Nov 9, 2016 | Compliance, Legal, and Malpractice, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing, Management & Operations
Many pathologists and other physicians are accelerating their retirement plans as they become familiar with how MACRA, MIPS, and ADM will change the way the Medicare Program pays for physician professional services
Will Medicare’s make-over to how it pays physicians accelerate the retirement of more doctors—including pathologists? That’s the question many experts are asking as the nation’s physicians learn more about the rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA), with its Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) programs.
With the Center for Medicare and Medicaid Services (CMS) expected this fall to finalize changes in how physicians—including pathologists—get paid for Medicare services, it appears many physicians are considering retirement, rather than contend with Quality Payment Program (QPP) rules for a new value-based reimbursement system and other healthcare reforms.
The Physicians Foundation’s latest biennial survey, “2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” indicated that 46.8% of physicians plan to “accelerate” their retirement plans due to changes taking place in healthcare. That number rises to 50% among doctors age 46 and older, and to 54.2% among physicians who own their own practices. (more…)
Aug 12, 2016 | Instruments & Equipment, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
As the number of on-site and near-site clinics grow, medical laboratories and pathologists could find unique opportunities to bridge the information gap between traditional health systems and new employer-based offerings
Employers have a big stake in lowering the cost of healthcare. That is one reason why more employers are incorporating employee wellness programs into their health benefit offerings. This is a favorable trend for medical laboratories, because such wellness programs often incorporate clinical laboratory tests as benchmarks from which employees can monitor their progress.
In 2013, Dark Daily reported on the increase in employee wellness programs across corporations. Medical laboratories and pathology groups found new opportunities to help with wellness monitoring, screening, and helping individuals through medical consultations.
Three years later, this trend continues to evolve and grow. Today, employers are going beyond simple wellness programs, creating on-site or near-site clinics to save their employees a trip to their local doctor, urgent care, or hospital. (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…)
Jul 13, 2016 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
The amount of patient debt healthcare providers face depends on multiple, complex factors, including whether they engaged in Medicaid Expansion
Often the challenges facing hospitals and medical pathology laboratories are similar. So it is with patient debt. Blame that on two trends. One is the increase in the number of patients with high-deductible health plans. The other is the increase in the number of people enrolled via the Affordable Care Act (ACA) health insurance exchanges with similar high-deductible health plans.
These two factors are contributing to increased levels of bad debt that confront the nation’s hospitals, clinical laboratories, and anatomic pathology groups. However, in some states where Medicaid programs have been expanded, hospitals have reported declines in the level of patient bad debt.
When President Obama signed the Affordable Care Act into law in 2010, many people thought that fewer uninsured people would mean less bad debt for hospitals. Now, six years later, the reality is not so clear-cut.
Hospitals, clinical laboratories, and other entities within the healthcare system are seeing different levels of bad debt depending on what part of the country they are in, what kinds of policies they have enacted, and probably most importantly, whether or not the state in which they are located has expanded Medicaid. (more…)
Apr 27, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Laboratory Testing, Management & Operations
Binder argues that groups opposing ‘value’ often diminish clinicians’ role in hospital quality and patient outcomes; clinical labs often have the data on the outcomes generated by different clinicians
As healthcare moves steadily toward a value-based reimbursement model, Leapfrog Group CEO Leah Binder is urging healthcare providers to rethink their opposition to quality measures and criteria that reward improved medical outcomes.
“Clinicians have a choice: Seize the momentum of the value movement to finally get rewarded for excellence, or recite tired political talking points that minimize your life’s work,” Binder stated in an editorial she penned for Modern Healthcare. “Value will succeed either way, but it will be so much better infused with the knowledge and gifts of practicing providers.”
Many clinical laboratory managers and pathologists know that the Leapfrog Group carries quite a bit of clout in healthcare. Its members include some of the largest corporations in the United States. Collectively, Leapfrog’s members provide health benefits to more than 37 million Americans in all 50 states, and spend tens of billions of dollars on healthcare each year, according to this 2009 Leapfrog Group Fact Sheet. This is why health insurers, hospitals, and physicians pay attention to Leapfrog’s programs and public statements.
“If all hospitals implemented just the first three of Leapfrog’s four ‘leaps’ (our recommended quality and safety practices): over 57,000 lives could be saved, more than 3 million medication errors could be avoided, and up to $12.0 billion could be saved each year,” states the fact sheet.
Physician Opposition to Value-based Reimbursement Models Will Backfire
Leapfrog’s Binder argues the value-based reimbursement movement will succeed for three reasons:
1. “Value” is enshrined in the Affordable Care Act, with the Centers for Medicare and Medicaid Services (CMS) now tying almost 6% of hospital Medicare reimbursement to performance, and Congress replacing the sustainable growth-rate (SGR) with a value-based formula.
