The most complete archive of clinical and pathology lab industry news available, including issues from 1997 to the present.
UNDERREPORTED BUT CRITICAL TRENDS dominate this issue of THE DARK REPORT. In one, the evidence shows that ICD-10 codes’ richer data are now giving payers brand new opportunities to reject lab payment claims or even try to claw back payments already made. Also, lawsuits alleging that the Blood Brothers are overcharging uninsured patients might actually be an opportunity for labs to be more competitive with the big national labs.
THE DARK REPORT DETAILS THE NEW CMS RULE targeting Medicare fraudsters that could entrap clinical labs and pathology groups. At the same time, attorneys outline ways for labs to navigate this new minefield and avoid problems. Also, an expert details six different ways that labs can use their valuable data — without selling it — to improve patient care and lower healthcare costs, with new revenue streams as a bonus.
ALL LABORATORIANS must take heed of the disruptive new trends in the healthcare industry, which will affect the way patients, doctors, labs, payers and others interact with each other. Also, THE DARK REPORT explains how a genetic testing fraud, recently the target of federal prosecutors, was executed by the alleged perpetrators.
A MAJOR HEALTH NETWORK is addressing the opioid crisis: Community Health Network of Indianapolis recognized that clinical lab toxicology tests are one of the few sources of objective data about patient compliance, and is using that data in its new Chronic Opioid Therapy program. This first-time intelligence briefing on such a program also includes insights about lessons learned and discusses how offering additional analytical reports and services add value to the health network’s COT patient management program.
SOME PATHOLOGISTS AND LAB EXECUTIVES find the FDA’s latest actions regarding pharmacogenetic testing confusing, unclear and beyond the FDA’s authority. Other observers note that the FDA does indeed have a legitimate concern. THE DARK REPORT examines both sides of this controversy. Also reported is the opinion of respected pathology consultants that the result of deep fee cuts by Anthem to some anatomic pathology services will harm patients.
THE DARK REPORT TAKES A DEEP DIVE into the alleged lab fraud case against True Health Diagnostics, which has seen its CMS reimbursement completely cut off, leading the company to file for bankruptcy. The details will help laboratory management understand how a single case of alleged lab fraud affects all labs. Also, TDR is the only lab news source to report on how the leaders of some physician specialties are criticizing Anthem for cutting anatomic pathology professional fees by as much as 70% in states across the nation.
THE MILLENNIAL WORKFORCE BOMB is coming soon to your lab or pathology group, and THE DARK REPORT delivers strategies for attracting, hiring and retaining these newcomers that are vastly different from what has been done in the past. Also, a nightmare-scenario of three patient deaths partly attributed to clinical labs is a warning sign to labs to review their best practices to avoid a similar fate.
MAJOR CHANGES TO ANTHEM’S PATHOLOGY GROUP RELATIONSHIPS include massive cuts of 50-70% in payments. THE DARK REPORT also offers a unique analysis that points to the consequences of another, less-visible change: switching AP groups from its professional services division to its ancillary services division. At the same time, Aetna has decided to end payment to out-of-network pathologists for the professional review of lab tests, which one pathology consulting firm tells TDR could cut some pathology groups’ revenue by as much as $300,000 per year.
THE U.S. HAS LOST ALMOST 18% of its pathologists since 2007. This means the U.S. has even fewer pathologists than other countries who have already suffered adverse clinical lab quality events. TDR also digs further into what this means for the industry, finding that while salaries and benefits are increasing, higher pay will come with a heavier workload. Also, in a Clinical Lab 2.0 case study, TDR walks readers through the steps Northwell Health took to help improve patient care – and add value – by using its data to identify patients who were undiagnosed or misdiagnosed.
IT’S ONE THING TO IMAGINE IT, but another thing altogether to actually achieve it: TriCore Reference Labs demonstrates in this DARK REPORT exclusive how it’s actually making money by selling its data and analytics to insurers. Also, nine clinical laboratory associations and groups are working together to convince CMS to correct serious problems with new guidelines for the National Correct Coding Initiative.
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