You don’t have to be the compliance geek to wonder how health care reforms passed last spring (due to be enacted next year) could soon affect you, especially if you work in a small lab.

The HMO model of aggregating health care providers’ efforts to keep patients in the pink may underlie an incentive plan you’ve heard about called accountable care organizations (ACOs). In ACOs, physicians would join forces with other health providers, such as clinical labs, in a loose partnership to keep Medicare patients in good health. The twist here is that rather than just helping the feds save big bucks (HHS expects ACOs could save Medicare more than $400 million over a 3-year span), health providers would divvy up a portion of the “unspent” funds realized by the overall savings they generate.

The pilot plan for ACOs would embark on discovering how savings can be realized while providing equal or better outcomes than those seen today. Some say HHS is fast-tracking the new program without having worked out many key points in advance.

Criticism of the new model seems to focus on a dispute about whether anticipated cost savings can be achieved. Critics voice concern about how all of the moving parts will fall into place, and how unfunded mandates would add to the inevitable costs.

Some are concerned that in an attempt to cut costs, physicians may feel pressured not to order certain tests or perform certain procedures. Or, that they would rely heavily on large labs that can perform many tests at a fraction of the cost of smaller labs. High volume buoys the bigs to be able to charge less. So if they buddy up into ACOs, they start out ahead of the game.

Which is not to say that the current fee-for-service model necessarily serves labs best now or will into the future. Labs are clearly the pivot point of the ACO team. They are indispensable. Outcome and value are the buzzwords. Fleet-of-foot labs that find a way to revamp the (outmoded?) cost-per-test model to help rein in overall costs—being good team players, in effect—and zero in on top-value tests, retain their high standards, provide more context/content, and partner up with the right ACO—whether hospital- or physician-based—may weather the storm and even better their position.

Switching gears… . Looking ahead to July’s AACC annual meeting in Atlanta, I can’t wait to prowl the show floor, seeking out vendors’ newest products and technologies to share with you, and brown-bagging it to hear what’s on the minds of those on the front lines.

Judy O’Rourke
Editor, CLP

(213) 254-5449