Apr 11, 2010 | Compliance, Legal, and Malpractice, Managed Care Contracts & Payer Reimbursement
Apparently physicians in several states besides New Jersey are catching the attention of their insurance regulators over UnitedHealthcare’s effort to fine doctors who continue to use out-of-network laboratories. Now, state authorities in Texas, Connecticut, Iowa, Florida, and California have joined New Jersey state regulators by announcing plans to review the legality of the $50 fine announced by United Healthcare for doctor’s who refer their patients to out-of-network laboratories.
In March, the California Medical Association said that this new policy illegally interferes with PPO patients’ right to access out-of-network benefits and improperly obstructs the physician-patient relationship. “Patients have the right to decide where to receive health care services, without having to worry that their physicians are being fined or otherwise penalized for their choices. This right is particularly acute for patients who pay premiums for nonexclusive PPO benefits,” wrote CMA chief legal counsel Catherine Hanson. “And physicians have the right to speak freely with their patients about their health care choices, without having to worry that they will be fined or otherwise penalized should their patients choose an out-of-network option.”
The Florida Medical Association initially asked United Healthcare to take the policy out of its protocols with physicians, but now simply says “We’re confident United is going to be working with physicians not to charge that $50,” said Lisette Gonzales-Mariner, FMA spokeswoman.
United Healthcare spokesman Roger Rollman said that the policy was for “worst-case scenarios” and that fines would not be imposed the first couple of times a doctor didn’t abide by the policy.
American Medical Association spokesman Robert Mills said, “I think, while others [insurers] may have protocols that talk of out-of-network labs, I don’t believe any other insurers are using the stick approach versus the carrot.”
It is not difficult to see that United Healthcare is receiving significant bad press from the medical community on the $50 fine for doctors with patients that use out-of-network labs. This decision has triggered growing concern among doctors, who are worried that they can be made responsible for the actions of their patients. The American Association of Family Physicians has clarified United Healthcare’s new lab protocol and outlined how and when fines can be dispensed, trying to put physicians at ease.
However, it is important to remember that, as part of the 10-year exclusive national lab services contract between UnitedHealth and Laboratory Corporation of America, UnitedHealth has a commitment to take active steps to enforce compliance by its physicians with the laboratory services network. It is believed that the financial benefits to UnitedHealth from this exclusive national lab services contract are significant enough to motivate it to continue its tough stance. What remains to be seen is whether the bad press and negative impact on relationships built with state medical associations will do lasting harm to the long term relationship between UnitedHealth and its physician panel.
Related Articles:
CMA Calls United Healthcare’s New Lab Policy Illegal and Ill-Advised
Doctors upset over insurer’s new policy
AAFP Clarifies UnitedHealthcare’s New Lab Protocol
Apr 5, 2010 | Laboratory News, Laboratory Pathology
Consumer products giant acquires 100% ownership of concierge medicine company
Clinical laboratories and pathology groups may soon be serving physician practices owned by Procter & Gamble (P&G) (NYSE:PG). That’s because the consumer products giant now owns 100% of MDVIP, a nationwide concierge practice of 350 doctors in 28 states.
The deal is noteworthy because it further expands Procter & Gamble’s presence in healthcare. In 2006, P&G invested $325 million in a joint venture with Inverness Medical (NYSE:IMA). The joint venture announced its intention to develop and market diagnostic test kits for use by consumers that can be sold in retail outlets. At the time, The Dark Report wrote that, “P&G’s interest in consumer self testing is based on its belief that consumer demand for health services and healthcare products will soar in the coming decades.” (See The Dark Report, June 4, 2007, “ Inverness Buys Biosite, Has New Venture with P&G” )
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Mar 29, 2010 | Laboratory News, Laboratory Pathology
Multi-marker pathology cancer tests likely to be developed from this research
Pathologists and other clinical laboratory scientists can expect to see a number of multi-biomarker genetic tests for cancer as a result of research that is identifying specific gene abnormalities that are common to certain cancers and promote the growth of these cancers. Variations in these mutations make a difference in the effectiveness of certain treatments.
With the aid of recent advances in genomic mapping technology, an international team led by researchers at the Dana-Farber Cancer Institute and the Broad Institute have found that many of these aberrations in the genetic code are shared by a variety of cancers occurring in many different types of tissues. The study appears in the February 18 issue of Nature.
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Mar 10, 2010 | Laboratory News, Laboratory Pathology
Appropriate use of clinical pathology laboratory tests to detect and treat cancer will be a scorecard factor
One primary goal of pay-for-performance programs is to reduce or eliminate the variability of care that physicians provide to their patients. Getting physicians to follow the recommended care protocols 100% of the time with 100% of their patients would contribute to improved outcomes, while reducing overall healthcare costs.
Pathologists and clinical laboratory professionals are well positioned to see this variability in care, since they regularly handle the laboratory test requests from client physicians. Over time, they can recognize the good and bad practice patterns of individual doctors, since it is reflected in both the lab test orders and the laboratory test results for that doctor’s patients.
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Feb 1, 2010 | Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Sir Muir Gray addresses Frontiers in Laboratory Medicine
“Manage knowledge as though it is money” was the advice that Sir Muir Gray offered pathologists and clinical laboratory scientists attending last week’s Frontiers in Laboratory Medicine (FiLM) conference that took place in Birmingham, England. He was explaining how 20th Century Medicine is evolving into 21st Century Medicine.
Sir Muir Gray is the Chief Knowledge Officer for Great Britain’s National Health Service (NHS) National Library for Health.
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