It's clear that the portion of the outreach business based on private physician offices is declining as the number of such practices decreases (see: Bureaucrats are killing private medical practice). However lab outreach is still big business as the profits of LabCorp (see: LabCorp 3Q Profit Rises 17% Amid Cost Controls) and Quest (see: Quest Diagnostics revenue beats and profit up 67%) can attest. The Dark Daily recently came up with one new possibility for the lab outreach business: employer medical clinics (see: Continuing Popularity of Employer Medical Clinics Brings New Opportunities for Medical Laboratory Outreach). Below is an excerpt from this article:
Employers have a big stake in lowering the cost of healthcare. That is one reason why more employers are incorporating employee wellness programs into their health benefit offerings....Today, employers are going beyond simple wellness programs, creating on-site or near-site clinics to save their employees a trip to their local doctor, urgent care, or hospital....As this expansion continues, so will the potential opportunities for outside service providers to fill demand and provide services.....In a 2015, Willis Towers Watson...conducted a survey that polled 137 U.S. employers representing 4.6-million employees. Willis determined that 75% of employers found that investing in on-site clinics helped to boost productivity. Two-thirds found on-site clinics an ideal way to increase access to affordable healthcare for their employees.... More than one-third of businesses plan to increase on-site clinic access by 2018....This is a prime opportunity for pathology groups and clinical laboratories, as they are uniquely positioned to bridge the gap between hospitals and on-site clinics by consolidating information and helping to form personalized treatment plans, organize screening routines, and help employers to optimize their offerings based on the health needs of their workforce.....Because the majority of employers cite “convenient access” as a leading reason for developing on-site options, local medical laboratories and providers offer accessibility—along with an ability to tailor services to the needs of the employee population—that most national providers find difficult to match.
I think this idea of lab testing is a good one for large employer clinics with high patient volume that offer more complex tests. However, I suspect many of these clinics probably function as the equivalent of a physical office laboratory (POL), performing relatively few simple tests on-site with occasional send-outs. I had not heard much about POLs lately but did know that CLIA regulations and POLs were closely intertwined. Below is an excerpt from a Wikipedia article on POLs (see: Physician office laboratory):
On January 1, 1987, the Health Care Financing Administration ruled physicians must accept assignment for performed in-office Medicare lab testing, significantly cutting physician revenues. This, combined with plans from third-party to reduce POL payments and increased pressure on Congress to regulate POLs like other clinical laboratories, led to suggestions of physicians banding together into limited partnerships to start their own reference labs. That pressure on Congress led to the signing into effect of the Clinical Laboratory Improvement Amendments (CLIA) on October 31, 1988.
It seems, however, that POLs continue to have some market share nationally (see: Physician office laboratory):
In July 2015, the Centers for Medicare and Medicaid Services (CMS) reported nearly half of all CLIA-certified laboratories in the United States (122,189) were physician office laboratories. Additionally, 61.3% of the POLs in the United States today are running Clinical Laboratory Improvement Amendments (CLIA) waived tests, and 22.7% hold provider performed microscopy (PPM) certificates. However, in late 2010, POLs were estimated to be processing only about eight percent of all clinical laboratory tests. That number went up to nine percent in late 2014.
I personally think that there will be a growing demand for point-of-care (POC) instruments, both for small labs located in employer clinics, decentralized hospital locations, and perhaps walk-in drug store clinics (if they emerge post-Theranos). What is also clear at this time is that the lab test data generated in these locations must always be integrated into patient EHR records. This can be a challenge, particularly about what EHR records are involved.