Since 1995, Reliable Business Intelligence for Clinical Laboratories, Pathology Groups and Laboratory Diagnostics

Commentary and Opinion by R. Lewis Dark

Why Capitate Genetic and Molecular Test Prices?

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

HOW MANY OF YOU LIVED THROUGH THE DECADE OF THE 1990s and experienced the free fall in the prices managed care plans paid for clinical laboratory testing? In California—at the peak of this insanity—some lab companies offered full risk, capitated contracts for as low as 20¢ PMPM (per member per month)! Also during this decade, […]

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Molecular Code Stacks Now in the Payers’ Bull’s Eye

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

LIKE A STEAM BOILER READY TO EXPLODE FROM TOO MUCH PRESSURE, the nation’s health insurers have reached a point of no return on the subject of code-stacked claims for genetic testing and molecular diagnostics assays. Simply put, payers are ready to tackle this sensitive issue. Payers have reasonable questions about this type of clinical lab

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Economics of Lab Testing to Be Challenged

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

BY ANY MEASURE, 2012 IS SHAPING UP TO BE A YEAR OF MAJOR CHANGE for healthcare and the clinical laboratory testing industry. Unfortunately, an early reading of the tea leaves indicates that the outcomes are not likely to be favorable for most clinical laboratories and anatomic pathology groups. Let’s start with one bright spot in

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Forecast: Tough Fee Cuts Are in Labs’ Future

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

EVERY CLINICAL LABORATORY AND ANATOMIC PATHOLOGY GROUP PRACTICE in the United States should prepare for some big-time financial belt-tightening during the next 36 months. That certainly is the message coming from intense budget battles unfolding in Washington, DC, this fall. Most of you reading this probably know that the Medicare patient lab test co-pay/co-insurance proposal

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Does Anyone Know the Law in California?

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

WHAT IS THE LAW IN CALIFORNIA THAT DEFINES PROVIDER PRICING and how Medi-Cal should be billed? You probably think that question would be rather easy to answer after you read one of the state statutes that governs pricing relative to Medi-Cal claims. Popularly known among the lab industry as 51501(a), it requires that “no provider

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Healthcare Reform and Laboratory Testing

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

WE ARE ONLY 120 DAYS FROM IMPLEMENTING another round of programs mandated by the Patient Protection and Affordable Care Act (PPACA) of 2010 and associated legislation. Certain programs become effective on January 1, 2012. On that date, the transition to HIPAA form 5010 takes effect. All clinical laboratories and pathology groups should be prepared for

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Consequences of Underfunding Lab Test Services

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

HOW LONG CAN IT TAKE FOR A HEALTHCARE SYSTEM to underfund clinical lab testing and anatomic pathology services before this ongoing financial erosion becomes visible in the form of systemic quality problems with lab tests? I believe the United States is now on the path to learning the answer to this question. As you will

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Tougher Financial Times Ahead for Lab Industry

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

THE YEARS 2008 THROUGH 2010 WERE TOUGH ECONOMIC TIMES for all healthcare providers, including clinical laboratories and pathology groups. Moreover, although the deepest recession in 30 years was declared over by mid-2009, many hospitals continue to struggle financially and the national unemployment rate still hovers at about 9%, meaning that millions of Americans cannot find

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Pathology Across State Lines and National Borders

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

WE ARE SWIFTLY APPROACHING THE DAY when community hospital-based pathologists will be able to serve hospitals and physicians located across state lines with the same ease that they serve hospitals and office-based physicians in their own cities and regions. In the same vein, at least two major academic pathology groups in the United States have

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What Future for Deeply-Discounted Lab Prices?

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

IN THE LABORATORY TESTING INDUSTRY, there is probably no single issue that causes more rancor than the regular use of deeply-discounted pricing of laboratory tests by a certain cohort of laboratory companies. This fault line in our industry is quite distinct. Those managers and pathologists in lab organizations that refuse to use low cost pricing

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