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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Health Insurers Balk at Paying for Multigene Panels While Clinical Pathology Laboratories and Physicians Pursue Evidence of Clinical Utility

News reports state that Anthem and Cigna have denied payment for some multigene panel tests, saying that the tests are unproven. Other insurers, such as UnitedHealthcare and Priority Health, pay for such tests but only for certain patients

A conflict is building between patients and health insurers over the reluctance among health plans to pay for new, expensive molecular diagnostic assays and genetic tests that clinical laboratory companies offer.

This conflict has caught the attention of the nation’s media. That is probably because it makes a great story, for example, to interview parents who can assert that their sick child suffered because their health insurance plan would not pay for a genetic test the parents believed would make a difference in their child’s clinical care. Of course, pathologists and medical laboratory professionals know that there are a significant number of expensive genetic tests being offered by various lab companies that lack extensive data to support their clinical efficacy. (more…)

Florida Rheumatologist Says UnitedHealthcare’s Management Program for Clinical Laboratory Tests Could Jeopardize Patient Care

Miami physician asks why UnitedHealthcare requires use of the BeaconLBS system for authorization for recommended medical laboratory tests that may help identify lymphoma early

In Florida, the confrontation between one of the nation’s largest health insurance corporations and physicians, clinical laboratory managers, and pathologists continues. The source of this confrontation are the restrictive and burdensome requirements for medical laboratory test ordering imposed last fall by UnitedHealthcare (NYSE:UNH) and administered by BeaconLBS, a business division of Laboratory Corporation of America (NYSE:LH).

For Florida rheumatologist Olga Kromo, M.D., UnitedHealthcare’s new decision-support system that physicians are required to use when ordering clinical laboratory tests is highly flawed. (more…)

Medical Laboratories at Hospitals Urged to Improve Newborn Screening Procedures After Wisconsin Report Uncovers Shocking Testing Delays

Analysis of almost 3 million newborn blood samples found that tens of thousands of specimens were not screened promptly for rare but deadly disorders, leading to patient harm in some cases

State-mandated newborn testing has come under increased media scrutiny following the discovery that delays in reporting the clinical laboratory test results had resulted in harm to some children with genetic diseases. One source of problems is some hospitals fail to promptly submit specimens from babies to their state’s newborn testing laboratory.

In Wisconsin, pathologists and medical laboratory and laboratory managers probably know the story of Colton Hidde because of news stories about his case. When Karen and Mike Hidde brought their newborn baby Colton home from the hospital after his birth in October 2012, they had no idea that he would soon be close to death. He appeared to be a normal newborn. But he was not, and the Hiddes didn’t find out that he had a rare and life-threatening genetic defect until they rushed him back to the hospital less than 24 hours after bringing him home. (more…)

Generational Differences Now Reshaping Physician Attitudes and Will Likely Affect Private Pathology Group Practices

One consequence of the difference in intergenerational attitudes of physicians is the trend to more employee physicians

For the dominant generation working in healthcare today—the Baby Boomers—retirement looms. At the same time, however, the younger generation—particularly Generation X—is acquiring the experience and maturity needed to assume leadership roles. As these individuals move into senior executive and administrative positions, healthcare experts are predicting growing conflict over the role of physicians in the new models of integrated healthcare now taking shape in this country.

This is a demographic and societal trend with major implications for the operating culture of clinical laboratories and anatomic pathology groups. Generation X physicians, including young pathologists, are ready to challenge Baby Boomer physicians about the best way to organize and deliver clinical services. (more…)

Physician Business Leader Predicts Healthcare’s Winners and Losers as More Organizations Take Steps to Become Patient-Centered Medical Homes

Growth in the number of medical homes could make winners of those pathology groups and medical laboratories that learn how to best meet the needs of these providers

Physician executives at TransforMED, a wholly-owned subsidiary of the American Academy of Family Physicians, are blogging with their opinions about which providers will be winners and losers in healthcare. Although most pathologists may not agree with these opinions, there are useful insights to be gleaned from the reasoning behind these opinions.

According to TransforMed’s physician-leaders, healthcare is not about to transform—it already has! The healthcare world is no longer changing, it has changed, and “there will be winners and losers,” stated Terry McGeeney, M.D., MBA, FAAFP, in a blog published on the TransforMed Website.