101
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Chapman B. Doing more with less in histology. CAP TODAY 1995; 9:1, 14, 16 passim. [PMID: 10159679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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102
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Hannan RE. Future practices in diagnostic medicine. Arch Pathol Lab Med 1995; 119:890-3. [PMID: 7487384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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103
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Ohtani H. [Effective management and its counter plan in clinical laboratories]. RINSHO BYORI. THE JAPANESE JOURNAL OF CLINICAL PATHOLOGY 1995; 43:653-659. [PMID: 7674536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The effective management for clinical laboratories at Kitasato University Hospital in these seven years was reported. To improve the economical efficiency, I pointed out that it is important to improve the efficiency of the laboratory work and to reorganize the clinical laboratory. In addition, we may have to take advantage of contract tests in consideration of profit-and-loss. On the other hand, it is desirable among the clinicians to improve emergency tests, to support their research, to consult on the test results and to ask for any additional interpretations of the obtained data. A system that can satisfy their needs should be established.
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104
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Berkowitz EN. Marketing the pathology practice. Arch Pathol Lab Med 1995; 119:655-8. [PMID: 7625911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Effective marketing of the pathology practice is essential in the face of an increasingly competitive market. Successful marketing begins with a market-driven planning process. As opposed to the traditional planning process used in health care organizations, a market-driven approach is externally driven. Implementing a market-driven plan also requires recognition of the definition of the service. Each market to which pathologists direct their service defines the service differently. Recognition of these different service definitions and creation of a product to meet these needs could lead to competitive advantages in the marketplace.
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105
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Bauer SN. The pathologist and managed care. Integration into the new health care delivery system. Arch Pathol Lab Med 1995; 119:619-23. [PMID: 7625903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As the health care system evolves, managed care plans are expanding rapidly, and pathologists face radical changes in contractual relationships and payment methodology. As a result, entirely new relationships will often need to be negotiated to adapt successfully. The experience of pathologists in areas where there is already high market penetration by managed care plans can be used in strategic planning, learning to gain entry to negotiations, and planning what and how to negotiate. Proper preparation is critical to successful negotiations in our new health care system and requires an understanding of capitation, contracting risks, and opportunities.
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106
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Wilkes JD. Pathology group management. Dealing with growth. Arch Pathol Lab Med 1995; 119:635-9; discussion 639-41. [PMID: 7625906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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107
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Lepoff RB. Academic medical centers and managed care. Arch Pathol Lab Med 1995; 119:598-9. [PMID: 7625898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Academic medical centers are threatened by the expansion of managed care. Hampered by their higher cost, lack of primary care capability and specialist orientation, organizational sluggishness and inflexibility, and relative lack of managerial expertise, these organizations, long a national resource in education, research, and clinical care, face an uncertain future. Academic pathology departments must aggressively manage their resources and maximize their market advantages to compete effectively.
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108
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Markel SF, Venner AM. A market analysis approach to bidding for capitated clinical laboratory and pathology services contracts. Arch Pathol Lab Med 1995; 119:627-30; discussion 630-4. [PMID: 7625905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Traditional episodic, fee-for-service medical care and indemnity-type insurance are rapidly being replaced by managed health care plans that often include financial risk assumption by health care providers. This paper describes the application of marketing principles to the evaluation and capture of capitated clinical laboratory and pathology services contracts. It includes a method for developing capitation rates and describes advantages enjoyed by hospital-based laboratories that enhance their competitiveness in the marketplace.
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109
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Leverone JP. The hospital-based group in a managed care environment. Reading the terrain. Arch Pathol Lab Med 1995; 119:642-5. [PMID: 7625907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The root-level changes in health care delivery that are in progress will make demands on pathologists that are almost without precedent in the post-Medicare era. Their turbulent pace and uncertain direction confer an added sense of urgency to the need for an effective response. For pathologists, the most uncomfortable changes may involve assuming responsibilities that are a marked departure from traditional training and practice. Chief among these are a need for more familiarity with the ways a corporate structure operates, a more thorough understanding of the needs and wants of buyers of physicians' services, and the ability to manage a practice successfully as an enterprise. Despite the variety of current approaches to managed care, there are common themes that invite the careful consideration of pathologists. Many of these reflect basic problems with which care managers must cope routinely. Of equal importance to the future success of pathology practice is the need to develop a high level of skill in constantly evaluating the strengths, weaknesses, and future directions of one's own practice.