2. Private insurers also are transitioning their payment models, with 40% of commercial payments linked to value, up from 9% a year earlier. In addition, consumers, who are paying more out of pocket, are increasingly sensitive to value.
3. Big data is enabling quality to be quantified. Binder pointed to the leadership of the National Quality Forum (NQF) and others in showing “we can defensibly measure the quality side of the value equation.”
Binder warns that arguments made in the name of clinicians to denounce specific quality measures can backfire. In particular, she pointed to a study published in the BMJ that concluded clinicians have little impact on the “standardized mortality ratio,” therefore they should not be held accountable for it.
“Here’s the damaging assumption in the study: The only way physicians or nurses improve patient survival is by avoiding killer mistakes. Surely clinical skill impacts mortality more than that,” Binder stated in her Modern Healthcare editorial.
Similarly, Binder pointed to a study published in the Journal of the American Medical Association (JAMA) that also minimized the impact of clinicians. The study compared how United States hospitals scored on CMS composite safety measures versus alternative measures the researchers invented based on process quality composites. She summarized the findings as stating, “Some hospitals excel on the invented quality composites but fail on the CMS safety composite. Illogically, the researchers conclude that the CMS safety composite is flawed. One might just as well conclude that the researchers’ composites are flawed.”
“Ultimately, this paints a dismal portrait of individual clinicians. … If you excel on some but not all measures, the measures are wrong and you don’t excel at anything,” she stated.
Leapfrog Group CEO Leah Binder is urging healthcare professionals to embrace the move toward value-based reimbursement and rethink their opposition to quality measures that reward high-quality patient care. “Clinicians have a choice: Seize the momentum of the value movement to finally get rewarded for excellence, or recite tired political talking points that minimize your life’s work,” Binder says. (Photo copyright: Aaron Eckels/Crain’s Detroit Business.)
Leapfrog Group Advocates Transparency for Both Insurers and Patients
The Leapfrog Group was formed in 2000, a year after the Institute of Medicine’s (IOM’s) landmark report on medical errors, “To Err Is Human: Building a Safer Health System,” in which the IOM estimated that preventable medical errors caused 44,000 to 98,000 deaths annually, with an associated cost of $17 billion to $29 billion.
The watchdog organization operates out of Washington, D.C. and is made up of more than 170 of the nation’s largest purchasers of healthcare, including:
• AARP;
• Boeing;
• Lockheed Martin;
• Marriot International;
• University of Michigan; and
• the Florida Healthcare Coalition.
Through its annual hospital surveys and research, the non-profit urges insurers and patients to use transparency to improve the safety and quality of the healthcare system.
The Leapfrog Group’s movement for transparency has grown to include more than 1,700 hospitals that participate in its annual survey on safety, quality, and resource use. In 2015, a record 1,750 hospitals submitted a survey, representing 46% of hospitals nationwide. It also has focused attention on reducing early elective deliveries, launched a pay-for-performance program, and designed a Hospital Safety Score to help consumers to make better healthcare decision.
Providers Should Seek Transparency
While negotiations about quality measures have reached a fever pitch, Binder would like to see providers insist on transparency and accountability for their patients, a step she says would validate clinicians’ work and expertise.
“While thoughtful critiques of measures are important, politically-motivated denial of measures is destructive in unintended ways,” Binder stated in her editorial for Modern Healthcare. “It often follows the unfortunate pattern of these studies in assuming that providers perform at essentially the same level of quality and/or their actions can’t be linked to patient survival or healing,” she observed.
“If all physicians and nurses believed their work had such modest impact, the burnout problem might be even worse,” continued Binder. “People who choose a career in healthcare tend to be bright, competitive and caring, and they won’t last long if they believe their talents make virtually no difference.”
As noted above, since the Leapfrog Group represents many of the major purchasers of healthcare, Binder’s recent comments should grab the attention of pathologists and clinical laboratory executives. They would do well to anticipate continued calls for more quality and more measurement of quality in healthcare as the movement toward value-based reimbursement marches on. Contributing value to hospitals, physicians, and payers is quickly becoming the new paradigm for clinical laboratories and pathology groups.
—Andrea Downing Peck
Related Information:
Clinicians Must Push Back Against Critics Challenging the Role of Quality Measures
Standardized Mortality Ratios Should Not Be Used to Benchmark Hospitals, Study Concludes
Leapfrog Group Fact Sheet
Concerns About Using the Patient Safety Indicator-90 Composite in Pay-for-Performance Programs
To Err Is Human: Building a Better Health System
