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

May 19, 2017 | Compliance, Legal, and Malpractice, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement

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…)

Medicare Moves Forward with Bundled Payment Reimbursement as Part of a Trend That Has Major Ramifications for Clinical Pathology Laboratories

Jun 27, 2016 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Operations, Laboratory Pathology, Laboratory Testing

Pathologists and clinical laboratory managers can expect that CMS will accelerate the shift from fee-for-service reimbursements to bundled payment models

It is still not widely recognized among clinical laboratory managers and pathologists that Medicare program officials are serious about moving forward to replace fee-for-service provider payment with value-based payment methods. In fact, many medical lab professionals may not have heard the news from earlier this year that one-third of Medicare payments are now value-based.

It is important for all clinical lab executives to be aware of the press release issued by the federal Department of Health and Human Services on January 26, 2015. It was the first time that the Medicare program had published goals for moving away from fee-for-service that were tied into specific dates. (more…)

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