Nov 25, 2015 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Clinical laboratories and pathology groups can expect to see more growth in the number of patients served by ACOs and that will require labs to have a new pricing strategy
Will ACOs be the next big thing in American healthcare? Many people are betting that will be true as the number of ACOs continues to increase. Some reports indicate that as many as 750 Medicare and private ACOs were in operation as of early 2015, compared to about 250 ACOs in 2013.
Pathologists and clinical laboratory managers watching the ACO trend will find it significant that Medicare ACOs now serve about 5.6 million beneficiaries. According to a report issued by Oliver Wyman, that is about 11% of all Medicare beneficiaries. Providers in these ACOs are paid under a different arrangement than the long-established Part B fee-for-service price schedule.
The big question mark about ACOs is whether they can deliver significant cost savings while improving patient outcomes. This summer, officials at the federal Centers for Medicare & Medicaid Services (CMS) reported on the savings generated by the agency’s pilot ACO programs. The two main accountable care organization programs are the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. (more…)
Aug 10, 2015 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
CMS wants pathologists and other healthcare providers to report “every issue—small, medium and large,” when someone gets in the way of information sharing
Federal health officials are taking steps to end technology vendors’ “data blocking” practices that inhibit the electronic transfer of patient information. This is a tactic that has proven costly for pathology groups and clinical laboratories that want to interface their laboratory information systems with providers’ or hospitals’ electronic healthcare records (EHRs).
The fiscal year 2015 Omnibus Appropriations Bill passed by Congress in December directed the Office of the National Coordinator for Health Information Technology (ONC) to decertify electronic health record products that are knowingly interfering with the sharing of health information. (more…)
Jul 27, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, News From Dark Daily, Uncategorized
Payment reform unlikely to require legislation or raft of new regulations, but shift to value-based payment model will cost clinical labs and pathology groups
Today there is wide recognition in healthcare that the days of fee-for-service (FFS) medicine are numbered. But what is less certain is how fast government and private payers will introduce other reimbursement models, such as bundled payments and budgeted payments. Clinical laboratories and anatomic pathology groups likely will be the most impacted by this payment shift since their economics are driven by high volumes and FFS payment. (more…)
Jul 24, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations, Uncategorized
With cancer care costs soaring, will health insurers be asking whether the patient outcomes justify new and expensive diagnostic and therapeutic advances?
Medical laboratory companies offering expensive molecular tests for cancer and pharmaceutical companies that sell super-expensive cancer drugs are ready to hit the financial wall with payers and the healthcare system. That’s the opinion of Paul Keckley, Ph.D, a widely-read healthcare strategist.
Keckley warns that the cost of cancer care management is nearing a tipping point where the relative value of innovations may no longer outweigh the cost. In this new environment, Keckley expects pathologists, medical laboratory scientists, and others working in cancer care to face challenges over the cost-effectiveness of their diagnostic and therapeutic advances. (more…)
Jul 20, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations, News From Dark Daily
HDL also got approval to question executives from UnitedHealthcare in court over unpaid claims, its third dispute with a health insurance company
Following a string of major setbacks, Health Diagnostic Laboratory (HDL) of Richmond, Virginia, put itself up for sale last week. This action comes after HDL’s announcement in April that it would pay more than $100 million to settle charges with federal investigators that it violated the False Claims Act. Then, early last month, the clinical laboratory company filed for bankruptcy protection.
On Tuesday, July 14, U.S. Bankruptcy Court Judge Kevin R. Huennekens approved HDL’s request to put itself up for sale through a court-monitored auction, the Richmond Times-Dispatch reported. No potential buyer has been named, but the clinical laboratory company has businesses that are interested in acquiring HDL, the Times-Dispatch added. (more…)
Jun 22, 2015 | Coding, Billing, and Collections, Digital Pathology, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Innovative medical laboratories shared their successes in improving lab test utilization that included physician engagement and close monitoring of key metrics
DATELINE: ORLANDO, FLORIDA—One big challenge facing medical laboratories and anatomic pathology groups in the United States today is the need to transition from a transaction-based business model (increasing specimen volume leads to increasing revenue) to a value-based business model (helping providers improve their use of clinical laboratory tests in ways that measurably improve patient outcomes while controlling or reducing the cost of care.)
Two trends reinforce the need for clinical laboratories to craft strategies to develop new ways to add value to lab testing services.
One trend is the move by Medicare and private health insurers to shift reimbursement for providers away from fee-for-service and toward bundled reimbursement and budgeted reimbursement.
The second trend is the emergence of integrated clinical care organizations. The most visible of these are accountable care organizations (ACO) and patient-centered medical homes (PCMH). What these care delivery organizations have in common is that they require hospitals, physicians, clinical laboratories, imaging centers, nursing homes and other types of providers to work together more effectively so that patients receive healthcare in a seamless fashion because there is a continuum: primary care to specialty care to acute care and back again. (more…)
