Feb 13, 2015 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations
Accelerating pace of hospital consolidation brings new pressure to pathologists and clinical laboratory directors to maximize the value of pathology services
Large and financially-stable multi-hospital health systems are racing to form regional mega-systems. It’s a strategy to get ahead of the Affordable Care Act’s (ACA) mandate to improve quality and increase efficiency through coordinated care across the entire care continuum.
This growing national trend means further consolidation of clinical laboratory testing services within the merging organizations. For pathology groups, the new super-systems may encourage the different pathology groups within the system to consolidate into a single practice entity. This would help improve how pathology services are more deeply integrated into the care continuum. It would also facilitate contract negotiations between the pathologists and the parent health system. (more…)
Dec 15, 2014 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Specialist physicians will benefit from enriched medical laboratory consultations involving pathologists and other clinical laboratory scientists
Increasing numbers of medical specialists are launching patient-centered specialty practices (PCSP). This trend has implications for clinical laboratories and pathology groups because these office-based physicians will want tighter clinical and operational integration with other healthcare providers who treat the same patients.
Specialist physicians are watching the growth of patient-centered medical homes (PCMHs) and how PCMHs are organized to provide proactive clinical services and maintain access to patients. In adopting this care model for specialty medical practices, these specialists will typically utilize a more extensive menu of medical laboratory tests and anatomic pathology professional support from their laboratory providers. (more…)
Oct 29, 2014 | Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News
Pathology groups and medical laboratories may benefit if federal and state legislators legislate broadening of provider networks
Insurers are increasingly using narrow networks as a business strategy to control costs. As a consequence, more consumers are complaining even as some excluded providers are suing health insurers. For pathologists and clinical laboratory managers, this accelerating trend of excluding providers means increasingly restricted access to patients.
Health Insurers Walk a Fine Line between Cost and Access
Many health plans currently sold on the new state insurance exchanges offer substantially smaller networks of providers than was typical in recent years, according to a story published in Modern Healthcare. The payers say narrower networks are necessary for two reasons.
First, narrow networks can keep premiums affordable. Second, health insurers say narrow networks help them address the requirements of the Patient Protection and Affordable Care Act (ACA). (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…)
May 23, 2014 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
For first time since launch of the Medicare program, CMS released data on Medicare payments to individual physicians
Once again, Medicare officials have stuck a blow for price transparency. On April 9, 2014, the Centers for Medicare and Medicaid Services (CMS) released data on total payments made to individual physicians for the year 2012. In several states, pathologists were identified as among the highest-paid physicians.
Release of this information generated stories by the national and local media. There was also plenty of criticism from a number of prominent national physician associations, including the American Medical Association. It was just last year when CMS released data on what 3,000 hospitals charged Medicare for the 100 most-frequently billed discharges. (more…)
