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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Kaiser Family Foundation Study Predicts Big Increases in Obamacare Premiums for 2017; However, Narrow Networks Often Exclude Clinical Laboratories and Other Providers

Accountable Care Act has reduced the number of uninsured, but has failed to deliver lower costs for most Americans or employers

More big increases are coming to Obamacare premiums during 2017. This is an important development and, depending on how the new Congress decides to address problems with the Affordable Care Act (ACA), the consequences can be either positive or negative for clinical laboratories and anatomic pathology groups.

Large increases in healthcare premiums can have a trickle-down effect on clinical laboratories and pathology groups since health insurers tend to reduce reimbursements to providers when they are in a financial squeeze. And while the November election puts the future of the ACA in doubt, a recently released Kaiser Family Foundation (KFF) study adds further evidence that Obamacare (colloquial for the ACA) has fallen short of its goal of reining in healthcare costs while simultaneously expanding healthcare coverage to millions of Americans.

The KFF study shows premiums in the ACA’s Health Insurance Marketplace will continue to increase in many regions in 2017. Researchers blame the higher price in part to the phasing out of the ACA’s reinsurance program and the unexpected losses many participating insurers have experienced. (more…)

Growth in High Deductible Health Plans Cause Savvy Clinical Labs and Pathology Groups to Collect Full Payment at Time of Service

Medical laboratories can increase revenue and reduce bad debt by using technology to verify patient ID and insurance information before a specimen is provided

Due to a need to collect payment directly from the growing number of patients with high-deductible health plans, many clinical laboratories and anatomic pathology groups are experiencing flat or even declining cash flow. This issue has medical lab CFOs scrambling to find solutions.

Moreover, this problem is noticeably greater in 2014 than it was in 2013. One factor behind this worrisome trend is the Affordable Care Act (ACA). As of January 1, most newly insured patients enrolled under ACA have high-deductible health plans (HDHPs) that require substantial copayments when patients receive healthcare services. Employers are also increasingly shifting their employees to HDHPs, as well.
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