New Obamacare Mandate on Screening and Preventive Care May Benefit Clinical Pathology Laboratories

Increased medical laboratory test utilization might result from this new policy

Last month, another Obamacare mandate took effect which may lead to an increased volume of laboratory tests referred to the nation’s clinical laboratories and pathology groups. Effective on September 23, 2010, health plans must cover a host of screening and preventive medical services for which patients are not to be required to pay any money out-of-pocket.

It would appear that this mandate was included in the 2,700-page healthcare reform law as a benefit to consumers—thus giving democratic lawmakers a positive feature that they could talk up with their voters. These 75+ preventative and screening services (thanks to the new health reform legislation) have the potential to increase the volume of laboratory testing specimens, if large numbers of consumers were take advantage of these “free” medical services. (more…)

Doctors turn Tables on Payers with Satisfaction Ratings

When it comes to satisfaction ratings, physicians in Houston have turned the tables on payers! In a groundbreaking survey, the Harris County (Texas) Medical Society allowed physicians to rate health insurance companies. Results were made available late last year and were widely publicized across newspapers and healthcare magazines. It seems only fair that physicians, who increasingly find themselves rated by health insurance companies, should get the opportunity to turn the tables and rate the health insurance companies for the benefit of their patients.

“All insurers were rated very low by doctors in most areas, and the response was quite uniform,” said Kimberly Monday, M.D, a neurologist and Vice-Chairwoman of the Harris County Medical Society’s board of medical legislation. “The survey shows insurance companies are failing patients, doctors and employers who pay for healthcare services by creating ways and resistance to hold onto their money.”

487 physicians in Houston responded to the survey, which evaluated Aetna, Cigna, Humana, The Texas Blues, Unicare, and UnitedHealthcare. Here are some interesting statistics from the survey:

  • More than 65% of the doctors reported they have experienced difficulty getting their patients’ medical services approved.
  • 69% have problems with prompt payment, and 64% say they are paid less than their contracted rate.
  • 58% say their patients do not understand benefits, copayments, deductibles and limitations of their coverage.
  • 65% say their patients rarely understand preventative services and care-coordination services available to them.
      The Harris county group is not the first medical society to conduct a survey on health insurers – the Colorado Medical Society has conducted several similar surveys. The difference is that Harris County chose to make their results public and transparent. In the age of transparent healthcare services, this will probably become a trend. This means that health insurance companies may need to pay as much attention to physician satisfaction as they do to employer and beneficiary satisfaction.

      For laboratory administrators and pathologists, the attention garnered by the Harris County Medical Society physicians’ rating of payer services demonstrates how transparency is opening up new channels of information for the public. Many patients are smart enough to know that if their health insurance company treats doctors poorly, that can affect both the patients’ access to care and the quality of care they receive. That is why public disclosure of physician satisfaction with different health plans can trigger improvement in how payers work with providers.

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Businesses Turn to On-Site Health and Wellness Clinics to Cut Cost

American employers, faced with the rising costs of insuring their employees, are turning to on-site health and wellness clinics to improve employee health, boost employee productivity, and reduce their costs. When Cerner Corporation (NASDAQ: CERN) told the story of its health and wellness clinic at its main corporate campus in Kansas City, it was a rapt audience at the Executive War College in Miami last May. Bill Wing, Cerner’s Vice President for Health-E Services, shared the many ways that Cerner was improving the health of its employees while reducing the overall cost of health benefits. This is achieved by getting involved with their employees’ health at an earlier stage, and encouraging preventative screenings and wellness programs.

On-site clinics at corporate campuses may offer a wide range of services, from primary care to travel medicine, to nutrition counseling. Preventative services, such as health screenings and immunizations, are the most common type of service offered in the latest wave of clinics, according to a recent survey by Watson Wyatt and the National Business Group on Health. They report that four in 10 clinics offer pharmacy services, making it easy for employees to fill their prescriptions.

Most on-site clinics are run by third parties due to privacy concerns of employees. Major players offering these services include CHD Meridian Healthcare LLC and Whole Health Management. These clinics may be staffed by physicians, nurse practitioners, or registered nurses in isolation or in teams.

Harrah’s Entertainment recently added a 7,000 square foot clinic offering acute and primary care services, nutritional counseling, and physiotherapy-all located on the floor above a 12,000 square foot gym. “We recognized that there was going to come a point where we couldn’t pass on the additional cost of providing health care to employees,” said Jeff Shovlin, Vice President of benefits at Harrah’s. “We concluded that the only way to control costs was by helping employees to get and stay healthy.”

Employees who use these corporate on-site clinics frequently get in faster and spend more time talking to their practitioner. Practitioners have the opportunity to explain the importance of preventative medicine. Within one year, Harrah’s has seen a 13% increase in the number of people getting colonoscopies, because of how practitioners at the new clinic raised awareness about the importance of the screenings (which are provided free under their health plan).

David Beech, a senior health management consultant and Hewitt Associates, Inc, said a clinic serving about 1,000 employees-usually considered a minimum number for critical mass-can expect to make hard-dollar savings of $70,000 in the first year, mainly because of fewer visits to the ER and self-referrals to outside specialists. These savings can rise to $250,000 annually by the third year, when preventative savings kick in. Productivity also gets a boost because workers spend more time on the job. Sick days dropped over 20% in 12 months when Regis Corp., to serve its 800 employees, opened two clinics staffed by a nurse practitioner.

Preventative medicine is good business for clinical laboratories that run routine blood work. It is an opportunity for local laboratories to approach corporations operating on-site health care facilities in their area and tailor a custom package of added-value services for that company. Labs might offer to staff the clinic with phlebotomists on a certain day of the week for routine blood draws for preventative blood tests. Laboratories should be creative in how they establish relationships with corporate on-site clinics.

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