May 13, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Faster than expected transition from fee-for-service healthcare should grab attention of clinical laboratories and anatomic pathology groups who face financial unknowns under new payment systems
Clinical laboratory executives should take note of a key financial fact. The transition from fee-for-service healthcare to value-based reimbursement is occurring at a faster clip than the Department of Health and Human Services (HHS) anticipated last year when federal officials announced a plan to tie 30% of traditional Medicare spending to alternative payments models by the end of 2016.
That means the transition away from fee-for-service payment for medical laboratory tests and other healthcare services is moving ahead of schedule. As evidence, HHS recently announced it reached the 30% target at the start of 2016, nearly a year ahead of the schedule laid out when the Obama Administration outlined a plan to reward healthcare providers based on quality of care rather than the volume of services they provide.
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May 20, 2015 | Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
More collaboration between radiologists and pathologists could speed up diagnoses, increase accuracy, and improve patient outcomes, say advocates of an integrated diagnostic service
For years, certain pathologists and radiologists have floated the idea that an integrated diagnostic service involving both medical specialties could improve patient safety and contribute to improved patient outcomes. Now that the U.S. healthcare system is encouraging tighter integration of clinical services, advocates of an integrated diagnostic service involving radiology and pathology believe that the era of integrated diagnostics may be soon upon us.
There is appeal to the concept of an integrated diagnostic service that would deliver a single, unified report to the referring physician. For example, pathologists and radiologists often work together to work up certain types of cancer. They bring complementary skills to the diagnostic process. Often, particularly in complex cases, their collaboration improves the precision of their respective diagnoses and points the physician to the most appropriate therapies for the patient. (more…)
May 6, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations, News From Dark Daily
Primary themes were healthcare’s transition away from fee-for-service and how innovative medical laboratories are delivering more value with lab testing services
NEW ORLEANS, LA.—Two clear themes for clinical labs and pathology groups emerged from yesterday’s opening presentations at the 20th annual gathering of the Executive War College on Laboratory and Pathology Management.
Transitioning from Fee-For-Service to Value-based Reimbursement Programs
Theme one is that the pace of transformation within the U.S. healthcare system is accelerating. In his opening remarks, Executive War College Founder Robert L. Michel warned medical laboratory professionals that they must not allow their lab organizations to be unprepared or unresponsive to the changes now unfolding across the nation’s healthcare system.
In particular, Michel reminded the more than 850 lab executives and pathologists in the audience that fee-for-service payment for clinical laboratory tests and anatomic pathology services will not remain the dominant form of reimbursement for much longer. “This market trend is aptly described as ‘volume to value,’” noted Michel. “For decades, labs maximized revenue and operating profits by maximizing the volume of specimens that they tested. Those days are coming to an end. Healthcare will increasingly want lab testing services to be high value. These lab services will be paid as part of a bundle, or included in the different forms of global payments and budgeted payments that are made to integrated care delivery organizations, such as ACOs and patient-centered medical homes.” (more…)
Apr 13, 2015 | Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Under the DOJ’s settlement agreement, HDL may need to pay as much as $100 million, according to a published report
Health Diagnostics Laboratory Inc. (HDL), of Richmond, Virginia, and Singulex Inc., of Alameda, California, agreed to pay $48.5 million to settle charges that they violated the False Claims Act, the Department of Justice (DOJ) announced Thursday.
According to the DOJ, the labs violated the Anti-Kickback Statute by paying physicians in exchange for patient referrals, in addition to billing federal health care programs for medically unnecessary testing. Pathologists, medical laboratory scientists, and clinical laboratory directors have watched this case closely since it became public knowledge last fall.
Other Clinical Laboratories and Lab Executives Face Federal Lawsuits (more…)
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…)
