Feb 4, 2026 | Clinical Laboratory/ Pathology Coding, Billing, and Collection Resources, Coding, Billing, and Collections
A new KFF Health Tracking Poll shows healthcare costs are now the top economic worry for U.S. households—raising concerns that patients may skip screenings or shop more aggressively for lab tests, reshaping utilization and revenue patterns in 2026.
Healthcare costs are now the top economic concern for US households—and that anxiety is likely to ripple directly into clinical laboratories, according to a new KFF Health Tracking Poll released January 29.
Roughly one-third of the public (32%) say they are “very worried” about their ability to afford healthcare, a higher share than those most concerned about food, housing, utilities, or transportation. More broadly, 56% expect healthcare to become less affordable for their families in the coming year, signaling sustained pressure on patients’ willingness and ability to engage with the health system.
For clinical laboratories, that concern translates into two distinct, and potentially competing, patient behaviors.
Rising Costs Could Reshape Patient Testing Behavior
In one scenario, patients worried about out-of-pocket costs may delay or skip preventive screenings and fail to follow through on physician-ordered diagnostic testing. KFF found that about one in five respondents said their healthcare costs have risen faster than basic necessities like utilities or groceries. That perception alone can be enough to discourage patients from completing tests they view as optional, even when those tests are clinically indicated.
In another scenario, cost-conscious patients may still pursue testing but do so more selectively. Rather than abandoning care altogether, these patients may “shop around,” comparing prices, turnaround times, and service offerings across clinical laboratories. This trend could increase demand for clearer test pricing, stronger patient-facing communication, and more transparent billing practices—areas where some labs may find both challenges and opportunities.
The poll also suggests that cost concerns are not confined to any single demographic or political group. Healthcare costs ranked as the top economic worry among Democrats, independents, and Republicans alike. More than four in ten voters (44%) say healthcare costs will have a “major impact” on whether they vote in the upcoming midterm elections, underscoring how personally felt the issue has become.
Policy Shifts Add New Pressure to Coverage and Affordability
Recent policy changes may be amplifying these anxieties. Congress allowed enhanced Affordable Care Act (ACA) tax credits to expire, a move that two-thirds of the public (67%) say was “the wrong thing” to do. The expiration is expected to increase premium payments for many marketplace enrollees, potentially leaving patients with less discretionary income for lab testing and other medical services.
While most Americans still view the ACA favorably—58% overall—that support has softened since last fall, reflecting ongoing uncertainty about coverage stability and affordability. For labs, fluctuations in insurance coverage can complicate reimbursement, increase patient self-pay balances, and add friction to pre-test counseling and billing workflows.
Taken together, the findings point to a year in which clinical laboratories may see uneven test utilization patterns. Some patients may disappear from the testing pipeline altogether, while others arrive armed with questions about cost, necessity, and alternatives.
As financial anxiety increasingly shapes patient decision-making, labs that can clearly communicate value—clinical relevance, quality, speed, and cost transparency—may be better positioned to maintain trust and test volume in an environment where affordability is front of mind.
—Janette Wider
Jul 3, 2017 | Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
OIG suggests better use of analytics by CMS could prevent gaming of the system by providers; clinical laboratories can help through test utilization management technology
It may come as a surprise to many hospital-based pathologists and clinical laboratory managers that the Centers for Medicare and Medicaid Services (CMS) has reason to suspect that some hospitals are “gaming” the system in how they report hospital-acquired infections (HAIs).
In 2015, CMS implemented the Hospital-Acquired Condition Reduction Program (HACRP) as part of the Patient Protection and Affordable Care Act (ACA). The HACRP program incentivizes hospitals to lower their HAI rates by adjusting reimbursements according to the inpatient quality reporting (hospital IQR) data provided by the healthcare providers. Hospital IQR data is the basis on which CMS validates a hospital’s HAI rate (among other things CMS is tracking) to determine the hospital’s reimbursement rate for that year.
