Apr 18, 2014 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
This hospital industry sector is expected to achieve lower growth rates and less revenue and are likely to reduce operating budgets for medical laboratories
Tough financial times are ahead for not-for-profit hospitals, according to the projections of multiple rating agencies. Financial analysts attribute this to an extended period of massive and disruptive change. This is not good news for hospital-based clinical laboratory managers and pathology groups.
Big Three credit-rating agencies Moody’s Investors Service (NYSE: MCO), Fitch Ratings, and Standard & Poor’s Financial Services LLC (S&P) echoed a common theme in their 2014 outlooks for not-for-profit hospitals, which represent 60% of the nation’s hospitals. Environmental pressures will suppress revenue growth, while fresh cost-cutting measures will become increasingly harder to find. (more…)
Feb 12, 2014 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Market indicators support predictions of tougher financial times ahead for hospital-based clinical laboratories and pathology groups
New statistics for 2013 on employment in the healthcare and hospital sectors show the lowest rates of growth since 1990. This is a signal to pathologists and clinical laboratory executives that much belt-tightening is taking place by all types of providers.
For 2013, the healthcare sector added just 271,000 jobs. This was 2% less than the annual average since 1990, noted a recent report in Modern Healthcare. (more…)
Feb 3, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Other states are studying Oregon’s innovative Medicaid experiment, which could lead to different forms of reimbursement for clinical laboratories
Once again, Oregon’s Medicaid program is blazing a new trail in the delivery of healthcare. This time, Oregon is organizing its Medicaid services—known as the Oregon Health Plan—to do two things. First, it is developing 16 coordinated care organizations (CCOs) across the state. Second, those Medicaid beneficiaries who represent the majority of costs to the program will receive special case management and clinical services.
Because there will be capitated payments to providers under this program, clinical laboratory managers and pathologists will want to understand how medical laboratories will be reimbursed by the Oregon Health Plan. (more…)
Aug 30, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Managed Care Contracts & Payer Reimbursement
Confusion, unhappiness, and many unresolved issues remain about the way government and private payers are handling claims for molecular diagnostic tests covered by the 114 new CPT codes
Dust is settling from the fiasco triggered by the Medicare program’s failure to be ready on January 1, 2013, to settle molecular diagnostic test claims filed under the 114 new Tier 1 and Tier 2 molecular CPT codes. The damage is not just limited to Medicare test claims, but also involves private health plans that were waiting to let the Medicare program set precedents on coverage and prices for the new molecular test codes.
Many Clinical Laboratories Must Cope With an Unsatisfactory Situation
Although federal Medicare officials and Medicare contractors have scrambled to rectify the situation, even today there is much unhappiness across the clinical laboratory industry about the current state of things. That unhappiness extends to state Medicaid and private payers because many of these payers have been slow to publish coverage guidelines and prices for these new molecular test CPT codes.
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Aug 7, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
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…)
