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Utilization management in anatomic pathology.

Kent Lewandrowski1, Steven Black-Schaffer

  • 1Department of Pathology, Gray 5, Massachusetts General Hospital, Fruit Street, Boston 02114, MA, United States.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|October 22, 2013
PubMed
Summary
This summary is machine-generated.

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Utilization management in anatomic pathology presents cost-saving opportunities for departments and payers. Developing national guidelines is crucial to mitigate medical-legal risks and ensure a medically sound approach.

Area of Science:

  • Pathology
  • Healthcare Management
  • Medical Economics

Background:

  • Limited published literature exists on utilization management within anatomic pathology.
  • Numerous recognized opportunities for utilization management are present in anatomic pathology.
  • These opportunities affect both internal departmental costs and external third-party payer charges.

Purpose of the Study:

  • To highlight the existing utilization management opportunities in anatomic pathology.
  • To underscore the potential impact of utilization management on cost structures and third-party payments.
  • To emphasize the need for national guidelines to address medical-legal liabilities.

Main Methods:

  • Literature review on utilization management in anatomic pathology.
Keywords:
Anatomic pathologyReimbursementSurgical pathologyUtilization management

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  • Analysis of cost structures within pathology departments.
  • Assessment of charges for third-party payers.

    • Main Results:

    • Significant utilization management opportunities exist in anatomic pathology.
    • These opportunities offer potential cost reductions for both departments and payers.
    • Failure to manage utilization can lead to medical-legal liabilities.

    Conclusions:

    • Pathology professional societies should develop national utilization guidelines.
    • Guidelines are essential for a medically sound approach to utilization management.
    • Implementing such guidelines can mitigate risks and optimize resource allocation.