Mar 6, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
After seeing a rise in the volume of clinical lab tests physicians order, managed care plans are develop a variety of strategies to manage utilization and costs
Health insurers are taking more aggressive actions to control the cost of clinical laboratory testing. For many years, clinical laboratories and pathology groups have been concerned about the strategies used by Medicare to control the utilization and costs of medical laboratory tests. Private health insurers usually follow the actions of Medicare, the nation’s largest health insurer. But today, managed care plans are developing their own lab-test-utilization strategies in addition to following those of Medicare.
Recently, Managed Care magazine explained many of the steps health insurers take to keep the costs of clinical laboratory tests under control. The cover story in the October issue of the magazine, “Health Plans Deploy New Systems To Control Use of Lab Tests,” outlined how health insurers Cigna, Group Health Cooperative, Priority Health, and UnitedHealthcare (UHC) are managing lab test utilization. (more…)
Feb 20, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
NPR stations in San Francisco and Los Angeles crowdsourced healthcare cost data from listeners to reveal arbitrary pricing of medical services
Over the past two years, Dark Daily has published a number of stories dealing with price transparency, or lack of it, most of which involved government agencies or nonprofits concerned about the high cost of healthcare services. This latest effort to shine a light on healthcare pricing, however, comes from National Public Radio (NPR).
San Francisco’s NPR station, KQED, initiated PriceCheck, an innovative project designed to reveal just how arbitrary medical pricing is in California, in June 2014. KQED partnered with Los Angeles’ NPR station, KPCC, and ClearHealthCosts.com, a New York City start-up that publishes a national list of low to high charges for common healthcare services, to crowdsource healthcare cost data.
The two NPR stations appealed to listeners to share the charges they paid for four medical services: mammograms, lower-back MRIs, IUDs, and diabetes testing. Hundreds of people responded to share prices they paid for these services, and thousands of people looked up prices on ClearHealthCosts.com. (more…)
Nov 19, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Pathologists and clinical laboratory managers will want to stay abreast of what emerging data is revealing about the broader impact of slowed growth in Medicare spending
Contrary to the predictions of some analysts, a recent study suggests that slowing Medicare price growth by lowering hospital reimbursements will slow hospital utilization and spending for all age groups. For pathologists and clinical laboratory managers, the study represents credible evidence that cuts in Medicare prices cause a measurable and linked decrease in hospital utilization for both the elderly and the non-elderly.
The Affordable Care Act of 2010 (ACA) permanently suppressed the rate of growth in Medicare reimbursements to hospitals and most other medical providers, according to a recent study by the Center for Studying Health System Change (HSC). In this study, the HSC sought to measure spillover effects of changes in Medicare inpatient hospital prices on patients under age 65. (more…)
Oct 31, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
It turns out that Florida, California, and Texas have the largest number of hospitals on the list
Are you curious about which hospitals in the United States charge the highest prices? A new list of the 100 most expensive U.S. hospitals has the answers. The list was compiled in an effort to provide greater price transparency. Not surprisingly, the highest-priced hospitals are likely to also have some of the highest clinical laboratory test prices.
The study was conducted by National Nurses United (NNU), the largest nurses union in the country, and the Institute for Health & Socio-Economic Policy (IHSP). Researchers used the information from Medicare cost reports that included hospital charges and costs for fiscal year 2012. (more…)
Aug 25, 2014 | Compliance, Legal, and Malpractice, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Health insurers offering Medicare Advantage plans are narrowing their networks and favoring the national clinical lab companies over local medical labs and pathology groups
Enrollment in Medicare Advantage health plans is booming. This development is not auspicious for local medical laboratories, hospital lab outreach programs, and anatomic pathology groups because the private health insurers operating these plans typically prefer to contract with national lab companies while narrowing their lab networks.
The mathematics of this trend are simple. As Medicare Advantage enrollment increases, the proportion of patients covered by traditional Medicare Part B fee-for-service shrinks. The consequence is that local labs have fewer Medicare Part B patients to serve and are locked out of providing medical laboratory testing services to Medicare Advantage patients. (more…)
