CEO SUMMARY: Will 2015 turn out to be a watershed year for the clinical laboratory industry? Not only are two federal agencies pushing forward with initiatives that will touch nearly every medical lab in the United States in the next 12 months, but other equally powerful trends continue to negatively influence the prices labs are paid for their testing services. All these factors make it essential for lab administrators and pathologist business leaders to work proactively to maintain their lab’s financial stability.
Issue: Volume XXII No. 1 - January 5, 2015
Our editorial team was discussing this quote as we assembled this issue of THE DARK REPORT. It features two primary stories. First is the effort by UnitedHealthcare, BeaconLBS (and its owner, Laboratory Corporation of America), to require all physicians and all laboratories serving UHC patients in Florida to comply with a specific system of lab test pre-notification and pre- authorization. We report on more dissatisfaction by physicians about the intent and function of UHC’s laboratory benefits management program.
BY FILING A LAWSUIT IN FEDERAL COURT against Becton Dickinson, Theranos, the ultra-secretive lab testing company based in Palo Alto, California, has once again put itself in the headlines.
CEO SUMMARY: Physicians in Florida continue to express significant concerns about UnitedHealthcare’s pilot program requiring pre-notification for 80 clinical laboratory tests, including many routine tests, and pre-authorization for two genetic tests. The pro- gram is so onerous that some physicians have said they want to get out of their United contracts. Moreover, during a recent webinar to show Florida physicians how the BeaconLBS system works, officials from BeaconLBS could not get the system to function!
CEO SUMMARY: In a letter to UnitedHealthcare, the Florida Society of Pathologists says UHC’s pilot laboratory management program will have a negative effect on patient care by delaying access to care and timely diagnoses of disease. Signed by more than 120 members of the society, the letter lays out inconsistencies in the requirements of UHC’s pilot program that Florida physicians must follow to obtain pre-notification or pre-authorization for more than 80 clinical laboratory tests.
LAST WEEK, ONE PART OF THE Beacon Laboratory Benefit Solutions pilot pro- gram in Florida was postponed. A UnitedHealthcare spokesperson provided additional information about this decision.
HEALTH DIAGNOSTIC LABORATORY of Richmond, Virginia, is mounting its own offensive against the dual blows
it suffered recently: a federal fraud investi- gation and a lawsuit by Cigna, a health insurer in Bloomfield, Connecticut.
OVER THE PAST TWO DECADES, pathologists and lab managers have regularly watched certain new lab companies burst on the scene and generate startling growth in revenue and profits by offering proprietary tests–often unsupported by published clinical studies that demonstrate the utility of these tests.
CEO SUMMARY: While working in the office of a physician who was a client of Health Diagnostic Laboratory, a phlebotomist says he was instructed to write the same 10 diagnoses on every test requisition a doctor sent to HDL, a lab company in Richmond, Virginia. HDL is under federal investigation, according to published reports. The same 10 diagnoses were recorded for every patient even though some of these tests were appropriate only for women, the source said.
In Vermont, a multi-year effort to create a statewide single-payer health insurance program has failed. On December 17, Governor Peter Shumlin announced that the state would not go forward with its plans to create a health program called Green Mountain Care.