Issue: Volume XXIII No. 12 - September 6, 2016

Labs Caught Between Employer Hammer, Payer Anvil

STARTING ON JANUARY 1, 2017, THE CLINICAL LABORATORY INDUSTRY will undergo a new experiment in price-setting (and price-cutting) by the federal Centers for Medicare & Medicaid Services. On that date, certain labs must begin reporting market price data for each test and each payer to CMS. That data will be used to set Part B …

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Alert to All Labs: Beware Of ‘Reference Pricing’

CEO SUMMARY: “Reference pricing” does not refer to how a lab negotiates prices with its reference lab! Rather, reference pricing describes a specific approach to health plan benefits that incentivizes the consumer to choose lower-cost providers while allowing that consumer to still use a higher-priced provider, so long as that consumer pays the additional costs …

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Why Lab Prices Declined 32% During 3-Year Study

CEO SUMMARY: Researchers studied the effect reference pricing had on an employer’s efforts to steer consumers to low-cost clinical labs. The study showed that patients were particularly sensitive to lab test prices—in part because those prices varied widely. Over the course of the study, a grocery chain saved $2.7 million when the percentage of patients using higher-priced labs …

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Castlight Health’s Data Should Concern Lab Executives

CEO SUMMARY: Transparency tools, such as those from Castlight Health, help consumers see the significant variation in clinical laboratory test prices. In this analysis, THE DARK REPORT argues that lab executives and pathologists should recognize how two factors are poised to change the status quo in how labs price their tests. One is the credibility …

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Lead Researcher Outlines New Details Of Laboratory Test Price Study

CEO SUMMARY: There is always a story behind the story, and THE DARK REPORT went to the lead researcher of the reference pricing study published in JAMA Internal Medicine to get it. In this interview, James C. Robinson, PhD, of the University of California, Berkeley, discusses how the findings of his team’s study may encourage …

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Strategy Lowers CalPERS’ Price of Joint Surgeries

CEO SUMMARY: Probably the most-watched reference pricing program in healthcare to date was initiated by CalPERS. It focused on the variability in the prices of knee and hip replacement surgeries. Just as Safeway experienced a drop in clinical lab test prices of 32% in its reference pricing program, CalPERs paid 30% less for these surgeries …

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September 6, 2016 Intelligence: Late Breaking Lab News

During the widespread floods in Louisiana last month, Pathology Group of Louisiana (PGL) activated its disaster preparedness plan and managed to avoid any interruption of its pathology services. One vital element of that plan was a telephone tree that kept managers and staff in communication. CEO Pika Sdrougias reported that the laboratory facility survived undamaged. …

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The newest threat to lab revenues: reference pricing in healthcare

This is an excerpt from a 1,600-word article in the September 6 issue of THE DARK REPORT. The complete article is available to paid members of the Dark Intelligence Group. CEO SUMMARY: It’s the newest threat to clinical lab survival. A new study shows exactly how reference pricing in healthcare is likely to work, as …

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