Healthcare Systems and Managed Care

The Healthcare Setting

• Healthcare has evolved into an integrated delivery system.
• The goal is to ensure patients receive needed care promptly and appropriately.
• Modern healthcare has varied organizational structures.
• Healthcare organizations range in size from large tertiary care and teaching hospitals to community hospitals and free-standing specialty clinics or phlebotomy stations.

The Changing Healthcare System

• Healthcare systems are undergoing continuous revisions.
• Government and managed healthcare plans negotiate reimbursement discounts, which forces facilities to cut costs and downsize.

Managed Care

• Functions as a payment system to manage cost, quality, and access to healthcare.
• It achieves this by detecting illnesses/risk factors early, using financial incentives for providers, offering patient education, and encouraging healthy lifestyles.

Case Management

• Case management is an important concept in managed care.
• A designated case manager coordinates patient healthcare.
• A case manager advocates for patients.
• A case manager provides early detection and treatment to reduce the cost of care.

Clinical Laboratory Services

• Clinical Laboratory Services (CLS) perform tests on patient specimens.
• Results confirm health, aid in diagnosis, and evaluate/monitor medical conditions.
• Clinical laboratories are located in hospitals, outpatient clinics, physicians' offices, and large reference laboratories.

Clinical Analysis Area

• Specimen processing and testing occurs in this area.
• Includes hematology, chemistry, microbiology, blood banking/immunohematology, immunology/serology, and urinalysis.

Hematology

• It identifies diseases associated with blood and blood-forming tissues.
• A Complete Blood Count (CBC) is a commonly ordered test.

Chemistry

• Uses computerized instruments to perform most lab tests.
• Single samples are used.
• Serum is a common component of the sample, but can be others.

Microbiology

• Analyzes body fluids and tissues for microorganisms.
• Culture and sensitivity testing is the primary method.

Blood Banking/Immunohematology

• Blood products are prepared in this area for transfusions.

Serology/Immunology

• Serum is tested to evaluate the body's response to bacterial, viral, fungal, or parasitic diseases.
• Testing is done by stimulating antigen-antibody reactions.

Urinalysis

• A macroscopic, microscopic, and chemical evaluation of urine.

Anatomical and Surgical Pathology Area

• Tissue analysis, cytologic examination, surgical biopsy, frozen sections, and autopsies are performed.

Histology

• The structure of tissues from biopsies/autopsies is studied to determine if they are normal or pathological.

Cytology

• The structure of cells in body tissues and fluids are studied.
• Cells are identified, counted, and studied to diagnose malignant and premalignant conditions.

Cytogenetics

• Samples are analyzed for chromosomal deficiencies related to genetic diseases.

Clinical Laboratory Personnel

• Laboratory Director/Pathologist: Directs lab services to benefit physicians and patients.
• Laboratory Administrator/Lab Manager: Oversees all operations involving physician and patient services.
• Technical Supervisor: Administers a section/subsection of the lab and reports to the lab manager.
• Medical Technologist/Medical Lab Scientist: Performs all levels of testing, reports results, ensures quality control, evaluates procedures, and troubleshoots instruments.
• Medical Laboratory Technician: Performs routine testing, operates equipment, performs basic instrument maintenance, recognizes problems, and assists in problem-solving.
• Clinical Lab Assistant: Has phlebotomy experience, specimen processing skills, and basic lab testing skills; assists MLS/MLT.
• Phlebotomist: Trained to collect blood for necessary lab tests for diagnosis and patient care.
• Other Lab Personnel: May include Quality Assurance Managers.
• Other Lab Personnel: May include MT/MLS who collect statistics for QA purposes.
• Other Lab Personnel: May include programmers and LIS managers for lab computer software.

Historical Perspective on Phlebotomy

• Phlebotomy: "Incision into the vein for drawing blood."
• From Greek "phlebos" (vein) and "tome" (incision).
• Hippocrates believed disease was due to excess blood, phlegm, and bile; removal would restore balance.
• Early phlebotomy: venesection ("vein cutting") from Latin "vena" (vein) and "sectio" (cutting).
• Large quantities of blood were removed to cure or prevent illness.
• Guild of Barber-Surgeons: Formed in 1210, barbers were divided into Short Robe and Long Robe surgeons.
• Short Robe surgeons: Forbidden to do surgeries except bloodletting, wound surgery, cupping, leeching, shaving, tooth extraction, and enema administration.
• Short Robe surgeons: Distinguished by a striped pole with a suspended bleeding bowl.

Instruments in Bloodletting

• Cupping: Heated suction apparatus applied to draw blood to the surface.
• Fleams: Wide, double-edged blade used to open an artery or vein for large blood removal.
• Leeches: Localized bloodletting, leech engorges itself with blood from the patient's skin.

Phlebotomy Today

• Blood is obtained for diagnostic purposes.
• Blood is obtained to monitor prescribed treatment.
• Blood is removed for transfusions.
• Blood is removed for therapeutic purposes.
  • Example: polycythemia.
• Today's phlebotomy includes venipuncture and capillary puncture.