral plays in the practice of outpatient
medicine.”2 These specialty tests, in conjunction
with traditional diagnostic tests such as
Complete Blood Count (CBC), Blood
Chemistry Tests/Basic Metabolic Panel and
Urinalysis, have created a one-stop shopping
approach to medical care in many private
practices. But, as patients’ needs and medical
technologies continue to change, so, too, must
the POL.
In looking at future trends in lab testing, the
factors to consider are as varied as the number
of tests labs can provide. “Growth in physician
office testing is fueled by trends in preventative
medicine and proactive approaches in treating
the increasing number of diagnosed diabetics;
by the globalization of infectious diseases and
the associated public health issues; and by the
need to monitor the explosion of people with
cardiovascular disease and other chronic
conditions,” according to a 2010 Kalorama
Information market research report, “Physician
Office Laboratory (POL) Testing Markets
Worldwide: Status Quo and Future Trends.” 3
POLs are uniquely positioned to be able to
provide high quality, immediate testing that can
directly impact treatment and patient care,
while also generating additional revenue for
their practices.
Major factors to consider in testing trends
are government regulation and oversight. The
Physician Fee Schedule (PFS) was put on the
table in 2013 by the Centers for Medicare &
Medicaid Services (CMS) to trim excess costs
and reduce physician overpayment or alleged
abuse for self-referral based-testing. This
legislation is still being considered, as
thousands of physicians and laboratory
organizations are voicing their concern over the
methodology used in reducing these
reimbursement fees. According to a recent
article in the American Society of Clinical
Pathology’s ePolicy News, “Under the physician
payment cap proposal, a ceiling on PFS
payment rates is imposed, but only in cases
where payment for the service provided at a
‘non-facility’ (non-hospital setting) exceeds the
payment provided under the Medicare
Outpatient Prospective Payment System’s
(OPPS) fee schedule. Payment amounts for
services that are less on the PFS than the OPPS
are not affected. CMS’s rationale for imposing
the cap is based on the belief that physician...
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