Dec 7, 2016 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Uncategorized
Big data offers new opportunities for healthcare providers, clinical laboratories, and pathology groups, and this new alliance hopes to accelerate big data capabilities
Big data has the potential to deliver unprecedented insight into optimizing the patient care experience and managing outcomes for healthcare providers. That is particularly true for clinical laboratories, and pathology groups. Yet, with the sheer amount of data generated by today’s ever-expanding menus of diagnostic procedures, communicating this data between systems and analyzing data at high-levels still presents challenges.
To help healthcare organizations jumpstart their Big Data programs, key stakeholders are joining forces. One such alliance involves Siemens Healthineers and IBM Watson Health. In an October 2016 press release, the two organizations announced a five-year global strategic alliance aimed at helping healthcare professionals optimize value-based care that leverages increasingly complex data collected for use in precision medicine.
What should intrigue pathologists and medical laboratory managers about this new alliance is the fact that Siemens Healthineers owns two of the world’s largest businesses in radiology/imaging and in vitro (IVD). Thus, it can be expected that the alliance will be looking to identify ways to combine radiology data with clinical laboratory data that produce knowledge that can be applied to clinical care. (more…)
Sep 14, 2016 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Pathology, Laboratory Testing
Two new studies show patients are being increasingly burdened with a greater share of healthcare costs, which requires providers, including medical labs, to collect more money from patients at time of service
Although wage increases remain stagnant, consumers now pay a steadily increasing share of their healthcare costs. That’s because of rising deductibles, co-insurance, and other out-of-pocket costs. Not only will this cost-sharing trend continue to stretch patients’ budgets, it also will apply more pressure on clinical laboratories and pathology groups to increase price transparency for patients.
A recent study at the University of Michigan (UM), published in the Journal of the American Medical Association (JAMA), highlighted the growth in out-of-pocket insurance costs for hospitalized patients. For the average consumer with private health insurance, costs rose from $738 in 2009 to $1,013 in 2013—a 37% increase. During that same 4-year period, overall healthcare spending grew at 2.9% per year and health insurance premiums went up 5.1% annually.
Two types of health insurance plan charges were responsible for the biggest change in out-of-pocket spending: deductibles and co-insurance. During the same period, deductibles rose by 86%! Co-insurance costs increased 33% over the same period. Co-payments (a flat fee) were used in fewer hospitalizations. (more…)
Aug 10, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing
Findings of this HCCI study, may increase pressure for more transparency in clinical laboratory and pathology test prices
Consumers in states with high healthcare costs may spend more than twice as much for common medical procedures as patients in other states. That’s a surprise finding in a milestone report from the Health Care Cost Institute (HCCI). The report also revealed that pathology and clinical laboratory tests are among the services with the widest price fluctuations. Prices also were shown to vary significantly within individual states.
The HCCI study is the latest salvo in the battle to provide consumers with healthcare price transparency and likely will increase demands on clinical laboratories and pathology groups to make lab test prices easy to find and understand.
HCCI Report Identifies Wide Variance in Prices of Clinical Laboratory Tests (more…)
Apr 15, 2016 | Coding, Billing, and Collections, Instruments & Equipment, Laboratory Pathology, Laboratory Testing
Filing a complaint with the Louisville division of the District Court for the Western District of Kentucky, Exact Sciences seeks payment from Humana for at least 4,664 Cologuard tests as well as coverage for the procedure in the commercial plans offered in mandate states
Citing more than $800,000 in unpaid service fees and damages, the Exact v Humana lawsuit is the latest example of the on-going struggle between health insurers and clinical laboratories offering proprietary and patent-protected lab procedures.
Exact Sciences Corp. (NASDAQ: EXAS), and Exact Sciences Laboratories, LLC (Exact) allege that Humana (NYSE: HUM) has denied 120 claims in Kentucky worth approximately $70,000 as well as 293 additional claims in other states with coverage mandates worth approximately $169,000.
Exact claims that attempts to appeal denied claims resulted in payment for some services but that more than half remain rejected. They also report roughly 350 claims in which Humana underpaid.
They are seeking full payment for all claims made since the start of 2014 in Kentucky, Georgia, Missouri, North Carolina, Texas, Illinois, Nevada, and Oklahoma. (more…)
May 27, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Surging enrollment in Medicare Advantage moves patients out of Medicare Part B and thus reduces the ability of regional clinical labs to have access to these Medicare beneficiaries
Smaller clinical laboratories and pathology group practices are facing an inauspicious trend. It is the fast growth of enrollment in Medicare Advantage plans that has reached record high numbers each year since 2010.
This is not a positive development because it moves Medicare Part B patients out of the fee-for-service program and shifts them into Medicare Advantage plans. These plans tend to sign contracts with the national laboratory companies, such as Quest Diagnostics Incorporated (NYSE: DGX) and Laboratory Corporation of America (NYSE: LH) because of their lower lab test prices while excluding most local medical laboratories and pathology groups from their provider networks. The net effect of this trend is that local labs lose access to those patients who were formerly in the Medicare Part B program, but are now enrolled in Medicare Advantage. (more…)
