May 1, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
If bundled payment becomes more common in treatment of cancer, then anatomic pathologists need a strategy to demonstrate their clinical value to physicians and payers
MD Anderson Cancer Center and UnitedHealthcare (NYSE: UNH) announced a bundled payment agreement for the treatment of certain types of cancer. This development has implications for anatomic pathologist who provide cancer testing services to hospitals throughout the United States.
The new three-year pilot at MD Anderson’s Head and Neck Center in Houston, Texas, is the first use of a bundled payment model in a large, comprehensive cancer center. Officials say it is expected to lower costs while improving the quality of patient care and outcomes. As many as 150 patients with head and neck cancer who are enrolled in employer-sponsored UnitedHealthcare (UHC) plans will participate in the pilot.
“For the last five years, MD Anderson and its Institute for Cancer Care Innovation have been looking at how to best approach a single price for treating cancers. It is a complex question because cancer is a complex disease and each patient unique,” stated Thomas W. Feeley, M.D., Head of Anesthesiology and Critical Care, and Head of the Institute, in an MD Anderson news release. “Bundled pricing is something that patients and care providers want, and this is our first opportunity to better understand how we can manage costs without sacrificing quality care and patient outcomes.” (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…)
Sep 3, 2013 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Commission issues 12 recommendations to enhance physician and patient satisfaction, while creating a financially sustainable healthcare system
How quickly will fee-for-service disappear as a primary source of reimbursement for clinical laboratories, pathologists, hospitals, and physicians? If the recommendation of one credible group of physicians has its way, fee-for-service reimbursement could disappear in as little as five years.
This recommendation was made by National Commission on Physician Payment Reform as part of a report it issued in May. In its press release, the commission issued a call “for eliminating stand-alone fee-for-service payment by the end of the decade.” The group urges a transition over five years to a blended payment system that will yield better results for both public and private payers, as well as patients.” (more…)
Aug 19, 2009 | Laboratory News, Laboratory Pathology
One approach is to bundle payments to hospitals, physicians, labs, and other providers
Momentum is building around a new effort to drive down existing rates of hospital readmissions. Different reimbursement proposals to encourage hospitals and physicians to reduce current readmission rates will likely also change the reimbursement status quo for laboratory testing. For example, bundling Part A and Part B payments may be one approach.
Experts increasingly believe one game changer in lowering healthcare costs and improving outcomes is avoidable hospital readmissions. One in five Medicare patients returns to the hospital within 30 days. Overall, readmissions cost Medicare an estimated $17 billion yearly. Of this total, about $12 billion are believed to be avoidable cases
(more…)
Apr 17, 2009 | Laboratory News, Laboratory Pathology
Bundled Payment Demonstration Project Changes How Labs Would Be Paid
Efforts in the nation’s capital to reform healthcare are still in the formative stage as the new President and the new Congress consider various approaches. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) started the new year by launching pilots for a bundled-service payment scheme. Not only may this be the beginning of the end of the fee-for-service payment system, but it has important implications for clinical laboratories and anatomic pathology groups.
The bundled payment system demonstration projects are a first step to what’s coming next. The Medicare Payment Advisory Commission, better known as MedPAC , released its blueprint for reforming the delivery system to Congress on March 17 in its annual Report to the Congress: Medicare Payment Policy.
(more…)