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110
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Elevitch FR. Practicing pathology as a health care contractor. Business planning for managed care. Arch Pathol Lab Med 1995; 119:612-7; discussion 617-8. [PMID: 7625902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Managed care requires a pathology practice to take on the role of a health care contractor whose existence depends on obtaining, managing, and renewing competitively bid contracts for the group's services. This presentation is a primer on how to write a formal business plan for a pathology practice using a model case study to illustrate, among several business issues, the differences between and the key elements for success in operating a pathology practice in both fee-for-service and capitated managed care environments.
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111
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Lambird PA. Practicing pathology through multiple hospitals at multiple sites. Practice management issues. Arch Pathol Lab Med 1995; 119:650-2. [PMID: 7625909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe a successful method of management for pathologists to use in an environment of hospital consolidation and managed care. DESIGN This article draws on the experience of a large, pathologist-owned regional laboratory in applying management principles needed for practice in the future. SETTING A group of 20 pathologists, with 19 affiliated pathologists (multiple groups) practicing in rural and urban areas of five states in the Southern Plains. PRINCIPAL FINDINGS Planning, personnel management, organizational structure, finance, and information systems are necessary keys for pathology management in a dispersed system. CONCLUSION The opportunity exists for a professionally and economically satisfying practice in the medical environment of the future.
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112
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Skinner M. Integrating yourself into the new health care delivery system. A Florida experience. Arch Pathol Lab Med 1995; 119:624-6. [PMID: 7625904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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113
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Mori M. [Problems of national health insurance reimbursement revision, especially for laboratory tests]. RINSHO BYORI. THE JAPANESE JOURNAL OF CLINICAL PATHOLOGY 1995; 43:660-4. [PMID: 7674537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The reimbursement fees for laboratory tests are lowered at every revision of Health Insurance Reimbursement (HIR), carried out every 2 years. This leads to the financial trouble for laboratory operation in university hospitals as well as general hospitals. Medical care costs in Japan account for 6% of GNP and is not as high as that in advanced countries such as USA, Canada, and Germany. The Central Pharmaceutical Affairs Councils gives manufacturing and sales approval for in-vitro diagnostics after examination of the applied documents. The Committee on Application of Medical Care Remuneration in the Japan Medical Association decides the following; Propriety of reimbursement establishment for new in-vitro diagnostics, reimbursement fees for new in-vitro diagnostics, propriety of reimbursement establishment for medical devices and propriety of reimbursement for new drugs. The MOSS (Market-Oriented, Sector-Selective) approach was initiated also in the in-vitro diagnostics field in January 1985 the target of which is to abolish the economic barrier and relax regulations in Japan. The Ministry of Health and Welfare lowered the reimbursement fees based on actual prices in commercial laboratories, which is very low because of price dumping through excess competition. In future, we would like to propose additional reimbursement fees for in-house emergency tests. Furthermore, we would like to request the judgment fee for diagnosis of myelogram, immunoelectrophoresis and isoenzymes for which clinical laboratory physicians play a role.
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114
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Haber SL. Kaiser Permanente. An insider's view of the practice of pathology in an HMO hospital-based multispecialty group. Arch Pathol Lab Med 1995; 119:646-9. [PMID: 7625908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The practice of pathology in a physician-driven health maintenance organization can be professionally and personally satisfying. Much of what The Permanente Medical Group has learned is applicable, comforting, and helpful to other pathologists. The organization of Kaiser Permanente, the largest health maintenance organization in the United States, is presented, as are some of the pertinent practice parameters of its pathologists.
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115
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Sodeman TM. Managing opportunities under managed care. Arch Pathol Lab Med 1995; 119:591-7. [PMID: 7625897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Health care reform is driving significant changes in associations between physicians, hospitals, insurers, and patients. This restructuring of the delivery of care will affect the practice of pathology. At these crossroads, practices have to decide to continue without change or to adopt new approaches. Horizontal mergers between pathology practices offer one opportunity under health care reform. Such mergers reflect the general trend toward consolidation of operations as a cost-effective approach to health care delivery. They will require a reevaluation of the manpower needs in pathology. The move to consolidated health plans also suggests that pathology practices should consider vertical integration with other physicians. Restructuring of practices is not the sole answer to addressing health care reform. Practices must become involved in cost-saving strategies in the systems.
