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Accountable Care Organizations: What is the role of the pathologist? What are the public policy implications?. David Gross, PhD, Director, Policy Roundtable Kavita Patel, MD, The Brookings Institute Elizabeth November, JD, MPH, Centers for Medicare and Medicaid Services - PowerPoint PPT Presentation
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Accountable Care Organizations:
What is the role of the pathologist?
What are the public policy implications?
• David Gross, PhD, Director, Policy Roundtable
• Kavita Patel, MD, The Brookings Institute
• Elizabeth November, JD, MPH, Centers for Medicare and Medicaid Services
• Donald S. Karcher, MD, FCAP, Professor and Chair of Pathology, Director of Laboratories, The George Washington University Medical Center
David Gross, PhDHighlights from Policy Roundtable White Paper on ACOsMay 7, 2012
Goals for Presentation• Share findings from CAP’s case
study of three ACOs where pathologists have taken leadership roles
• Highlight barriers to and opportunities for pathologist success in an ACO environment
• Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs
Background Review• What is an ACO?oA network of health care
providers accountable for the costs and quality of health care services provided to a defined group of patients
oACOs exist in many forms−Medicare−Private sector
Background Review (continued)
• Why should pathologists care about ACOs?
• ACOs visited
Goals for Presentation• Share findings from CAP’s case
study of three ACOs where pathologists have taken leadership roles
• Highlight barriers to and opportunities for pathologist success in an ACO environment
• Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs
FindingsWe identified four common ways in which pathology and laboratory medicine provide a “value add” in ACOs1.Development of protocols for laboratory ordering2.Population health management
Findings (continued)We identified four common ways in which pathology and laboratory medicine provide a “value add” in ACOs3.Improving physician access to actionable data from the laboratory4.Greater collaboration with other clinicians
Findings (continued)We also identified challenges that both pathologists and ACO leadership are facing:1.How to pay pathologists for their contributions2.Improving the capabilities and interoperability of HIT systems
Findings (continued)We also identified challenges that both pathologists and ACO leadership are facing:3. The difficulties of culture change
− For pathologists− Of how other clinicians view
pathology
Goals for Presentation• Share findings from CAP’s case
study of three ACOs where pathologists have taken leadership roles
• Highlight barriers to and opportunities for pathologist success in an ACO environment
• Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs
Opportunities for Pathologists Pathologists—working with other clinicians—have the opportunity to develop evidence-based guidelines for optimal use of laboratory tests to: •Monitor the health status of patients with chronic disease•Detect illness in at-risk patients•Facilitate initiation of treatment interventions
Barriers for Pathologist Participation in ACOs• Many practices lack the expertise
needed to make these kinds of ACO contributions
• Particularly true for small- and medium-sized practices
• Areas for greater expertise may include laboratory medicine, molecular testing, and informatics
• How to pay for enhanced expertise is not clear
Recommendations for Pathologists Seeking to be Active in ACOs• Be proactive• Reach out to local ACO organizers
and leaders• Explain how pathology and
laboratory medicine contribute to ACO goals
• Seek leadership position by joining ACO committees
• Join CAP’s ACO Network at [email protected]
Recommendations for Pathologists Seeking to be Active in ACOs• Document how pathologists
have contributed to enhanced outcomes, more appropriate care, and cost reductions for the ACO
Goals for Presentation• Share findings from CAP’s case
study of three ACOs where pathologists have taken leadership roles
• Highlight barriers to and opportunities for pathologist success in an ACO environment
• Present recommendations of policies to enhance pathologists’ ability to contribute in ACOs
Policy Recommendation #1
ACOs should establish an advisory board that recommends clinical laboratory testing protocols and guidelines.
Policy Recommendation #2
CMS should encourage or recommend that patient electronic health records (EHRs) allow for bi-directional exchange of data between the pathologist and other relevant health care providers.
Policy Recommendation #3
CMS should study the extent to which patients and smaller health care practices in rural areas are able to take advantage of any cost and quality improvements that may be associated with ACOs.
• David Gross, PhD, Director, Policy Roundtable
• Kavita Patel, MD, The Brookings Institute
• Elizabeth November, JD, MPH, Centers for Medicare and Medicaid Services
• Donald S. Karcher, MD, FCAP, Professor and Chair of Pathology, Director of Laboratories, The George Washington University Medical Center
Panel Discussion