Feb 3, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Other states are studying Oregon’s innovative Medicaid experiment, which could lead to different forms of reimbursement for clinical laboratories
Once again, Oregon’s Medicaid program is blazing a new trail in the delivery of healthcare. This time, Oregon is organizing its Medicaid services—known as the Oregon Health Plan—to do two things. First, it is developing 16 coordinated care organizations (CCOs) across the state. Second, those Medicaid beneficiaries who represent the majority of costs to the program will receive special case management and clinical services.
Because there will be capitated payments to providers under this program, clinical laboratory managers and pathologists will want to understand how medical laboratories will be reimbursed by the Oregon Health Plan. (more…)
Jan 29, 2014 | Coding, Billing, and Collections, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Big data is poised to change the healthcare ecosystem and that creates opportunities for forward-looking medical laboratories
First-mover academic center, Mount Sinai Medical Center (MSMC), is taking steps to incorporate “big data” into the daily patient-care setting. For the medical laboratory industry, this is a signal event because a major component of healthcare big data will be patient genetic and molecular information.
Included on MSMC’s big data team are its genetics laboratory experts. These are high-profile “data scientists” who help doctors make personalized predictions about their patients. This project shows how integrated healthcare informatics—including clinical laboratory test data—will be a key attribute of healthcare moving forward.
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Jan 22, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Statistics indicate that inpatient admissions and revenues are falling nationally, a development that affects clinical laboratories in hospitals and health systems
One important trend that directly impacts the medical laboratories of hospitals and health systems is the falling rate of inpatient registrations seen nationally in recent years. What exacerbates this trend is the fact that many payers are cutting the prices they pay for certain inpatient services.
Collectively, these two developments mean less inpatient revenue for many hospitals and that often translates into reduced budgets for the clinical laboratories.
But that is not the whole story concerning inpatient revenue. Spurred by the Affordable Care Act (ACA) and other market developments, payers now want to shift reimbursement away from fee-for-service to new models of reimbursement. This includes capitation or bundled payment models. (more…)
Dec 27, 2013 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Healthcare Experts Now Exploring New Care Coordination Strategies and Overcoming Gaps in Measuring Performance
For many healthcare professionals, the jury is still out as to whether accountable care organizations (ACOs) will prove effective at delivering the two important goals of improved patient outcomes at a lower overall cost of care over an extended period of time.
That is why close attention is being given to the experience of Medicare’s Pioneer ACOs, since they were among the first ACOs to begin delivering clinical services. In particular, physicians and hospital administrators want to learn useful lessons from the successes and setbacks of the different Pioneer ACOs.
By improving the coordination of care, accountable care organizations are expected to provide patients with better care while reducing healthcare costs. That’s why the Center for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program is structured to pay ACOs financial incentives or impose penalties, depending on whether performance quality measures and healthcare spending targets are met. (more…)
Nov 4, 2013 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Management & Operations
With payouts riding on patient outcomes and value, ACO providers will welcome innovative services that clinical labs and pathologist could provide that improve patient outcomes
Both private health insurance companies and employers are betting on value-based insurance as the key to improving healthy behavior in patients. This will require more patient engagement in managing their chronic conditions. It will also include motivating patients to consider less expensive treatment options, particularly when the more expensive treatment path has limited benefits.
In this way, accountable care brings the patient into picture. It is a trend that opens the door for innovative clinical laboratories and anatomic pathology group practices to develop medical laboratory testing services that payers and employers recognize as contributing to improved patient outcomes—and for which they will adequately reimburse the laboratories providing these services.
Private Health Insurers Have More Flexibility in Design of Health Plans (more…)