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116
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Elevitch FR, Kass ME, Kasten BL, Lepoff RB, Pierce AD, Skinner MS, Sodeman TM, Wilkes JD. The College of American Pathologists Conference XXVII on the Impact of Managed Care on the Practice of Pathology: summary. Arch Pathol Lab Med 1995; 119:659-61. [PMID: 7625912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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117
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Elevitch FR. A pathologist is as a pathologist does. Changing roles in a changing time. Arch Pathol Lab Med 1995; 119:586-90. [PMID: 7625896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Managed care challenges pathologists to a paradoxical cultural transition requiring clinical participation in the community while refining competitive managerial skills to maintain a livelihood. This presentation explores several role changes that a pathologist may undertake to acquire perceived clinical and economic value in a managed care system.
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118
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Ohkubo A. [Reducing unnecessary laboratory use through education and regulation]. RINSHO BYORI. THE JAPANESE JOURNAL OF CLINICAL PATHOLOGY 1995; 43:647-52. [PMID: 7674535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Elimination of unnecessary laboratory use is becoming more and more important in the control of the rapid growth of medical costs in Japan. Among several measures to reduce unnecessary laboratory use, advising doctors about rational use of clinical laboratory is effective but not sufficient. At Tokyo University Hospital we have established a system to reduce unnecessary laboratory use. In this system warning about excessive use of laboratory tests appears on the display when a doctor orders more laboratory tests by the console than the maximum number of tests covered by health insurance. With this warning system we can effectively minimize unnecessary use of laboratory tests.
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119
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The College of American Pathologists Conference XXVII on the Impact of Managed Care on the Practice of Pathology, November 4, 1994. Arch Pathol Lab Med 1995; 119:583-661. [PMID: 7625895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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120
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McDonald JM. Clinical laboratory scientist training--a need for reform. Clin Chem 1995; 41:817-8. [PMID: 7767999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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121
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Raab SS, Bottles K, Cohen MB. Technology assessment in anatomic pathology. An illustration of test evaluation using fine-needle aspiration biopsy. Arch Pathol Lab Med 1994; 118:1173-80. [PMID: 7979909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although anatomic pathology diagnoses are the standard on which treatments often are based, many facets of anatomic pathology have not been rigorously examined. These areas include the evaluation of a procedure's technical and diagnostic characteristics, clinical utility, and cost. Technology assessment is the disciplined scientific and systematic evaluation of a test or procedure, and it can be used to evaluate these areas in anatomic pathology. To illustrate and promote the use of technology assessment in anatomic pathology, we show examples in fine-needle aspiration biopsy, which is a subspecialty of cytopathology. We discuss some of the more commonly encountered problems and misconceptions of test evaluation and also the need for further fine-needle aspiration biopsy evaluation. We conclude that technology assessment is a powerful but underutilized tool for test evaluation in fine-needle aspiration biopsy and in anatomic pathology.
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122
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Penneys NS. Determining the processing cost of a skin biopsy specimen. J Cutan Pathol 1994; 21:472-5. [PMID: 7868761 DOI: 10.1111/j.1600-0560.1994.tb00292.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An integral part of directing a pathology laboratory is to understand the nature and behavior of relevant costs. Until recently, pathologists did not need to accurately know the specific costs assigned to various steps in the processing of tissue specimens. With the advent of a more competitive approach to the delivery of health care, laboratory directors must accurately cost their product in order to use competitive pricing strategies. In this article, I review the principles that are used to analyze costs that are identified in a typical dermatopathology laboratory.
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123
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Chapman B. Residencies and health reform. CAP TODAY 1994; 8:1, 22-4, 26 passim. [PMID: 10150199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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124
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Phillips PK, Voak D, Smith K, Rowan RM, Lewis SM. The illusion of quality in quality management systems: meaningful accreditation. Transfus Med 1994; 4:179-83. [PMID: 7820224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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125
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LeBoit PE, Cockerell CJ. The effort to decapitate American dermatopathology through laboratory capitation: an urgent and dire warning to dermatologists and dermatopathologists. J Am Acad Dermatol 1994; 31:98-100. [PMID: 8021379 DOI: 10.1016/s0190-9622(09)80231-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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