College of American Pathologists and associations for family physicians and ob-gyns in Florida have asked UnitedHealthcare to discontinue implementation of BeaconLBS system
Medical laboratory testing is at the center of a contest of wills in Florida. On one side is a health insurer that wants to require physicians to obtain pre-notification or preauthorization for a list of clinical laboratory tests. On the other side are the physicians who question the clinical basis for these requirements and the time and resources required to comply with the health insurer’s program.
This rancorous dispute is in reaction to the laboratory benefit management program created by UnitedHealthcare (NYSE: UNH) (UHC) administered by BeaconLBS, a business division of Laboratory Corporation of America (NYSE: LH) (LapCorp).
Florida Physicians Must Pre-Notify BeaconLBS When Ordering Lab Tests
Effective October 1, UHC allowed physicians in Florida to use the BeaconLBS system to obtain pre-notification or preauthorization for a list of approximately 82 medical laboratory tests. UHC did not require the use of the BeaconLBS system and it’s not clear if any physicians actually used the program since October 1.
As of January 1, 2015, UHC will cease to pay physicians, clinical laboratories, and pathology groups for any tests that are not properly pre-notified or preauthorized by BeaconLBS at the time the physician orders the lab test.
In September, the College of American Pathologists asked UHC to suspend the implementation of the BeaconLBS program.
UHC’s Program ‘Will Negative Affect Patient Care and Pathologists’
“The program will negatively affect patient care and pathologists,” CAP said. “For instance, new requirements—particularly for practices in some geographies and of a certain size—will impede access to care and delay test results and diagnoses. They also impinge upon medical judgment. Further, the sheer volume of routine tests covered by the program will disrupt workflow for ordering physicians and laboratories, especially as the Beacon system currently does not electronically interface with many electronic medical records and laboratory information systems.”
UHC denied the request, CAP reported. UHC is Florida’s second largest health insurer with approximately a 14% share of the market.
Referring physicians also have complained about the BeaconLBS system. In September, the chairman of the Florida District of the American College of Obstetricians and Gynecologists asked UHC to end the program immediately and indefinitely. (See The Dark Report, November 3, 2014.)
In August, members of the Florida Association of Family Physicians expressed concern about the program, saying it could have a negative effect on patient care and on office workflow.
Doctors, Pathologists, and Clinical Labs Might Not Be Paid for Lab Tests
On January 1, UHC will require all physicians serving UHC patients in commercial HMOs in Florida to use the BeaconLBS service when ordering any of 82 tests. On its website, UHC lists some 80 laboratory tests that require advance notification and two (BRCA1 and BRCA2) that require prior authorization. If referring physicians do not use the BeaconLBS system when ordering any of the tests, UHC may not pay the physicians or the labs that run theses tests, UHC said.
Pathologists are particularly concerned that BeaconLBS requires them to get a second review when ordering certain tests and to ensure that subspecialist pathologists who review tests have specific certifications, CAP said. After CAP asked UHC to reconsider these two requirements, UHC left these requirements in place. UHC confirmed these facts but did not respond to questions sent by email.
For obstetricians and gynecologists, the effect of BeaconLBS on patient care is a serious concern, said Robert W. Yelverton, M.D., Chair of District XII (Florida) for the American Congress of Obstetricians and Gynecologists. In a letter sent September 11 to Linda Stewart, Vice President of UHC’s national lab program, Yelverton said ACOG members are concerned the program will disrupt physicians’ office workflow.
Florida Ob-GYN Says BeaconLBS Is ‘a Giant Step Backward’
“ACOG District XII values its relationship with UHC and recognizes our shared responsibility in improving the quality and efficiency of patient care,” Yelverton wrote. “However, we view the implementation of the BeaconLBS program, in its current form, as a giant step backward.”
Dennis Saver, M.D., a family physician, geriatrician and founder of Primary Care of the Treasure Coast in Vero Beach, Florida, also has complained to UHC about the BeaconLBS system. “The requirements of this system are onerous and the workflow interruptions for office-based physicians will be substantial,” he said in an interview with Dark Daily’s sister publication, The Dark Report. “There are few better examples of an unfunded mandate than this Beacon system.”
An Adjunct Clinical Associate Professor at the University of Florida School of Medicine and a Clinical Associate Professor at the Florida State University College of Medicine, Saver said family physicians have expressed concerns about the time required to use the BeaconLBS system and the fact that the BeaconLBS decision support system is not integrated with most electronic health record systems that physicians use.
Doctor Complains that BeaconLBS Is ‘Time-consuming, Frustrating’
“It will be time-consuming, complicated, and frustrating—all for no change in pay!” noted Saver. “A lot more work for the same pay constitutes a decrease in the pay rate. Period!”
Saver and his office staff found that using the BeaconLBS system requires five to seven extra minutes for a single test order. The system design is so clumsy, he said, it requires 20 to 30 mouse clicks and page changes to enter the information for each patient requiring laboratory testing.
