2012 Laboratory Reform Committee Laboratory Services Plan Date: February 1, 2013 Acknowledgements The Laboratory Reform Committee would like to recognise the contribution of the many individuals who volunteered their time and expertise on the working groups and on the production of materials. Their work was instrumental to the creation of this Report. To each of you, the Laboratory Reform Committee extends its appreciation for your valuable contribution to this process. Page 2 of 197 February 1, 2013 Honourable Dr. Margaret MacDiarmid Dr. Shelley Ross Minister of Health President, BC Medical Association Room 337, Parliament Buildings 115 - 1665 West Broadway Victoria, BC V8V 1X4 Vancouver, BC V6J 5A4 Mr. Graham Whitmarsh Mr. Allan Seckel Deputy Minister of Health Chief Executive Officer, BC Medical Association 1515 Blanshard Street 115 – 1665 West Broadway Victoria, BC V8W 3C8 Vancouver, BC V6J 5A4 Dear Minister MacDiarmid, Dr. Ross, Mr. Seckel and Mr. Whitmarsh: As per the Terms of Reference of the Laboratory Reform Committee (LRC), a bipartite government and British Columbia Medical Association (BCMA) endeavor, we are pleased to provide to you the Laboratory Services Plan for your consideration. The mandate of the LRC was to develop a plan to be submitted to the government and the BCMA, by no later than February 1, 2013, to achieve additional laboratory savings from outpatient laboratory services, and achieve a more efficient integration of inpatient laboratory services. As part of this process, the LRC worked to find an additional $25 million in outpatient savings and $18 million in inpatient savings to support the Lower Mainland consolidation. The total potential savings identified by the LRC was $ 30.3 million outpatient and $35.1 million inpatient. The Laboratory Services Plan is a culmination of six months of collaborative endeavor between the Ministry of Health, the health authorities, and a number of laboratory medicine physicians to achieve the LRC mandate and the ensuing savings. The majority of the recommendations in the report were achieved based on consensus; however, the parties agreed to submit separate recommendations on governance. The findings and recommendations of the LRC are summarized in the attached report. Thank you for your consideration of the Laboratory Services Plan. Sincerely, Ms. Nichola Manning, Dr. Chris Bellamy Co-Chair, Laboratory Reform Committee Co-Chair, Laboratory Reform Committee Assistant Deputy Minister Past President Medical Services and BC Association of Laboratory Health Human Resource Division Medicine Physicians Ministry of Health Page 3 of 197 SCOPE OF DOCUMENT This document is the key deliverable stemming from the Terms of Reference for the 2012 Laboratory Reform Committee (LRC), established through negotiations of the 2012 Physician Master Agreement. It serves as the consolidated summary of the activities accomplished during the LRC’s six month mandate, outlines the opportunities identified by the LRC, and includes a priority Plan as mandated by the LRC’s Terms of Reference. For more information please contact: Laboratory, Diagnostic and Blood Services Branch, Medical Services and Health Human Resources Division, Ministry of Health 6th Floor, 1483 Douglas Street Victoria, British Columbia Canada V8W 3K4 Page 4 of 197 Table of Contents Table of Contents ................................................................................................................ 5 1 EXECUTIVE SUMMARY ............................................................................................... 6 Summary of Recommendations ............................................................................................. 7 2 BACKGROUND ........................................................................................................ 13 3 METHODOLOGY ...................................................................................................... 15 3.1 Process ....................................................................................................................15 3.2 Stakeholders ............................................................................................................17 4 RECOMMENDATIONS .............................................................................................. 18 4.1 Governance .............................................................................................................19 4.2 Service Delivery and Integration .................................................................................23 4.3 Utilization, Costing and Funding .................................................................................25 4.4 Outpatient ...............................................................................................................26 4.5 Quality ....................................................................................................................28 4.6 Clinical Guidance ......................................................................................................29 4.7 Human Resources .....................................................................................................31 4.8 Technology and Information Sharing Summary ............................................................33 5 THE PLAN ................................................................................................................ 34 5.1 Overview .................................................................................................................34 5.1 Estimated Timeline and Savings ..................................................................................34 5.2 Assessment ..............................................................................................................40 5.2.1 Benefits .......................................................................................................40 5.2.2 Assumptions ................................................................................................41 5.2.3 Dependencies ..............................................................................................41 5.2.4 Constraints ..................................................................................................41 5.2.5 Barriers .......................................................................................................42 5.2.6 Risks ...........................................................................................................42 6 APPENDICES ........................................................................................................... 43 6.1 Appendix A – Laboratory Reform Committee Terms of Reference 6.2 Appendix B – Laboratory Reform Committee Framework 6.3 Appendix C – Laboratory Reform Committee Working Group Framework 6.4 Appendix D – Government Governance Terms of Reference 6.5 Appendix E – BC Medical Association Governance Terms of Reference 6.6 Appendix F – Service Delivery and Integration Working Group Report 6.6.1 Histology Processing Working Group Report 6.7 Appendix G – Utilizations, costing and Funding Working Group Report 6.8 Appendix H – Outpatient Working Group Report 6.9 Appendix I – Quality Working Group Report 6.10 Appendix J – Clinical Guidance Working Group Report 6.11 Appendix K – Technology and Information Sharing Working Group Report 6.12 Appendix L – Human Resource Working Group Report Page 5 of 197 1 EXECUTIVE SUMMARY The Laboratory Reform Committee (LRC) was established in response to the outcomes of negotiations for the 2012 Physician Master Agreement. The mandate of the LRC was to develop a plan to be submitted to the Government and the British Columbia Medical Association (BCMA) by no later than February 1, 2013 to: a) achieve additional laboratory savings1 from outpatient laboratory services; and b) achieve a more efficient integration of inpatient laboratory services that may include the following: • a single operating entity and governance structure to manage operations in the Vancouver and Fraser regions including single medical leadership; • a provincial laboratory technology and test assessment process; • ability to transition services and associated funding from the MSC payment schedule to an alternative payment arrangement and vice versa; • a provincial plan for physician human resources; • a single quality framework; • the integration of actual services and facilities; and • a timeline for achievement of the previously identified $18 million in annual savings. The inaugural meeting of the LRC was held on August 2, 2012. Over the next six months it engaged more than 35 stakeholders and experts and hosted 21 working meetings through which it collected and assessed articles, reports and select data to assist in the achievement of its mandate and development of the Laboratory Services Plan. The Laboratory Services Plan (the “Plan”) lays the foundation for enhancing the quality and delivery of laboratory services in British Columbia and provides the framework for more detailed planning, assessment and implementation of the LRC’s recommendations. 1 The Government has a target of $25 million in savings. The BCMA does not have a specific savings target however there is support to gain efficiencies and savings. Page 6 of 197 Summary of Recommendations The Laboratory Reform Committee identified eight strategic areas for recommendations: governance; service delivery and integration; utilization, costing and funding; outpatient; quality; clinical guidance; human resources; and, information