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
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Physicians Not So Happy with Health Insurers, According to Survey Conducted by MGMA

MGMA-ACMPE hopes survey data ultimately reduces distractions and resource diversion for physicians—including pathologists—that result from interactions with payers

When physicians and their practice managers are surveyed about their satisfaction with health insurers, the Medicare program outscores all private health insurers. This was just one finding of an annual survey on this topic conducted by Medical Group Management Association-American College of Medical Practice Executives (MGMA-ACMPE).

Certainly pathologists have their opinion about the service levels of different health insurers. However, MGMA’s survey does not break out physician satisfaction by different medical specialties.  The survey findings reveal that most physicians are neutral or dissatisfied to some degree when queried about different aspects of service provided by Medicare and private health insurers. (more…)

Aetna is Sued by California Medical Societies and Doctors over Its Out-of-Network Policies

It is not known whether any clinical laboratories or pathologists are plaintiffs in this unusual lawsuit of providers versus health insurer

When it comes to out-of-network policies, clinical laboratories clinical laboratory are not the only unhappy class of providers. In California, a coalition of healthcare organizations, physicians, and providers is suing the nation’s third-largest health insurer for its policies and practices relating to out-of-network providers.

It was in July when the Los Angeles County Medical Association (LACMA), California Medical Association (CMA), and various healthcare organizations and providers filed a lawsuit against Aetna Health of California, Inc. (Aetna CA). Aetna CA is a division of Aetna Health Management (NYSE:AET), based in Hartford, Conn. (more…)

Federal Government Agrees to Open Access to Medicare Data about Individual Doctors

Experts predict employers will use this data to create “report cards” on individual physicians

In a big step forward for public access to data about provider outcomes, the Department of Health and Human Services (HHS) will make its enormous Medicare claims database more broadly available to the public. Both the press and the public will be able to search for information about individual physicians. It is likely that information about pathologists will be searchable in this manner.

Specifically, Medicare will relax its restrictions on the release of information about individual doctors who participate in Medicare. This development was reported recently by The Wall Street Journal, which played a role in getting HHS to make physician data available to the public.

“This is a giant step forward in making our health care system more transparent,” stated Marilyn Tavenner, Medicare’s Acting Administrator. (more…)

LabCorp Ousted from Aetnas National Contract

In the heavyweight championship fight taking place between the two blood brothers, Quest Diagnostics Incorporated  has just won the next round. Earlier today, Laboratory Corporation of America issued a terse press release titled: “LabCorp Notified by Aetna of Contract Termination.”

LabCorp acknowledged that “it will no longer be a contracted laboratory provider for Aetna Inc. (NYSE:AET), effective July 1, 2007.” LabCorp further disclosed that it expects the loss of its contract relationship with Aetna to be the primary reason why it expects earnings per share in 2007 will decline from a projected $0.16 to $0.12 in 2007. That’s a 25% reduction.

This breaking development is not a total surprise. Quest Diagnostics found itself excluded from almost all UnitedHealth contracts last October (United Health Disrupts the National Contract Status Quo Between the Two Blood Brothers) and from New Jersey-based Horizon Blue Cross Blue Shield in January. In both cases, LabCorp had negotiated an exclusive relationship.

Now it’s tit for tat. Quest Diagnostics is likely to announce that it has an exclusive national contract with Aetna, effectively denying LabCorp access to Aetna’s 16 million members. Aetna is one of the five largest health insurance companies in the United States.

Each of these national managed care contracts has implications for clinical laboratory management. That’s because both of the blood brothers want to negotiate a national contract with insurer that include terms designed to exclude regional independent laboratories and hospital laboratory outreach programs. To help lab directors and pathologists stay on top of this emerging trend, this year’s Executive War College on Laboratory and Pathology Management has several sessions devoted exclusively to the latest developments in managed care contracting.

In particular, LabCorp’s new CEO, David P. King, will be discussing how managed care companies are altering their strategies for contracting laboratory testing services. This will be a unique opportunity to hear, first hand, what is likely to unfold in the next 24 months. That’s particularly important, since the developments of the past five months are pointing to a managed care contracting environment which is increasingly excludes independent lab companies and hospital laboratory outreach program in favor of the national laboratories.

Stay tuned to Dark Daily for more updates on both this story and this rapidly unfolding trend. Once LabCorp used its exclusive pact with UnitedHealth to break the managed carecontracting status quo between it and Quest Diagnostics, it set in motion forces which are already propelling the laboratory industry into uncharted territory.

PS: To get the latest news and effective strategies dealing with new trends, join us in Miami on May 10-11, 2007 for the 12th Annual Executive War College. You can access the full details using the links below. Take action today to reserve your place.

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