News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Bundled Payments for Joint Replacements Cuts Costs for Medicare; Hospitals Held Accountable for Quality of Care

Clinical laboratories must stay informed about the success of bundled-payment initiatives because they will need to negotiate a share of these payments where medical laboratory testing is involved

Research published this year concluded that bundled payments for joint replacement services performed on Medicare patients reduce Medicare’s costs without negatively affecting patient outcomes. Because these types of surgeries do not generally utilize many lab tests, the question is still out as to whether bundled payments allow clinical laboratories to be adequately reimbursed for their services.

The study of the bundled payment program was published in the Journal of the American Medical Association (JAMA). The researchers sought to determine the cause of the reduction in Medicare payments and hospital savings when bundled payment models for joint replacement surgeries were used.

The research was performed by staff at the Perelman School of Medicine at the University of Pennsylvania (UPenn). They examined hospital costs and Medicare claims for patients requiring hip and knee replacements at the 5-hospital Baptist Health System (BHS) in San Antonio.  (more…)

Federal Judges Block Anthem-Cigna and Aetna-Humana Deals to Protect Market Competition and Healthcare Consumers

Mergers that would have reshaped the nation’s largest insurance companies would directly affect the provider networks independent medical laboratories rely on

For pathology groups and medical laboratories, the news about two thwarted deals involving mega insurance companies might be seen as a positive development.

The proposed deals—Anthem’s $48-billion bid to buy Cigna, and a proposed $37-billion AetnaHumana merger—would have reshaped the US health insurance industry had they not been blocked by federal judges who cited possible harm to market competition, Bloomberg reported.

For now, all four health insurance companies will continue to use their existing provider networks, which is good news for clinical laboratories. Experts had expected the bigger players in each deal—Anthem and Aetna—to possibly prune the provider networks of Cigna and Humana, respectively, which could have financially burdened thousands of healthcare organizations and independent medical laboratories. (more…)

Further Advances in the Healthcare Price Transparency Trend Reveal Why Physicians Are Supportive; Hospitals and Medical Labs Are Slow to Post Their Prices

Blue Cross Blue Shield of North Carolina expands a website that allows consumers to check the prices charged by physicians; Clinical labs are watching the price transparency trend

Once again, a major health insurer has raised the stakes on transparency of the prices charged by physicians, hospitals, clinical laboratories, and anatomic pathology groups. Blue Cross Blue Shield of North Carolina (BCBSNC) recently expanded a website for its members that lists what the insurer pays to different providers for various clinical services.

The database is searchable. Members have been able to access it since January of 2015. The website lists 1,200 non-emergency procedures, along with the average price that BCBS pays for each one.

Physicians Also Want Price Transparency

Consumers want more transparency of the prices charged by providers. But they are not the only group pushing for it. In a surprising twist, physicians in North Carolina were supportive of having their prices posted on a public website. (more…)

American Medical Association’s Study of Nation’s 25 Largest Health Insurers Indicates that Biggest Companies Hold Dominant Market Share in Most Regional Markets

Survey results show pathologists and clinical lab managers why largest health insurers have market clout and can exclude local labs from their provider networks

Over the past two decades, ongoing mergers and acquisitions of health insurance organizations have led to ever-greater concentration of market share, even as the number of large health insurance companies has shrunk. One consequence of this trend is that many clinical laboratories and anatomic pathology groups have lost access to managed care patients.

The degree of market concentration will surprise most pathologists and medical laboratory professionals. The concentration of market ownership is clearly demonstrated by the fact that the 25 largest health insurers in the United States now control two-thirds of this $744-billion market. But the largest plans are not necessarily the best, according to 2013 consumer satisfaction surveys conducted by J.D. Power & Associates. (more…)

More Workplace Tension in Hospitals and Clinics as Three Generations of Physicians—Baby Boomer, Gen X, and Gen Y—Try to Get Along

Growth in the number of employed physicians is contributing to heightened workplace tensions due to the cultural differences among the three generations now working together

What happens when Gen Y, Gen X, and Baby Boomer physicians are employees in the same hospital, clinic, or medical laboratory? There can be a clash of expectations, values, and goals that may cause tension in the workplace.

This happens when physicians, including pathologists, from different generations and different levels of experience levels come together as employees of hospitals and large medical groups, noted a recent story published by Modern Healthcare.

This is a result of the trend where more physicians are employed by hospitals today than ever before. For example, in 2006, just 16% of doctors worked for hospitals. However, by 2012 that figure had climbed to 20%. If physicians working in medical practices partially owned by hospitals are counted, then 26% of all physicians are employed by hospitals. (more…)

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