CEO SUMMARY: One common complaint about the efforts of UnitedHealthcare to introduce its unpopular laboratory benefit management program in Florida is that the insurer-and its agent, BeaconLBS, a division of Laboratory Corporation of America-don’t respond to physicians when they request guidance. One family practice physician in Jacksonville said that UHC has not even acknowledged several letters he sent via certified mail, return receipt requested.
Last Friday, at Geisinger Medical Center in Danville, Pennsylvania, members of the health systems’s authority board were given tours of the new $63.4 million clinical laboratory facility. It is scheduled to open on May 4 and will feature the latest state-of-the art analyzers and lab automation systems. Located in a new building of 162,378 square feet, it will be home to more than 350 lab employees.
Every lab organization should aspire to achieve the attributes of Level Four: Use Benchmarks to Achieve Best-in-Class because this is the level of performance where the lab is delivering optimal clinical value at highest quality and lowest cost. This is an effort in which the business skills of laboratory management come to the fore. It …
BOTH OF THE NATION’S LARGEST clinical laboratory companies reported increased specimen volume as a result of the Accountable Care Act (ACA), as noted in their respective fourth quarter and full-year earnings reports.
CEO SUMMARY : This fourth installment of this special series about the laboratory value pyramid introduces “Level Four: Use Benchmarks to Achieve Best-in-Class.” This is the highest level of the four level pyramid. When a lab organization performs at this level, it will be delivering substantial measurable value to all stakeholders and it will have the metrics to substantiate this value. At the same time, the performance of a level four lab can be validated by its use of recognized third-party benchmarks that show it is performing equal to the best labs in the United States and across the globe. It will also have customer survey data showing it meets and exceeds its customers’ expectations.
ACO Table ALL ANATOMIC PATHOLOGISTS WONDERING ABOUT THEIR PLACE in a healthcare system dominated by accountable care organizations (ACOs) and similar models of integrated clinical care may find useful insights from the experience of a six-partner pathology group in Wisconsin as it established itself as a contributor in one of the state’s largest integrated care networks.
CEO SUMMARY: From the launch in 2013 of a big accountable care organization in Wisconsin, the North Shore Pathologists at Columbia-St. Mary’s Hospital have been involved. Among the lessons learned are the importance of structuring the pathology contract with the hospital to anticipate value-based reimbursement and having full access to the ACO’s data. The pathologists are using this data to develop test utilization programs that help physicians order the right lab test for the right patient.
CEO SUMMARY: Few pathologists and lab administrators know that, when the Protecting Access to Medicare Act of 2014 (PAMA) became law last April 1, language in the bill was scored to reduce Part B clinical laboratory test fees by $2.5 billion over 10 years. Congress used those lab fee cuts to patch the Sustainable Growth Rate (SGR) temporarily. The one-year patch expires on March 31, 2015. Now federal lawmakers must again address the SGR problem with some type of fix, including more spending offsets.
CEO SUMMARY: To date, many of the nation’s 500 accountable care organizations have launched with little involvement by independent pathology groups and clinical laboratories. That was not the case with an ACO in Alabama, however. From its inception in 2012, the ACO has contracted with CytoPath, P.C., a five-pathologist group in Alabaster, Alabama. CytoPath’s pathologists are currently paid on a fee-for-service basis and must provide detailed and timely data to the ACO.
APRIL 15 IS THE DATE when UnitedHealthcare will begin denying laboratory claims in Florida that do not meet the requirements of its unpopular laboratory benefit management program.