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How to spot the savings from a diagnostic team

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Amy Carpenter Aquino

October 2017—Few pathologists and laboratory professionals would argue with the potential clinical benefit of a diagnostic management team, a group that meets often and provides timely patient-specific reports that synthesize all test results. But getting C-suite executives on board may mean uncovering whether such a team can save the hospital money.

That’s what a health economist set out to find out and reported on at the first Diagnostic Management Team Conference earlier this year.

Several presenters at the conference in Galveston, Tex., in February spoke of the clinical need for and impact of diagnostic management teams, or DMTs. (See CAP TODAY: “Primary aldosteronism: diagnostic team lifts clinical practice,” April 2017; “Family physician makes the case for CP consults,” June 2017; “Integrative consults remove referral inefficiencies,” July 2017.) R. Lawrence Van Horn, PhD, MPH, MBA, executive director for health affairs and associate professor of economics and management, of health policy, and of law at Vanderbilt University, painted a picture of the economic impact and advised others on how they can do the same.

“How can you assign the [financial] impact to the efforts of the DMT specifically and not believe it’s due to X, Y, or Z outside the scope of what you’re looking at?” Dr. Van Horn asked, illustrating the chief challenge.

Dr. Laposata

Dr. Laposata

In 2009, when conference chair Michael Laposata, MD, PhD, was implementing multiple DMT pilots as chief of pathology at Vanderbilt University, Vanderbilt’s associate vice chancellor charged Dr. Van Horn, who had no involvement with DMTs, with proving that DMTs save money.

“It’s very difficult to show that we actually improve care because lots of things happen at the same time, and somebody will say, ‘Oh, patients did better because we implemented our new service,’” Dr. Laposata, now chair of the Department of Pathology, University of Texas Medical Branch at Galveston, said in introducing Dr. Van Horn. “Well, really it was us, because we manage the decision-making about the diagnosis. But when it comes to the data on financial impact from the DMT, they’re quite direct. So Larry did something spectacular.”

Dr. Van Horn told the audience he knew it would be a challenge to isolate the financial benefit of Dr. Laposata’s coagulation DMT pilot. “I had to come up with the ability to tell a story that said the efforts of this coagulation DMT initiative had impact punch and real tangible value,” he said.

The goal of every hospital executive, he noted, is to “get admissions to the hospital and then get them out as fast as possible.”

To show that a DMT can deliver on that goal, Dr. Van Horn dug into the data and other information captured in the Vanderbilt health system.

“I think that all of you appreciate that hospitals in particular are facing some pretty rough times right now, and they’re only going to get rougher,” Dr. Van Horn said. “For us to have the clinical impact that you all want to have on patients, the ability to align clinical effectiveness with the business problem of hospitals, and show that you’re solving the business problem along with the clinical problem, is going to make you much more effective.”

“Bringing down your cost structure and being more efficient with the use of resources will always be a win,” he added, “regardless of what happens with health care reform and what happens with third-party payment in the United States.”

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