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
Sign In

Major Healthcare Systems Begin Building In-House Whole Human Genome Sequencing Capabilities, Creating New Opportunities for Pathologists

Partners HealthCare and Geisinger Health are among health systems making investments and developing the clinical utility of genome sequencing

Next-generation gene sequencing is making fast inroads among the nation’s largest academic centers and health systems. This is an auspicious development for the clinical laboratory industry. It positions pathologists to play a greater role in clinical care and genetic medicine.

News accounts and published research suggest that mega systems—including Partners HealthCare, Geisinger Health System, Scripps Health, and Medical College of Wisconsin—are among first movers investing in genome-sequencing equipment and assembling the medical expertise necessary to establish genetic-testing programs and help physicians utilize gene sequences where appropriate for patient care. (more…)

Falling Inpatient Revenues at Many Hospitals Is Sign of Healthcare’s Transition to New Models of Integrated Clinical Care and Changes in Medical Laboratory Test Utilization

Statistics indicate that inpatient admissions and revenues are falling nationally, a development that affects clinical laboratories in hospitals and health systems

One important trend that directly impacts the medical laboratories of hospitals and health systems is the falling rate of inpatient registrations seen nationally in recent years. What exacerbates this trend is the fact that many payers are cutting the prices they pay for certain inpatient services.

Collectively, these two developments mean less inpatient revenue for many hospitals and that often translates into reduced budgets for the clinical laboratories.

But that is not the whole story concerning inpatient revenue. Spurred by the Affordable Care Act (ACA) and other market developments, payers now want to shift reimbursement away from fee-for-service to new models of reimbursement. This includes capitation or bundled payment models. (more…)

California’s New Health Insurance Exchange May be Unexpectedly Low, but Co-pays for Outpatient Services Are Relatively High

High Co-pays for Lab Tests May Create a Collection Nightmare for Clinical Laboratories
As new facts about the prices of premiums and the amount of patient co-pays for California’s health information exchange—called Covered California—are published, the news is not likely to be favorable for clinical laboratories and anatomic pathology groups in the Golden State.

Of particular note is that Covered California has published a requirement that patients will be charged a $35 co-pay for medical laboratory testing. Some lab industry executives have pointed out that it will be a challenge to collect these co-pays. They expect labs will incur higher costs attempting to collect these co-pays while at the same time seeing a substantial increase in levels of bad debt. However, all of this will not happen until 2014, when Covered California begins providing health insurance coverage.

For one category of insured beneficiaries, there is a bit of good news. Insurance exchange premiums for individuals not covered by employer health plans will be lower than previously expected. Covered California will charge, on average, $321 per month on average for the “Silver,” medium-tier plan, noted Peter V. Lee, Executive Director of Covered California, in a report published by the Wall Street Journal. (more…)

Health Insurers Spending Big Dollars to Be Players in ‘Big Data’; Trend has Implications for Clinical Pathology Laboratories

With healthcare reform likely to limit their growth, health insurers are expanding into data management to create new revenue streams

Faced with swift changes in healthcare, many of which are not favorable to the traditional business model of private health insurers, the nation’s largest payers are positioning themselves to be major players in the management of “big data.” That may have interesting implications for clinical laboratories and anatomic pathology groups, which typically generate large quantities of medical laboratory test data.

(more…)

Illumina Is Using Acquisitions to Challenge Roche in Fast-growing Market for Gene-based Clinical Pathology Laboratory Testing

Hot competition for genetic testing market share is a signal to medical laboratories to ramp up their molecular and genetic testing capabilities

Financial analysts see something of an “old west” style shootout on the horizon for genetic testing in the clinical laboratory testing market. Market leaders in next-generation gene sequencing are prepared to use acquisitions to build dominant shares in a gene testing market that experts say could hit $25 billion by 2022.

Reporters at Bloomberg Businessweek believe that San Diego-based Illumina, Inc. (NASDAQ: ILMN) is girding up to take on industry giant Roche Holding AG (ROG.VX). Both Illumina and Life Technologies Corp. (NASDAQ:LIFE) are buying up smaller players in the gene testing market.

These two market leaders in DNA sequencing equipment have played important roles in revolutionizing genetic testing. Now, they intend to stake out a share of the fast-growing genetic diagnostics market themselves, a recent Businessweek story reported. (more…)

;