Financial and clinical fortunes may soon shift for many medical laboratory organizations
By every measure, the clinical laboratory industry is entering a high-stakes period during the next 24 months. Powerful trends are reducing lab budgets and payers are cutting the prices paid for medical laboratory testing. The question on everyone’s mind is “will it get better or worse in the months ahead?”
This question will be asked plenty of times to speakers at the nation’s largest gathering of clinical lab executives and pathology business leaders. On April 30-May1, the upcoming 18th Annual Executive War College on Laboratory and Pathology Management will take place in New Orleans, Louisiana. A record crowd has already registered to attend.
Uncertainty about Reimbursement for Molecular and Genetic Tests
Molecular diagnostics and genetic testing are prime examples of the cloudy future that hovers over the entire profession of laboratory medicine. Just getting paid has become a challenge for many medical laboratories that perform these tests.
In fact, since January 1, 2013, the Medicare program has yet to pay clinical laboratories and pathology groups for a number of molecular CPT codes. That means many clinical labs have now gone more than three months without reimbursement from the Medicare program for a sizable number of essential molecular assays and genetic tests!
This development is without precedent and no less than Forbes Magazine has taken the federal government to task over this issue. Last week it published a story about this situation with the headline “Medicare Has Stopped Paying Bills for Medical Diagnostic Tests. Patients Will Feel the Effects.”
The uncertainly over when this situation may be corrected was addressed by Scott Gotlieb, M.D., who authored the story published by Forbes. Gottlieb, a physician who has worked at the Food & Drug Administration, wrote that “There’s no clear deadline on when this will all get resolved. There’s some speculation that when the Medicare contractors submit their 2013 pricing on April 30th, they’ll have to declare their prices for these various molecular tests. Once they do, the labs should get paid retroactively. But the April 30th deadline seems soft. This could linger much longer.”
Solving the Challenges of Reimbursement for Molecular Diagnostic Tests
At the Executive War College, numerous sessions will take up the issue of reimbursement for molecular assays and genetic tests. Three examples of nationally-prominent experts who will speak on this topic are:
- Charles Root, Ph.D., CEO of CodeMap, LLC, Schaumberg, IL, on: “Molecular Codes and More: What Your Lab Should Know to Get Speedy and Accurate Payment from Different Payers”
- Michael Snyder, Principal, Clinical Lab Business Solutions, LLC, Flemington, NJ, on: “Payer Access: Why Your Lab is ‘Out’! Can Your Lab Get ‘In’?”
- Trisha Brown, CGC, Genetic Counselor, MS, Genetic Counselor Ms, Principal, Shama Consulting,LLC, San Francisco, CA, on: “Payer’s Goals for Pre-Authorization, Medical Necessity, and Pricing for Molecular and Genetic Tests”
It is the goal of these sessions to help lab organizations collect all the money that’s legally due them—not just for molecular and genetic tests—but for the full menu of medical lab tests they perform for physicians and patients on a daily basis.
Of course, there are other developments that create uncertainty for clinical laboratory administrators and pathologists. One major trend is toward the integration of clinical care, in the form of accountable care organizations (ACOs), medical homes, and other new care delivery models. In these types of healthcare organizations, reimbursement will move steadily away from fee-for-service and toward new forms, including value-based reimbursement and bundled payment reimbursement.
This has significant implications for every clinical laboratory and anatomic pathology group practice. Will your lab organization have access to provide medical laboratory testing services to patients in an ACO? If so, how will it be paid for these lab tests? What pricing arrangements will be preferred by ACOs?
Market for Laboratory Outreach Testing is Undergoing Transformation
Another trend with the potential to upend the traditional market for laboratory outreach testing services is that of office-based physicians selling their medical practices to hospitals and health insurers. Several experts at the Executive War College will speak about this trend and offer insights on effective strategies that clinical labs and pathology groups can use to ameliorate the effect of this trend on their finances.
These descriptions of clinical laboratory industry trends only scratch the surface of topics to be covered at the Executive War College. There will be more than 60 sessions and 96 speakers. Presentations cover lab automation, lab and healthcare informatics, and new diagnostic technologies like mass spectrometry, just to name a few.
You can view the full agenda and speakers by visiting the Executive War College website by using the hotlinks in this sentence. Register now to reserve your place to be with us on April 30-May 1 at the New Orleans Sheraton Hotel. It will be the single-most valuable educational investment you’ll make this year, at a time when the entire profession of laboratory medicine faces a cloudy future.
—Robert L. Michel