Pathologists' roles in clinical utilization management - A financing model for managed care

    Authors

    J. J. Zhao;A. Liberman

    Abbreviated Journal Title

    Am. J. Clin. Pathol.

    Keywords

    pathologists; utilization management; financing; compensation; laboratory; hospital; managed care; HEALTH-CARE; PRACTICING PATHOLOGY; LABORATORY MEDICINE; UNITED-STATES; OPPORTUNITIES; PHYSICIANS; OUTCOMES; Pathology

    Abstract

    In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves. despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

    Journal Title

    American Journal of Clinical Pathology

    Volume

    113

    Issue/Number

    3

    Publication Date

    1-1-2000

    Document Type

    Article

    Language

    English

    First Page

    336

    Last Page

    342

    WOS Identifier

    WOS:000085475000002

    ISSN

    0002-9173

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