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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Experts Say Vendors Charge Excessive Fees to Interface EHRs with Clinical Pathology Laboratories, Other Providers, and Networks

Complaints are rolling in about the high-cost interface fees charged by EHR companies for federally mandated connections 

It won’t surprise pathologists and clinical laboratory managers to learn that vendors of electronic health record (EHR) systems are milking physicians and other health-care providers with excessive fees above and beyond the EHR cost. Vendors are socking it to providers—including medical laboratories—in the pricing they charge to create the mandatory interfaces required for the EHRs to connect with outside networks.

These excessive fees were the subject of a story published by Modern Healthcare. It reported that healthcare providers contend that the interface fees are excessive because the software developed for federally mandated connections are common to all vendor customers. Therefore, the interfaces are used over and over again. (more…)

Shopping for HealthCare Services Not Easy Due to Lack of Publicly Available Information on Quality and Value

Study Finds Most State Websites Aimed at Transparency in Healthcare Pricing Inaccurate and Basically Useless in Helping Consumers Shop for Services

With growth in high-deductible health plans, healthcare is becoming increasingly consumer-driven. But shopping for healthcare services isn’t easy due to lack of available resources that enable consumers to compare price and quality, according to a recent study published in the Journal of the American Medical Association (JAMA).

Recently, the U.S. Department of Health and Human Services  (HHS) revealed the arbitrary nature of hospital prices by publishing hospital-specific costs and outcomes data for 3,000 hospitals nationwide, according to a report published by Dark Daily. This step towards full transparency is aimed at helping consumers comparative shop for hospitals based on both quality and value.


Clinical Pathology Laboratories Should Understand How Wellpoint Used ‘Capped-Pricing’ Strategy to Save CalPERS $5.5M on Surgery Costs

New strategy by employers and payers encourages patients to choose lower-cost providers, or pay the difference over the price cap

Payers are teaming with employers to steer patients to lower cost providers. Their common goal is to reduce the cost of care without compromising the quality of care delivered to their beneficiaries. This trend may involve clinical laboratories and anatomic pathology groups, particularly where a lab is seen as a high-cost provider in its service area.

There is credible evidence that patients are willing to consider lower-cost providers. For example, a pilot project aimed a cutting the cost for knee and hip surgeries saved $5.5 million for the California Public Employees Retirement System (CalPERS), the nation’s largest pension fund and third largest purchaser of healthcare benefits. (more…)

Hospitals Generally Charge Self-pay Patients Top Price for Care, but Some Providers Now Offer Deep Discounts for Patients Who Pay with Cash

Clinical laboratories and pathology groups may want to review the prices they charge insured patients versus uninsured patients

There is a certain irony in the fact that hospitals and other medical providers typically charge patients without health insurance as much as three times what they charge Medicare or an insured patient. This situation is getting increased media scrutiny, which is one reason why clinical laboratories and pathology groups may want to review their own policies for charging patients without health insurance.

One good study on prices charged to self-pay patients was conducted by Gerard Anderson, Ph.D.,  a health economist at the Johns Hopkins Bloomberg School of Public Health. His study was funded by the Henry J. Kaiser Family Foundation and published in the May-June 2007 journal Health Affairs.

Anderson analyzed 2004 hospital billing data. He concluded that the gap between rates charged self-pay and insured patients has grown substantially since the mid-1980s. “In the 1950s, the uninsured and poor were charged the lowest prices for medical services. Today they pay the highest prices…,” wrote Anderson, noting that self-pay charges often reflect the hospital’s “chargemaster” prices–the top prices used to negotiate discounts with insurers. (more…)

Update on New Federal Regulations Affecting Clinical Pathology Laboratories: Stage 2 ‘Meaningful Use’ Rules Top the List

Final Stage 2 rules give providers another year to meet Stage 1 ‘meaningful use’ criteria and shorten Stage 2 requirements from one-year to just 90 days

Clinical laboratory managers and pathologists may be interested to know that, over the fall months, the U.S. Department of Health and Human Services (HHS) released three new rules that affect users of health information technology (HIT).

One rule covers Stage Two of Meaningful Use and includes guidance on how providers should address the need to encrypt patient data. The second rule updates eligibility criteria that providers implementing electronic health record (EHR) systems must meet to qualify for federal incentives. Because medical laboratories and pathology groups maintain ongoing electronic interfaces with hospitals and office-based physicians, it is useful to know some of the key elements of these three recently issued federal regulations. The third rule establishes a date for conversion to ICD-10.

The new regulations were contained in a 1,354-page document published in the Federal Register. These rules represent “a tsunami of change” for providers, observed Patricia B. Wise, RN, MS, MA, COL (USA ret’d), Vice President for healthcare information systems for the Chicago-based Healthcare Information Exchange and Management Systems Society (HIMSS). Wise was quoted in a Modern Healthcare story. (more…)