May 1, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
If bundled payment becomes more common in treatment of cancer, then anatomic pathologists need a strategy to demonstrate their clinical value to physicians and payers
MD Anderson Cancer Center and UnitedHealthcare (NYSE: UNH) announced a bundled payment agreement for the treatment of certain types of cancer. This development has implications for anatomic pathologist who provide cancer testing services to hospitals throughout the United States.
The new three-year pilot at MD Anderson’s Head and Neck Center in Houston, Texas, is the first use of a bundled payment model in a large, comprehensive cancer center. Officials say it is expected to lower costs while improving the quality of patient care and outcomes. As many as 150 patients with head and neck cancer who are enrolled in employer-sponsored UnitedHealthcare (UHC) plans will participate in the pilot.
“For the last five years, MD Anderson and its Institute for Cancer Care Innovation have been looking at how to best approach a single price for treating cancers. It is a complex question because cancer is a complex disease and each patient unique,” stated Thomas W. Feeley, M.D., Head of Anesthesiology and Critical Care, and Head of the Institute, in an MD Anderson news release. “Bundled pricing is something that patients and care providers want, and this is our first opportunity to better understand how we can manage costs without sacrificing quality care and patient outcomes.” (more…)
Mar 26, 2012 | Coding, Billing, and Collections, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Where hospital margins to be squeezed, that would place hospital laboratories under greater budget constraints
Hospitals are honing in on Medicare’s new value-based purchasing program quality metrics in an effort to improve patient care—and earn reimbursement rewards. Clinical laboratory managers and pathologists will want to track implementation of this program, because it is one further step forward in Medicare’s plan to move away from fee-for-service reimbursement.
As part of its effort to drive quality improvement at U.S. hospitals, the Centers for Medicare and Medicaid Services (CMS) issued final rules in 2011 for the first year of its Hospital Value-Based Purchasing Program (HVBP). The program is a pay-for-performance initiative that begins in fiscal 2013. Modern Healthcare reported on this story.
“[The HVBP structure] has been very eye-opening to a lot of people because we are not used to being compared that way,” observed Jeff Costello. He is Chief Financial Officer at Memorial Hospital & Health System in South Bend, Indiana. This 526-bed institution is on the latest Thomson Reuters’ 100 Top Hospitals list.
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Nov 4, 2011 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Private payers taking first steps on a path toward value-based purchasing that could eventually include clinical pathology laboratory testing services
Pay-for-performance just took a leap forward with news that one of the nation’s largest health insurers will link hospital reimbursement to specific quality measures. This development could be a precursor to similar payer initiatives that involve how private payers reimburse clinical laboratories and anatomic pathology groups.
Indianapolis-based WellPoint, Inc. (NYSE: WLP) will revamp the way it reimburses about 1,500 hospitals across the country. In a news story published by Bloomberg Businessweek, Rick Wartzman, Executive Director of the Drucker Institute at Claremont Graduate University, explained that, going forward, WellPoint wants to base annual payment increases to hospitals using a formula that incorporates the health insurer’s quality criteria, rather than to the quantity of services delivered.
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Jun 8, 2011 | Digital Pathology, Laboratory News, Laboratory Pathology
Smartphone mobile app is dubbed “MicroHIS” by Holy Name Medical Center
At one community hospital in New Jersey, physicians love getting clinical laboratory test results over their smartphones or similar wireless devices. Radiology and cardiology results can also be accessed or viewed using this unique mobile app developed for use at Holy Name Medical Center in Tea Neck, New Jersey.
The story about mobile applications at Holy Name Medical Center demonstrates to pathologists and clinical laboratory managers how fast the world of healthcare informatics is evolving. It took just months for the hospital’s informatics department to create a customized application that allows physicians to use their smartphones and mobile devices to access most of the information managed by the hospital information system (HIS). (more…)
Aug 19, 2009 | Laboratory News, Laboratory Pathology
One approach is to bundle payments to hospitals, physicians, labs, and other providers
Momentum is building around a new effort to drive down existing rates of hospital readmissions. Different reimbursement proposals to encourage hospitals and physicians to reduce current readmission rates will likely also change the reimbursement status quo for laboratory testing. For example, bundling Part A and Part B payments may be one approach.
Experts increasingly believe one game changer in lowering healthcare costs and improving outcomes is avoidable hospital readmissions. One in five Medicare patients returns to the hospital within 30 days. Overall, readmissions cost Medicare an estimated $17 billion yearly. Of this total, about $12 billion are believed to be avoidable cases
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