CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Ayvazian (Abbott Diagnostics): Health care systems are consolidating, budgets are under more pressure than ever, and new payer models are beginning to surface. Patient volumes are higher and the demand for analytics and information from the lab is greater, and customers are turning to their diagnostic partners to help them navigate these new waters. Instead of looking simply at throughput or the variable cost per test, they now want to take a more holistic view of the total value a system brings to them and how they can add more value throughout the care process. We are partnering with labs to help them understand the total value of their system’s policies and procedures, to help them better achieve operational efficiency and clinical care excellence.
Kaufman (Ortho): One of the big areas is to identify ways to better manage diseases and get patients treated faster and more efficiently and with fewer complications. It’s about enabling the shift from treatment to prevention, and it’s becoming easier to quantify the medical and economic value of that shift. We’re also finding that customers increasingly value service and support, including predictive analytics and e-Connectivity, which are differentiators for Ortho.
Dr. Cook (BioMérieux): PAMA and its impact on outpatient testing is a concern. Antimicrobial stewardship is becoming a more prominent topic, especially the role of the lab as the primary objective data source—for example, testing for procalcitonin, AST, and Clostridium difficile.
Can the industry’s success with automation and ease of use successfully match the worrying decline in skilled labor availability, or does there become a point at which this problem must be addressed by others (in the systems, schools, societies)?
Kaufman (Ortho): It has to be a balance. The role of the clinical laboratory scientist is becoming more important. We will need to continue growing the field of the clinical lab scientist to make up for all the retirements, but the ones who stay will continue to deliver greater value. Automation may automate many of the manual tasks they had to undertake previously, but that means the tasks we rely on the clinical lab scientist to perform are more critical and complex.
Amodeo (Siemens Healthineers): Skilled labor is indispensable, but in many situations vendor-supplied automation will be able to offset the decline for the short term. A shortage of skilled laboratory workers has been decades in the making—the result of a retiring workforce and a shrinking number of accredited training programs. Vendors have been designing products with this issue centrally in mind. When we developed the Atellica Solution, for example, we knew more customers needed analyzers with automation-level capabilities. The Atellica Solution saves time with sample loading, sorting, and routing to multiple analyzers. These types of product innovations make automation more accessible. A lab that outfits itself with the right complement of products can remain viable for five to 10 years even while sustaining some staff losses to retirement.
Ayvazian (Abbott Diagnostics): We are designing our innovative systems with automation that provides the flexibility and efficiency to meet changing demands with confidence. This includes using labor efficiently but also improving turnaround times, reducing human error, and adding the capability to manage increased volumes.
McCarthy (Binding Site): There will always be a need for skilled labor. In a few years we will have to reassess if the decline in skilled labor should be addressed and determine if additional action by schools or societies is needed. Labs are working well with the instruments offered today, and the ease of use of the instrument, such as our Optilite instrument, is helping in that situation.
Dr. Cook (BioMérieux): Increased automation allows laboratory managers to release trained staff from repetitive tasks. Simpler systems, such as the Vidas system, also offer the benefit of increased reliability, which is critical for high-value medical stat testing.
Cost concerns are always with us. What new approaches to cost and value do you see from customers and wish to pursue as a corporate matter?
Ayvazian (Abbott Diagnostics): We see forward-looking customers taking the approach of total value of ownership. Rather than looking simply at a technical specification and the cost of an instrument or assay in isolation, total value ownership looks at the entire value equation. Things like access to real-time data, long-term sustainability, waste and environmental impact, site impact, exception management, inventory management capabilities, multisite management capabilities, and more need to be considered. Approaching it from this perspective provides the tools and insights not only to better manage the lab but also to enable the lab to provide more value to its stakeholders to help achieve measurably better health care performance.
Amodeo (Siemens Healthineers): Doing more of the same is not necessarily an option for laboratories. They’re thinking about outsourcing some of their business or figuring out how to become more efficient. We want to arm them with IT and workflow transparency. When we put an inventory management or reagent efficiency tool in place, they can see more clearly from their own data whether it makes sense to run a test at a certain price. Maybe that’s an opportunity for cost improvement from an inventory management perspective. Some laboratories don’t know what they don’t know. We’ve seen these tools lead customers to optimize their ordering habits.
From a workflow perspective, we offer consultative observations and engagements for customers. Once labs realize how many minutes per day or year are being spent on repetitive activities, they can consider whether automation can handle their workload into the future, even after expected attrition of staff. Many times it can, and that can significantly lower operational costs.
Kaufman (Ortho): It’s about looking for tests that deliver greater medical value. If you can directly tie the use of a test and an application within a treatment protocol to reducing length of stay or having a lower level of complications from cardiac surgery, that becomes very impactful. As a vendor, we have a responsibility to help customers identify and promote those opportunities within their medical system, so that the medical system can decide if it wants to engage in adopting those new tests to get the associated improvements in patient care and savings. We may help them by providing tools to calculate the potential impact of new tests, using inputs that the laboratory or hospital would provide, and they in turn use those to help justify novel testing that goes beyond what their lab budgets would historically support, because the value they deliver to the hospital is many times greater than the incremental costs.
Dr. Cook (BioMérieux): The BioMérieux approach is to provide high-value medical tests that require rapid turnaround: procalcitonin for sepsis and antibiotic stewardship, NephroCheck for kidney injury through our recent acquisition of Astute Medical, and concussion-related biomarkers through our partnership with Banyan Biomarkers. The human suffering and dollar costs of antibiotic resistance, acute kidney injury, and traumatic brain injury are enormous. High-value medical immunoassays provide complete and accurate information to help clinicians make faster decisions in diagnosing and treating these conditions.
Our customers play an increasingly important role in antibiotic stewardship teams that are now mandated for every hospital in the U.S. The lab’s information sets in place the trajectory of patient care for every patient with a suspected infection. Incorrect or excessive therapies can be avoided.
Another cost-saving measure is longer-term agreements. Customers want a partnership that offers savings and added value in the form of enhanced education or support. Our education support and service response times are excellent. We help labs articulate their value to their institution in the form of stewardship, data integrity, and more, instead of being seen as a cost center.
McCarthy (Binding Site): We are working with customers to understand how to mitigate reduced reimbursement due to PAMA. We also look at the big picture with HEOR (health economics and outcomes research). This new approach is meant to help customers weigh the costs of diagnostic tests with the effectiveness of earlier diagnosis and treatment. Labs affect patient care by helping to provide an accurate diagnosis earlier, which enables treatment to be started sooner and reduces overall health care expense.
If you have thoughts about the following product guide—where it works well, where it doesn’t—we’d like to hear from you. Send comments to Kristen Eberhard at keberha@cap.org.