Issue: Volume XXVI No. 2 - February 4, 2019

In Tough Times, All Labs Need Success Strategies

By any measure, it is tougher today for clinical laboratories and anatomic pathology groups to generate the revenue needed to deliver state-of-the-art diagnostic testing services while remaining financially viable. Four recent trends prove the point. First, every year, the Medicare program and private health insurers are cutting the prices they pay for medical laboratory tests. …

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Useful Lessons for Labs That Report PAMA Data

CEO SUMMARY: Will clinical labs heed the lessons learned from the first PAMA private payer market price reporting cycle that CMS conducted in 2017? One major difference is that the definition of applicable laboratories now includes most hospital labs. This creates the opportunity for a larger number of clinical labs to submit their price data …

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Three Labs Make Big Bets to Build Major New Facilities

EVEN AS SOME CLINICAL LABORATORY COMPANIES are closing or selling following the deep cuts in what Medicare pays for lab tests, three major lab organizations are building new, super-sized laboratory facilities. Those three companies are ARUP Laboratories, DaVita Labs, and Quest Diagnostics Inc. In September, DaVita Labs, a division of DaVita Kidney Care, opened a …

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Lower Prices, More Data in UHC’s New Lab Network?

CEO SUMMARY: It’s been a common strategy among managed care payers to seek the lowest prices for clinical laboratory testing when negotiating contracts with labs. However, lower prices may become less important over time as the health system moves away from fee-for-service payment toward value-based reimbursement. Now evidence is accumulating that at least some large …

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California Lab Company Closes After Negative Medicare Decision

WITH EACH NEW RULING about coverage for a proprietary diagnostic assay, Medicare officials send a message to the entire clinical laboratory industry that any lab company with a proprietary test needs to submit adequate clinical evidence that demonstrates two positive aspects of the test. First, that the assay accurately measures the biomarkers that it says …

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February 4, 2019 Intelligence: Late Breaking Lab News

More than 63 healthcare and medical service organizations signed a letter asking officials at the federal Centers for Medicare and Medicaid Services (CMS) to reconsider their latest interpretation of a National Coverage Determination (NCD) on the subject of next-generation sequencing (NGS). Clinicalomics wrote that “the final NCD also included repeat testing when a new primary cancer …

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