Does BeaconLBS Impinge on Physicians’ Practice of Medicine?
What may elevate the dispute between Florida physicians and UHC about the design and use of the BeaconLBS system is how it intrudes in the physician’s practice of medicine. Saver discussed this aspect. Based on its interview with Saver, in its September 2, 2014 issue, The Dark Report wrote, “In cases where evidence-based medicine guidelines are established for specific clinical lab tests, Saver questions the need to have such test orders go through the new BeaconLBS decision support system.
“As I understand it, each time a patient needs a Pap smear, that test request must go through the new BeaconLBS decision support system,” stated Saver. “When you look at the list of tests that require decision support, every Pap smear has to go through the BeaconLBS system, and every test for Chlamydia and Gonorrhea. This despite accepted clinical guidelines and the fact that these screening tests are required for HEDIS reporting.
“Plus, the Centers for Disease Control and Prevention (CDC) has recommended that all baby boomers be screened for hepatitis C, yet the hep C screens are on the [UHC] preauthorization list,” he continued.
“The CDC guidelines also say every adult should be screened for HIV, and that lab test is on the preauthorization list,” observed Saver. “If these tests are recommended by expert organizations, why is decision support required [by UHC] before physicians can order such tests?”
Florida Family Physicians Have Concerns
Some members of the Florida Association of Family Physicians said they may discontinue their association with UHC rather than use the BeaconLBS system to order lab tests, Saver said. (See The Dark Report, August 15, 2014.)
One factor affecting workflow is the failure to link the BeaconLBS to other electronic health record systems, Yelverton added. UHC has said it has interfaces with two systems: Emdeon and Liaison Technologies. UHC plans to integrate with two other systems: Aprima and eClinicalWorks.
“Those two systems, Emdeon and Liaison, are very minor players and may represent only about 5% of the physicians in Florida,” Yelverton countered. “The fact that they haven’t worked out these interfaces tells me a lot about the low level of software capability that BeaconLBS has, and that causes worry about how successful the interface activity will be.
“If they do not have a thorough bidirectional interface, that may mean we will have to continue to step out of the EHR system we normally use and go to the BeaconLBS web site to put in the information BeaconLBS requires,” Yelverton said. “If you have an interface that is bilateral such as LabCorp has, you may not have to enter your order twice.”
Florida News Media Unaware of the Issues in Dispute
To date, Dark Daily is unaware of any news outlet in Florida to report on dissatisfaction among certain physicians on how the BeaconLBS program infringes on their clinical decisions involving lab test ordering.
There are other issues associated with the UHC scheme. For example, pathologists and clinical lab managers in Florida have questioned whether anti-competitive and anti-business practices might be associated with UHC-BeaconLBS’s determination on which clinical laboratories and pathology groups can be in UHC’s “laboratory of choice” network.
Another criticism by pathologists and lab executives is that BeaconLBS will actively manage the incoming test orders. They are concerned that its information technology system may be biased to favor labs operated by LabCorp over the other medical lab companies that agreed to participate in the BeaconLBS network.
Of Hundreds of Florida Medical Labs, Only 13 are in BeaconLBS
One fact demonstrates the wariness Florida medical laboratories. To participate in the BeaconLBS network, UHC has these labs to contract with one of their competitors. Out of hundreds of labs serving physicians in the Sunshine State, just 13 laboratory organizations are listed on UHC’s website as “laboratories of choice” participating in the BeaconLBS system. Notably, five of those 13 labs are LabCorp and laboratory business units of LabCorp.
In summary, the concerns placed in the public record about UHC’s laboratory benefit management into the daily clinical practice and workflow of Florida physicians in regards to the pre-notification and preauthorization of many important and frequently ordered lab tests have the potential to have a negative effect on three interest groups.
First, as noted above, Florida physicians are concerned about the intrusion into clinical decisions they make multiple times a day when ordering medical laboratory tests.
Second, nearly all of the hundreds of clinical labs and pathology groups serving physicians and patients in Florida have been reluctant to sign a contract with a business unit of a major lab competitor in order to serve patients insured by UHC.
Third, in coming months, patients will learn about the consequences of the UHC scheme. They may experience delays during their physician visits as doctors take time to enter lab test orders into the BeaconLBS system. Additionally, because nearly all the medical labs these patients have traditionally used are not in the “laboratory of choice” network, patients will discover that they cannot go to their familiar patient service center to provide specimens. Instead, they will need to go to an unfamiliar medical lab that may uses different lab test methodologies and reference ranges on their lab test reports.
Of course, all of these concerns and issues are likely to be outweighed as of January 1, 2015, when UHC ceases to reimburse physicians and medical labs if the tests ordered do not go through the BeaconLBS pre-notification and preauthorization process as required.
—by Joseph Burns