Apr 1, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Alternative payment models and value-based payment schemes create financial unknowns for clinical laboratories and anatomic pathology groups
What happens to pathologists and clinical laboratories when fee-for-service reimbursement ceases to be the primary payment method for anatomic pathology services and medical laboratory tests?
After all, fee-for-service reimbursement for lab tests is what underpins today’s financial model for lab test services. Under this transaction-based business arrangement, a clinical laboratory that can increase its specimen volume will realize a lower average cost-per-test because of economies of scale within the lab. At the same time, the lower costs mean a bigger net margin available from profit, given the fixed price of the reimbursement for lab tests.
So what is a medical laboratory to do as healthcare shifts to a value-based reimbursement (VBR) model, formerly known as pay-for-performance? The answer to that question won’t take long to answer because of a recent announcement by the Department of Health and Human Services (HHS). (more…)
Feb 13, 2015 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations
Accelerating pace of hospital consolidation brings new pressure to pathologists and clinical laboratory directors to maximize the value of pathology services
Large and financially-stable multi-hospital health systems are racing to form regional mega-systems. It’s a strategy to get ahead of the Affordable Care Act’s (ACA) mandate to improve quality and increase efficiency through coordinated care across the entire care continuum.
This growing national trend means further consolidation of clinical laboratory testing services within the merging organizations. For pathology groups, the new super-systems may encourage the different pathology groups within the system to consolidate into a single practice entity. This would help improve how pathology services are more deeply integrated into the care continuum. It would also facilitate contract negotiations between the pathologists and the parent health system. (more…)
Dec 17, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Study was published in Journal of the American Medical Association (JAMA) and showed how high-deductible healthcare plans are motivating consumers to use online transparency tools to search for providers that offer greatest value
Do consumers choose less expensive medical laboratories and imaging providers when they can see the prices in advance? The findings of a recently released study suggest that the answer is “yes”—that consumers will shop for the clinical laboratory with the cheapest test prices when they have access to price information!
This is one conclusion from a study of a half million consumers conducted by Castlight, Inc. (NYSE:CSLT), a San Francisco-based company that offers employers an online tool that enables their employees to compare healthcare pricing among their network providers. Researchers at Castlight confirmed that if consumers know the price of laboratory and imaging tests or physician visits in advance, they will choose the less expensive provider. (more…)
Nov 19, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Pathologists and clinical laboratory managers will want to stay abreast of what emerging data is revealing about the broader impact of slowed growth in Medicare spending
Contrary to the predictions of some analysts, a recent study suggests that slowing Medicare price growth by lowering hospital reimbursements will slow hospital utilization and spending for all age groups. For pathologists and clinical laboratory managers, the study represents credible evidence that cuts in Medicare prices cause a measurable and linked decrease in hospital utilization for both the elderly and the non-elderly.
The Affordable Care Act of 2010 (ACA) permanently suppressed the rate of growth in Medicare reimbursements to hospitals and most other medical providers, according to a recent study by the Center for Studying Health System Change (HSC). In this study, the HSC sought to measure spillover effects of changes in Medicare inpatient hospital prices on patients under age 65. (more…)
Oct 29, 2014 | Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News
Pathology groups and medical laboratories may benefit if federal and state legislators legislate broadening of provider networks
Insurers are increasingly using narrow networks as a business strategy to control costs. As a consequence, more consumers are complaining even as some excluded providers are suing health insurers. For pathologists and clinical laboratory managers, this accelerating trend of excluding providers means increasingly restricted access to patients.
Health Insurers Walk a Fine Line between Cost and Access
Many health plans currently sold on the new state insurance exchanges offer substantially smaller networks of providers than was typical in recent years, according to a story published in Modern Healthcare. The payers say narrower networks are necessary for two reasons.
First, narrow networks can keep premiums affordable. Second, health insurers say narrow networks help them address the requirements of the Patient Protection and Affordable Care Act (ACA). (more…)
