By R. Lewis Dark, from the Volume XXVI No. 2 – February 4, 2019 issue
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.
Second, most
By Mary Van Doren, from the Volume XXVI No. 1 – January 14, 2019 issue
CEO SUMMARY: This will be one of the most challenging years facing the clinical lab industry since the early 1990s. The CMS scheme to collect private payer lab test prices and use that data to set Medicare clinical laboratory test prices is proving to be an indiscriminate tool that is poised to undermine the financial integrity of many labs,
By Joseph Burns, from the Volume XXVI No. 1 – January 14, 2019 issue
NEW CLINICAL LABORATORY CONTRACTING INITIATIVES are planned at UnitedHealthcare (UHC), including the launch of a preferred laboratory network this summer.
The nation’s largest health insurer with 49 million beneficiaries, UHC announced in May that it would add Quest Diagnostics as an in-network lab provider effective Jan. 1, and retain Laboratory Corporation of America as a network
By Robert Michel, from the Volume XXVI No. 1 – January 14, 2019 issue
CEO SUMMARY: This will be one of the most challenging years facing the clinical lab industry since the early 1990s, when closed panel HMOs were the disruptive force that generated deep cuts in lab test prices. However, unlike HMOs of that era, the CMS scheme to collect private payer lab test prices and use that
By Joseph Burns, from the Volume XXV No. 18 – December 24, 2018 issue
CEO SUMMARY: With the year end approaching, lab buyers and sellers are working to finalize deals that may have been in discussion for months. The first big lab acquisition for this season came on Nov. 27, when Quest Diagnostics announced it was acquiring Boyce and Bynum Pathology Laboratories of Columbia, Mo. The pathologists will keep
By Joseph Burns, from the Volume XXV No. 18 – December 24, 2018 issue
CEO SUMMARY: By cutting out smaller, regional labs, UnitedHealthcare appears to want to shift an unknown percentage of its lab test volume to Quest Diagnostics Inc., which it recently restored to its national provider network. Clinical lab directors should be concerned about this development because UHC is the nation’s largest health insurer and because other
By Robert Michel, from the Volume XXV No. 18 – December 24, 2018 issue
CEO SUMMARY: This year’s list of the Top 10 Lab Industry Stories for 2018 is dominated by new directives from Medicare and private health insurers, as well as significant decisions by federal courts. Collectively, these developments create new compliance risks for all clinical laboratories and anatomic pathology groups. What is more notable about these top
By Robert Michel, from the Volume XXV No. 17 – December 3, 2018 issue
IN RECENT DAYS, RUMORS HAVE SURFACED that UnitedHealthcare has begun to terminate the contracts it holds with a number of regional and non-national clinical laboratories.
This news surfaced just as The Dark Report went to press. Given its importance to the clinical laboratory industry, we wanted to alert lab executives and pathologists to this development as
By Joseph Burns, from the Volume XXV No. 17 – December 3, 2018 issue
CEO SUMMARY: Since 2011, the University of Florida Health System has used pharmacogenetic test (PGx) results to guide physicians when they prescribe certain drugs. This initiative has improved patient outcomes, reduced the overall cost per episode of care, and gained partial reimbursement from health insurers for PGx test claims. As this testing becomes more widespread, clinical
CEO SUMMARY: At the last minute, Congress added all clinical laboratories to a far-reaching provision in the newly-enacted Support for Patients and Communities Act. Unlike the Anti-Kickback Statute, this provision applies to all payers, both government and private, and offers no safe harbors. Lab experts say this new law could turn relatively innocuous and heretofore
