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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MinuteClinic Gains Contract to Offer New Rapid Test for Conjunctivitis

Early example of how in-store walk-up clinics may expand their lab testing services

Pathologists concerned that in-store walk-up clinics might become important laboratory testing centers will be interested to learn about the latest development. The largest operator of these in-store clinics has just partnered with an in vitro diagnostics (IVD) manufacturer for exclusive access to a new rapid diagnostic test.

MinuteClinic, the pioneer and largest operator of in-store health clinics, has a deal with Rapid Pathogen Screening, Inc. (RPS), a Sarasota, Fla.-based biotechnology company, to offer the RPS Adeno Detector test for conjunctivitis, or pink eye. This new point-of-care (POC) test will be initially offered at the MinuteClinics located in 23 CVS pharmacy stores in the Atlanta area.

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Comparative Effectiveness: It’s Here! It’s Now! And It’s Funded to the Tune of $1.1 Billion!

Effort will identify which clinical procedures actually benefit patients—and are cost-effective

“Comparative effectiveness research (CER)” is likely to be one method that healthcare reformers use to establish reimbursement for different medical technologies and treatments. This will apply equally to clinical laboratory testing and pathology professional services as well as other medical procedures.

There is a compelling reason why comparative effectiveness is likely to happen on this turn of the healthcare reform wheel. Congress put teeth into the comparative effectiveness movement earlier this year when it provided $1.1 billion to support the effort in the American Recovery and Reinvestment Act of 2009.

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Consolidation of Nation’s Health Insurers Is Bad Medicine for Local Labs and Pathologists

While no one was looking, nine big insurers grabbed 76.7% of privately-insured patients!

Consolidation of major health insurance companies in recent years is a trend which reinforced the market clout of the nation’s two largest lab companies at the expense of local laboratories and pathology groups. However, few pathologists and clinical lab managers know precisely how much market power is currently concentrated into the hands of only a few health insurance companies.

Dark Daily now unveils a remarkable analysis. At this moment, just nine companies control 76.7% of all privately-insured individuals in the United States! Moreover, the three biggest of these health insurance firms—UnitedHealth Group, WellPoint, and Aetna—collectively cover 85.6 million of the185 million Americans enrolled in private health plans. That’s 48.3% of the total U.S. market.

As shown in the table below, when the other six companies are added—Humana, HealthCare Service Corp., Cigna Group, Kaiser, Highmark and Health Net—the nine biggest health insurers cumulatively insure 141.9 million of the 185.1 million Americans with private health insurance—or 76.7% of the total.
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CMS Proposes Preauthorization Imaging Services, a Dangerous Precedent for Laboratory Testing

MedPAC recommendation targets high-cost imaging done in physician’s offices

Following the lead of some private insurers, Medicare may soon require preauthorization for high-cost imaging tests—including CT, MRI and PET scans—done in physician offices. This is one of two strategies aimed at reducing payments for Part B physician radiology services that was recommended by the Medicare Payment Advisory Commission (MedPAC) in its report to Congress in March.

The General Accounting Office (GAO) estimates that preauthorization could save the Medicare program $220 million by 2014 and about $1 billion by 2019. To make preauthorization work, the Centers for Medicare & Medicaid Services would establish a panel of experts, to be known as a Radiology Benefits Managers (RBMs), to assist in evaluating and adjusting payment for potentially overvalued imaging services ordered by physicians with their own imaging facilities.

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UnitedHealth Offers Medicare 15 Ways to Save $540 Billion, While Improving Care Quality

List of recommendations based on UnitedHealth’s extensive database and experience

Every sector of the healthcare industry is offering both Congress and the Center for Medicare & Medicaid Services (CMS) advice on how to reform the system to improve quality of care, while reducing costs. Too often, the search for ways to save money that can be redirected to covering uninsured is a game of taking money from one existing health service and shifting it to another.

Recently UnitedHealth Group (NYSE:UNH) stepped into this debate over how to save money. In important ways, it is better positioned to provide this advice than most other entities. For example, UnitedHealth Group is the nation’s largest insurer in terms of revenue. UNH funds and organizes care for 70 million Americans. It arranges $115 billion in health care services provided by 5,000 hospitals and 650,000 physicians nationwide. Because of this, UNH’s Center for Modernization and Reform has collected more data on clinical services provided and resulting healthcare outcomes than anyone else.
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