However, an April 2017 report by the Office of the Inspector General US Department of Health and Human Services (OIG) noted that CMS was not doing enough to identify and target hospitals with abnormal reporting of HAIs.
The OIG reported:
- CMS, in 2016, met its regulatory requirement to validate inpatient quality reporting data;
- It reviewed data of 400 randomly selected hospitals as well as 49 hospitals targeted for failing to report half their HAIs, or for low scores in the prior year’s validation process;
However, OIG also reported that CMS did not include hospitals that displayed abnormal data patterns in its targeted sample. Targeting those hospitals, according to the OIG, could identify inaccurate reporting.
CMS staff had identified 96 hospitals with aberrant data patterns, but did not target them for validation—even though the agency can select up to 200 targeted hospitals for review, Becker’s Hospital Review pointed out.
Dollars More Important than Deaths
According to the OIG report, Medicare excluded in its investigation dozens of hospitals with suspected HAI reporting. This is odd since the CMS and the Centers for Disease Control (CDC) apparently are aware that some healthcare providers have manipulated data to improve their quality measure scores and thus increase their reimbursement rates.
“Collecting and analyzing quality data is increasingly central to Medicare programs that link payments to quality and value. Therefore, it is important for CMS to ensure that hospitals are not gaming [manipulating data to improve scores] their reporting of quality data,” the OIG report noted.
“There are greater requirements for what a company says about a washing machine’s performance than there is for a hospital on quality of care. And this needs to change,” stated Peter Pronovost, MD, PhD, in the Kaiser Health News article. “We require auditing of financial data, but we don’t require auditing of healthcare quality data, and that implies that dollars are more important than deaths.” Pronovost is Senior Vice President for Patient Safety and Quality at Johns Hopkins University School of Medicine.
Peter Pronovost, MD, PhD (above) testifying on preventable deaths before the Senate Subcommittee on Primary Health and Aging in 2014. He is Senior Vice President for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore. Pronovost told Kaiser Health News that there are no uniform standards for reviewing data that hospitals report to Medicare. (Photo copyright: US Senate Committee on Health, Education, Labor and Pensions.)
Medicare Missed Hospitals with Suspected HAI Data
CMS should have done an in-depth review of many hospitals that submitted “aberrant data patterns” in 2013 and 2014, the OIG stated in its report. According to a Kaiser Health News article, such patterns could include:
- A rapid change in results;
- Improbably low infection rates; and
- Assertions that infections nearly always struck before patients arrived at the hospital.
“There’s a certain amount of blind faith that hospitals are going to tell the truth. It’s a bit much to expect that if they had a bad record they are going to fess up to it,” noted Lisa McGiffert, Director of the Safe Patient Project at Consumers Union, in the Kaiser Health News article.
CMS Needs Better Data Analytics
So, what does the OIG advise CMS to do? The agency called for “better use of analytics to ensure the integrity of hospital-reported quality data.” Specifically, OIG suggested CMS:
- Identify hospitals with abnormal percentages of patients who had infections on admission;
- Apply risk scores to identify hospitals with high propensity to manipulate reporting;
- Use experiences to create and improve models that identify hospitals most likely to game their reporting.
CMS’ Administrator Seema Verma reportedly responded, “We will continue to evaluate the use of better analytics as feasible, based on Medicare’s operational capabilities.”
Medical Laboratory Diagnostic Testing Part of Gaming the System
A 2015 CMS/CDC joint statement noted “three ways that hospitals may be deviating from CDC’s definitions for reportable HAIs,” and two involve diagnostic test ordering. According to the OIG report, they include:
- Overculturing: Diagnostic tests may be overutilized by providers in absence of clinical symptoms. Hospitals may use positive results to game their data by claiming infections that appeared days later were present on admission and thus not reportable.
