With the passing and legitimization of the Affordable Care Act (ACA) the landscape of medicine has been forever changed. Subsequent changes have been impactful on Pathology and Laboratories, namely in how they have changed Medicare reimbursement rates for physicians and laboratories.
Recently, the big changes have centered on introducing “value-based” assessments of services rather than the traditional volume-based approach. A value-based model, it is argued, will reduce extraneous testing and create the link between quality of care and laboratory and physician practices.
While this line of reasoning is logical and should be endorsed, the practical matter of trying to measure value and quantify it is daunting, especially in the laboratory. Physicians can point to various successes in measuring quality, but laboratories must measure theirs almost like a factory would measure its own efficiencies and short-comings. In order to stay ahead and be rewarded for providing value to the process, laboratories should begin monitoring some of the following “factory-like” metrics now.
1. Days since last accident
No, I don’t actually mean that in the way they might use it at a construction site. What I mean here is essentially ‘how many days, months, and years have passed since an item was lost or grouped in with a different case?’ These are the most catastrophic errors for laboratories and can result in substantial time and money loss. Tracking your lab’s aversion to these massive mistakes is as good a place as any to start measuring quality.
2. How many defects per batch
Now that we are quantifying the big problems let’s quantify the small ones as well. The transformation of a specimen to a slide is a complicated process that involves plenty of detail and moving pieces. As such, it is prone to small errors stemming from both the human and machine components of the process. Errors may include improper processing in the tissue processor or over or under staining, dropped and broken slides, or any amount of contamination issues. These issues are loosely monitored in the lab, but they ought to be documented, stored and then mined as valuable information. Showing reduction of these errors over time is a real example of demonstrating quality and value.
3. Production time
We’re monitoring our big errors and our small ones so we can measure how often errors occur and the nature of the errors. If we combine this study with time we will really be in good shape. Measuring time spent processing a tissue sample is tough due to the variance in the process. However, setting industry-standard goal times on ubiquitous tasks in the lab allows us to measure and understand whether our lab is meeting its goals. As you begin to involve software solutions, time stamps aid in collecting the information and processing it into meaningful reports. In the end, you should be able to understand how effective your laboratory is against industry averages or your own goals.
Combining these three measures allows managers to fully grasp their laboratory’s deficiencies and strengths, while also providing a real measure of the value the laboratory imparts on the whole process of producing and diagnosing the sample. Being able to measure the lack of large and small errors over time and incorporating process speed into this measure allows us to see how the lab stacks up. Seeing these metrics over time will allow you to create a visual representation of improvements in process quality. Finally, starting to measure these laboratory metrics now gives laboratories and Pathology Departments an edge as healthcare transitions to the value-based model and the future.
