Clinical Laboratory Trends
Clinical laboratories, where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease, are facing numerous challenging trends as healthcare reform continues to evolve.
Some of these clinical laboratory trends include:
- The Protecting Access to Medicare Act (PAMA) of 2014.
Under PAMA, many clinical lab organizations will see a substantial decline over the coming years in the prices paid to them for the highest-volume lab tests reimbursed under Medicare Part B. The law specifies that the federal Centers for Medicare & Medicaid Services (CMS) can begin enacting those price cuts in 2017.
- Laboratory benefit management program
The laboratory benefit management program is a controversial program created by UnitedHealthcare in 2014. All outpatient laboratory services for members who are part of the Laboratory Benefit Management Program are subject to new requirements including advance notification and new medical policies.
Physicians serving UHC’s commercial patients in Florida must notify UHC when ordering any of 80 clinical laboratory tests. Pre-authorization is also required for certain tests.
During its introduction phase, the program has generated widespread resistance from Florida physicians, who protest that it will cause unnecessary delays for patient treatment, and undue burdens for doctors ordering tests. In addition to problems with lab test pre-notification algorithms within the BeaconLBS system, other problems cited by physicians include the exclusion of all but 13 Florida labs from the BeaconLBS “laboratory of choice network.”
- Accountable care organizations
ACOs are the product of a provision in the Affordable Care Act of 2010. They are integrated care networks of providers with the ability to provide care to, and manage patients, across the continuum of care that should include different institutional settings, such as ambulatory care, inpatient hospital care, and even post-acute care. Clinical labs have had difficulty gaining entry into newly- forming ACOs.
At the same time, a positive clinical laboratory trend is the increasing popularity of personalized medicine (PM), a medical model that proposes the customization of healthcare – with medical decisions, practices, and/or products being tailored to the individual patient. In this model, diagnostic testing is critically important, as it is often employed for selecting appropriate and optimal therapies based on the context of a patient’s genetic content or other molecular or cellular analysis.
Lab News Briefs: Labcorp, Tufts, Informa, HIMSS, Sanford, Fairview
By Scott Wallask | From the Volume XXX, No. 12 – August 21, 2023 Issue
Labcorp Buys Tufts’ Lab Outreach IN OUR LAST ISSUE, WE REPORTED THAT LABCORP HAD ACQUIRED the lab outreach services of two health systems in…
Hospital Lab Outreach Selloffs Continue with Labcorp as Buyer
By Scott Wallask | From the Volume XXX, No. 11 – July 31, 2023 Issue
OVER THE LAST FEW MONTHS, Labcorp has shaken up the hospital laboratory market in the Pacific Northwest, particularly as it concerns lab outreach services. …
HCCI Reports Higher Prices for Hospital Outreach Tests
By Robert Michel | From the Volume XXX, No. 10 – July 10, 2023 Issue
CEO SUMMARY: It’s another shot across the bows to hospital and health systems that use inpatient test prices when billing health insurers for outpatient/outreach lab tests. In its report, the Health Care Cost Institute documents how these hospital l…
Dartmouth Health Lab Recruits and Trains More CLSs
By Scott Wallask | From the Volume XXX, No. 10 – July 10, 2023 Issue
CEO SUMMARY: Keeping clinical laboratories fully staffed may be the single biggest issue confronting labs today. In New Hampshire, the lab team at Dartmouth Health crafted an innovative program that pays students as they pursue their clinical laboratory scientist certification. In…
Technical Assessment Challenges for Z-Code Applications
By Scott Wallask | From the Volume XXX, No. 10 – July 10, 2023 Issue
CEO SUMMARY: Effective on Aug. 1, UnitedHealthcare will require Z-code submissions for many genetic tests. During a recent webinar, experts tackled a topic that may prove troublesome for labs seeking Z-codes: technical assessments. Key advice is to provide specific data about clin…
UnitedHealthcare’s Z-code Policy Starts on Aug. 1
By Robert Michel | From the Volume XXX, No. 10 – July 10, 2023 Issue
CEO SUMMARY: UnitedHealthcare’s (UHC) response to the ever-growing number of unique genetic tests and the continuing growth in the volume of those claims is a new policy. Effective Aug. 1, UHC will require a Z-code with genetic test claims. This req…
CMS: TJC Made ‘Business Decision’ to Not Recognize COLA
By Scott Wallask | From the Volume XXX, No. 9 – June 19, 2023 Issue
Following up on a prior briefing, The Dark Report has learned that the Centers for Medicare and Medicaid Services (CMS) does not appear to hav…
UHC’s Z-Code Requirement to Commence on Aug. 1
By Scott Wallask | From the Volume XXX, No. 8 – May 30, 2023 Issue
CEO SUMMARY: In what may be an alarming development for certain clinical laboratories, as of Aug. 1, UnitedHealthcare will require Z-codes for molecular test claims filed under its co…
Kaiser Acquires Geisinger Health in Value-Based Deal
By Robert Michel | From the Volume XXX, No. 7 – May 8, 2023 Issue
CEO SUMMARY: This blockbuster combination of two respected integrated delivery networks (IDNs) caught the hospital industry by surprise. Post-closing, Kaiser and Geisinger will have combined revenue…
Kaiser-Geisinger Acquisition Sets Stage for More Deals
By Robert Michel | From the Volume XXX, No. 7 – May 8, 2023 Issue
CEO SUMMARY: Even as experts were predicting more consolidation among multi-hospital health systems at the Executive War College in New Orleans last month, acquisition of Geisinger Health by Kaiser …
CURRENT ISSUE
Volume XXXI, No. 4 – March 18, 2024
An expert attorney analyzes the most recent cases of EKRA violations, showing how many labs could be in violation themselves. Also, a major cyberattack on Change Healthcare, owned by UnitedHealth Group, creates disruptions to providers around the country. Other news includes a look at the worldwide pathologist shortage.
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