The clinical landscape is also changing. The typical sleep study requires a patient to spend the night in a hotel-style bed in a clinic, hooked up with various electrodes to monitor them from "stem to stern," says Bryan Fips, manager for the St. Joseph sleep disorder center. Sleep monitoring equipment that allows home evaluations are popping up, however, and that option could prove to be popular with patients and disruptive to the standard sleep center business model. Medicare is already reimbursing for select home sleep studies.
St. Joseph's is keeping an eye on the developments, but isn't concerned about a serious shift right now. "It's difficult to do an accurate procedure in an in-home environment, just because you've got wires that can come loose and don't have anyone there to monitor the visual," Fibs says. Still, even if the home options aren't as effective, there is a chance that freestanding centers or individual physicians could begin promoting home studies as a more convenient option for patients.
Emerging Service Line No. 4: Diagnostics
In most hospitals and health systems, diagnostic services are scattered across multiple departments, facilities, and inpatient and outpatient settings. But if more begin to follow the example of industry leaders like Geisinger Health System and Duke University Health System, diagnostic services may become more centralized and comprehensive. In that sense, diagnostics can be considered an emerging service line.
It is a logical next step, considering diagnostic services can account for as much as one-third or nearly one-half of the bottom line at some hospitals. To better manage that revenue stream, about three-and-a-half years ago Duke combined radiology, pathology, and clinical lab services to create an enterprisewide structure that covers all hospitals and ambulatory care sites.
"In most hospitals, radiology and laboratories are considered ancillary services. We think they are more of foundational services and really cut across hospital boundaries as well as clinic boundaries," says Asif Ahmad, vice president of diagnostic services and chief information officer for Duke University Health System.
Before the change, each hospital handled its own radiology department and diagnostic services were generally disconnected. Centralizing diagnostics into a service line allowed a more strategic approach and helped Duke ensure services weren't being underutilized or duplicated across the system.
Given the exorbitant startup and maintenance costs of equipment like MRI machines and CT scanners, the change in management structure helps cut costs on an ongoing basis, says Ahmad. Duke was able to increase utilization from 60%–65% to over 90% in some cases, and has seen 5%–7% growth in the diagnostic program—with relatively flat costs—since making the change.
A service line approach also helps evaluate diagnostic services strategically, with an eye for developing tests and procedures. As genomic testing and molecular diagnostics begin to play a larger role in U.S. healthcare, Duke's centralized diagnostic service line allows for coordination between outpatient testing facilities and inpatient treatment areas, as well as integration of new tests into different systemwide service lines.
Ahmad says centralizing diagnostics would be even easier outside of an academic medical center, where physician academic responsibilities don't complicate the management structure.
The genetic testing industry is young enough that many questions about how it will eventually operate have yet to be answered. Foremost: Can a company patent and own a specific human gene?
The question was taken up in federal court in New York earlier this year when the ACLU initiated a lawsuit on behalf of women's health groups, geneticists, and thousands of other plaintiffs against Myriad Genetics, which owns exclusive rights on BRCA1 and BRCA2, genes related to breast cancer susceptibility. As a result of these patents, research and diagnostic testing involving either gene must be done with Myriad's approval, usually at some cost.
The ACLU claims the patents deny some women access to genetic testing to find out about increased risk and don't allow for second opinions on test results. Major groups like the American Medical Association and the March of Dimes filed briefs in support of the challenge.
The U.S. Patent and Trademark Office (PTO) has granted thousands of patents on human genes—more than 20% of human genes have been patented. The lawsuit has broad implications for the future of genetic testing, particular if it makes its way to the Supreme Court.