The most complete archive of clinical and pathology lab industry news available, including issues from 1997 to the present.
THE DARK REPORT offers lab executives and pathologists specific guidance on the arduous process of correctly reporting lab test price data to CMS under the new PAMA rules, so that their organizations can avoid CMS’ $10,000-a-day penalties. Also, an intelligence briefing alerts DARK REPORT clients and readers to a major omission by the Office of the Inspector General in the reports it prepares about the implementation of the PAMA statute.
THE TWO NATIONAL LABORATORIES, LabCorp and Quest, are reporting reduced revenue and operating margins thanks to the PAMA price cuts. At the same time, executives predict higher market share for their companies, and note that as smaller labs fail due to the fee cuts, they’ll be snapped up by larger labs. THE DARK REPORT even extrapolates the devastating financial effects that the PAMA cuts will have on smaller labs, based on the Blood Brothers’ numbers. Also in this issue is an instructive example of a pathology group that gained a prized state contract by focusing its proposal on patient care instead of finances.
NOW THAT MOST HOSPITALS ARE INCLUDED as applicable laboratories that must report their PAMA private payer lab test price data to the Centers for Medicare and Medicaid Services, managers of those labs will benefit from the incisive analysis in this issue of the lessons learned during the 2017 PAMA reporting cycle. THE DARK REPORT further offers recommendations on how labs can do a better job of gathering and reporting their own data to CMS. Also, TDR delivers an exclusive analysis of why the Government Accounting Office’s assertion that CMS will be paying billions more for Part B clinical lab tests is simply wrong.
LAB ADMINISTRATORS AND PATHOLOGISTS should pay close attention to emerging new disruptive forces outlined in this issue — and their potential to upend the clinical laboratory industry as it exists today. From slashed Medicare prices, to the risk of $10,000-per-day penalties for PAMA price-reporting errors, to narrowing networks, 2019 will be one of the most challenging years facing the clinical lab industry since the early 1990s. At the same time, THE DARK REPORT details five specific strategies from a highly-respected lab industry executive that administrators can leverage to survive and thrive in the storm.
THE NEW YEAR will be a challenging one for clinical labs and pathology groups, based on significant events of the last year. For one: If your hospital is marked under the PAMA law as having “applicable” labs, you’ll be struggling to comply with reporting private payer lab price data. Meanwhile, all labs will face tougher anti-fraud rules, and common pass-through billing practices may prompt private payers to sue. These issues and more are reviewed in this issue, including expert guidance for lab managers on navigating the various minefields.
DID CONGRESS JUST PASS A LAW that makes innocent labs guilty of criminal acts? At the last minute, Congress added all clinical laboratories to a far-reaching anti-kickback provision in the newly-enacted Support for Patients and Communities Act — a provision that makes common practices such as paying commissions to sales staff or placing phlebotomists in labs could be illegal. Worse: The experts are baffled by the language of the new law. Notes one of these experts in this issue, “Someone in the clinical lab industry may have to get prosecuted before we get some clarity, unless the Secretary of HHS issues clarifying regulations.”
THE DARK REPORT ANALYZES a change of heart by the federal Centers for Medicare and Medicaid Services in the way it will collect data about the lab test prices paid by private health insurers. Good news? Not so fast. The changes CMS calls for won’t impact the Medicare fee schedule for two years. But on Jan. 1, 2019, CMS will make another painful 10% cut in what it pays for lab tests. Also in this issue is an exclusive look at how an innovative commercial lab company is developing ways to collaborate with physicians, health insurers, ACOs and others to improve patient care and lower the cost of care—and be paid for those contributions.
WHO WILL BE NEXT? As federal prosecutors indicate in court there’s more to come in the ongoing Theranos investigation, that leaves the lab industry wondering who else might be charged with crimes. Reported only in THE DARK REPORT, this development means that any number of people could be targeted: former members of the Board of Directors, various consultants, even vendors. Meanwhile, Medicare has begun publicly posting prices charged by every pathologist in the country — so that every one of them can find out what their competition is up to. Will a new price war result? THE DARK REPORT offers a pricing “sweet spot” for readers to consider.
TWO FEDERAL COURT RULINGS that will have immediate impact on the clinical lab industry are analyzed in detail in this issue. In a major setback for the ACLA lawsuit against the federal Department of Health and Human Services, a judge has ruled that the court lacks jurisdiction to take the case. THE DARK REPORT also offers an exclusive interview with the ACLA’s lead attorney to help readers understand the issues surrounding a possible appeal. Also exclusive to THE DARK REPORT is a report about a court ruling that two fairly common lab business practices are illegal inducements.
CLINICAL LABORATORY MANAGERS will learn in this issue about two trends that are driving a movement to standardize laboratory operations across large regions: the integration of clinical care and the need for hospitals and health networks to improve patient outcomes continuously. THE DARK REPORT dives deeply into the details of an ambitious program along these lines in Michigan. Also, Theranos’ dying breath is detailed as the once-vaunted company finally goes under.
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