MANAGEMENT OF PATHOLOGY COSTS

MHS PATHOLOGY MANAGEMENT PROGRAMME

DEFINITION
The MHS Pathology Management Programme has as its objective the facilitation of rational, appropriate and cost-effective pathology services to members of client medical schemes. It comprises the following elements:

IN RESPECT OF SPECIALIST PATHOLOGISTS:

• Pathology claims adjudication and audit,

• MHS Specialist Pathologist Profiles and Utilisation Review,

• The development of Best Practice Pathology guidelines in conjunction with national opinion leaders,

• The monitoring of pathology practice adherence to these Best Practice guidelines by auditing of claims.

N RESPECT OF GENERAL PRACTITIONERS AND CLINICAL SPECIALISTS:

• Inclusion of pathology service parameters as a component of MHS Practice Profiles,

• Interaction with existing MHS Coordinated Provider Networks for the implementation of Pathology Benchmarks and Clinical Rules and generally for the promotion of rational, appropriate and cost-effective utilisation of pathology services,

• Ongoing evaluation of the level and appropriateness of pathology services provided by practitioners in their rooms,

• Interventions with practitioners in respect of adherence to Best Practice Pathology guidelines,

• Pathology Account Audit and Review.

• Cost-effective use and consumption of pathology resources,

• Analyses and reports on pathology services performed by individual Pathology Laboratories and practitioners,

• Ongoing monitoring and maintenance of the adopted Best Practice guidelines as necessitated by the development of knowledge, technology and standards of practice,

• Interventions with laboratories and practitioners based on the above.