IN TODAY’S EVOLVING HEALTHCARE SYSTEM, labs and pathology groups of all sizes in all communities are dealing with the issues of payers narrowing networks and the formation of ACOs, with all the unknowns about reimbursement that come with this new organizational model of healthcare.
Issue: Volume XXII No. 4 - March 9, 2015
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.
CEO SUMMARY: Since Anthem launched its site of service program in New Hampshire in 2010, labs in the state’s hospitals have mostly been excluded from its network and have lost market share. Recently one community hospital developed an unusual strategy to win back those patients. Last year, Frisbie Memorial Hospital in Rochester, opened a stand-alone independent lab company that became a provider in the Anthem network. To date, the independent lab has been gaining patients steadily, hospital officials say.
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.
CEO SUMMARY: PerkinElmer is the latest U.S. organization to open a clinical laboratory business in China. Last December, it formally opened its new Suzhou PerkinElmer Medical Laboratory. The new lab is located about 60 kilometers (37 miles) west of Shanghai. It will provide neonatal and prenatal screening along with infectious disease testing. PE’s new venture hopes to leverage relationships developed from providing newborn and prenatal screening in China throughout for the past 20 years.
Many laboratory professionals are closely watching the development of Theranos, the lab testing company based in Palo Alto, California, that claims it has technology and a business model that will disrupt the clinical laboratory testing market.