- Underculturing: Hospitals underculture when they do not order diagnostic tests in the presence of clinical symptoms. By not ordering the test, the hospital does not learn whether the patient truly has an infection and, therefore, the hospital does not have to report it.
- Adjudication: Hospital administrative staff may inappropriately overrule those who report infections. HAIs are, therefore, not shared.
Clinical Laboratories Can Help
One in 25 people each day receives an HAI, CDC estimates. The OIG findings should be a reminder to medical laboratories and pathology groups that quality measures and patient outcomes are often transparent to media, patients, and the public.
One way medical laboratories in hospitals and health systems can help is by investing in utilization management technology and protocols that ensure appropriate lab test utilization. Informing doctors on the availability of appropriate diagnostic tests based on patients’ existing conditions, unique physiologies, or medical histories, could help prevent hospitals from inadvertently or deliberately game the system.
Clearly, transparency in healthcare is increasing. That means there will be more news stories revealing federal agencies’ failures to respond to healthcare data in ways that could have protected patients and the public. Clinical laboratories don’t want to be included in negative reporting.
—Donna Marie Pocius
Related Content:
CMS Validated Hospital Inpatient Quality Reporting Program Data, But Should Use Additional Tools to Identify Gaming
Medicare Failed to Investigate Suspicious Infection Cases from 96 Hospitals
CMS Can Do More to Validate Hospital-Reported Infection Data, OIG Report Finds
Study Suggests Medical Errors Now Third Leading Cause of Death in the US
Research Study at Johns Hopkins University Reveals CDC Does Not Record Medical Errors in Annual Mortality Report, Yet Such Errors Are Third Leading Cause of Death
Biggest Opportunity for Clinical Laboratory Industry is Utilization Management of Lab Tests, But Only If It Is Done Well
Lessons from the Pioneers: Reporting Healthcare-Associated Infections
Webinar: Simple, Swift Approaches to Lab Test Utilization Management: Proven Ways for Your Clinical Laboratory to Use Data and Collaborations to Add Value
Feb 5, 2016 | Laboratory Pathology, Laboratory Testing
Called ‘ViroCap,’ this new diagnostic technology is able to discover more viruses in patient samples, as compared to PCR genome sequencing tests
It could be the ultimate multi-analysis medical laboratory test ever. Researchers at Washington University School of Medicine in St. Louis have developed a diagnostic test that they claim tests for any virus infecting people and animals.
The new test, called ViroCap, detects viruses that standard tests based on genome sequencing cannot, according to a university statement.
Viruses Make for a Popular Research Subject
Are virus tests going, well, viral? It was just a few weeks ago that Dark Daily reported on research at Howard Hughes Medical Institute (HHMI) aimed at unlocking virus detection beyond one pathogen at a time. (See Dark Daily, “Researchers at Howard Hughes Medical Institute Develop Blood Test That Reveals a Patient’s Viral History; Could Reduce Unnecessary Clinical Laboratory Testing,” December, 30, 2015.)
The HHMI research resulted in VirScan, an alternative to medical laboratory tests that test for specific viruses one at a time, and which can detect all diseases a patient has had over his or her lifetime, according to an HHMI news statement about the new technology. (more…)
Dec 30, 2015 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
The VirScan test gives doctors insight into a patient’s lifetime exposure to viruses and thus may be developed into a useful medical laboratory test
Scientists and pathologists are learning that blood is like a time capsule, holding precious information about exposure to viruses over the years—chickenpox at five, mononucleosis at 18, flu at 40. You get the idea.
Now, researchers at Howard Hughes Medical Institute (HHMI) have found a way to tap that entire data stream, so to speak. An inexpensive blood test, they say, reveals every virus that has passed through the body over time.
New Discoveries Could Lead to a Useful Clinical Laboratory Test
The testing method, called VirScan by researchers, is an efficient alternative to current medical laboratory tests that test for specific viruses one at a time, according to an HHMI news statement about the new technology. (more…)
