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

In ancillary or laboratory utilization management, the roles of pathologist s have not been explored fully in managed care systems. Two possible reason s 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 p athologists in clinical practice may include clinical pathology and laborat ory services (which have long been well-defined and are compensated accordi ng to a resource-based relative value system-based coding system), laborato ry administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mech anisms such as percentage of total service revenue or fixed salary, the inv olvement of pathologists seems less today than in the past, owing to increa sed clinical workload and time constraints in an expanding managed care env ironment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely a ccounts for the current situation. Furthermore, the importance of pathologi st-driven utilization management in laboratory services lacks recognition a mong hospital administrators, managed care executives, and pathologists the mselves. despite its potential benefits for reducing cost and enhancing qua lity of care. We propose a financial compensation model for such services a nd summarize its advantages.