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
Sign In

Gap Insurance Trend Protects Employees from Crippling Out-of-Pocket Costs and Offers Clinical Laboratories New Method to Receive Payments

Medical laboratory and pathology groups could benefit from trend by receiving payments for testing services from secondary payer rather than directly from patient

As high-deductible health plans (HDHPs) become the norm for more Americans, gap insurance is being touted as an innovative way to protect consumers from crippling healthcare costs. This added insurance protection is proving attractive to a growing number of patients with HDHPs.

Use of gap plans by more patients also could benefit clinical laboratories and pathology groups. That’s because patients with HDHPs who would normally be required to pay 100% of their lab testing charges until their annual deductible is met, would be covered for these costs because of their gap insurance. In these situations, labs would have a secondary insurer to bill until the annual deductible was met. (more…)

CPC+ Continues CMS’ Efforts to Establish Medical Homes

The trend toward alternative payment systems continues as CMS announces the Comprehensive Primary Care Plus (CPC+) model

Efforts by Medicare officials to move providers away from fee-for-service payments and onto other models of reimbursement continue to move forward. This is one of several goals for a new primary care program that Medicare is about to launch in coming months.

Medical laboratories and pathology groups might feel an impact from this new program the Centers for Medicare and Medicaid Services (CMS) is testing. Announced in April, 2016, the program is called Comprehensive Primary Care Plus (CPC+). The CPC+ program is a five-year model that is designed to strengthen primary care, through establishing what are called “medical homes,” where patients experience more coordinated care. (more…)

Trend of Hospitals Re-entering the Health Insurance Market May Benefit Hospital Laboratories

As ACO movement gathers momentum, hospitals and health systems see opportunities in providing health insurance

Hospitals and health systems are getting back into the health insurance business. Not only is this seen as an opportunity created by the development of accountable-care organizations (ACOs), but it may help the clinical laboratories of these same hospitals that serve office-based physicians in their communities.

This trend is another result of the Obamacare legislation. Some hospital systems are seizing an opportunity to expand their roles and grow revenue by once again getting into the health insurance business. Some experts believe this trend is likely to create more competition among insurers.

It may also accelerate the shift away from fee-for-service reimbursement to a global or bundled payment structure. As this occurs, medical laboratories will need to develop services that offer greater value to physicians and patients. (more…)

Physician Adoption of EHRs Accelerates, but Rural Providers Slow to Embrace EHRs

Adoption of EHR systems by small practices, small hospitals, and rural health providers lags behind the pace of urban-based hospitals and physician groups

As larger numbers of physicians implement electronic health record (EHR) systems, clinical laboratories are faced with the task of building interfaces that connect their laboratory information systems (LIS) to those EHRs.

Recent numbers indicate that hundreds of thousands of physicians are now enrolled in the federal EHR incentive program. This puts medical laboratories and anatomic pathology groups squarely in the midst of the drive to encourage physicians to both implement an EHR in their clinical practice and use that EHR in ways that meet “Meaningful Use” requirements.

Some 225,765 providers are participating in the Medicare and Medicaid EHR incentive programs created by the American Recovery and Reinvestment Act of 2009. The Centers for Medicare and Medicaid Services (CMS) report that almost $4.5 billion in financial incentives have been paid to hospitals and physicians for implementation of electronic health record (EHR).