CEO SUMMARY: With programs now at the nation’s two largest insurers, is it possible to argue that prior-authorization is going mainstream? Some observers say, yes, as THE DARK REPORT predicted. What is certain is that starting Nov. 1, UnitedHealthcare is requiring prior authorization for genetic and molecular tests for its fully-insured commercial members nationwide. That
Tag: emr systems
CEO SUMMARY: It may not yet be open rebellion, but UnitedHealthcare faces strong opposition in Florida from physicians- and their medical societies-over the requirement that they obtain prenotification and pre-authorization when ordering tests listed in UHC’s laboratory benefit management program. Recent rumors say that UHC has exempted some medical groups from compliance with the program. If true, that could further complicate UHC’s relationship with physicians in the Sunshine State who must continue to comply with this program.
CEO SUMMARY: In Houston, Memorial Hermann Healthcare System has put together a health information exchange (HIE) to serve the Houston market. By design, this HIE not only gives physicians immediate access to a wide variety of patient data, but also supports the type of workflow required for Memorial Hermann’s new accountable care organization to succeed.
CEO SUMMARY: Based in Brentwood, Tennessee, Regional Diagnostic Laboratories (RDX) says it wants to purchase the laboratory outreach programs of nonprofit community hospitals. RDX is a partnership with Warburg Pincus, a New York investment company. It is a credible buyer and has $250 million available to fund these acquisitions. Brian Carr, RDX’s CEO, predicts that
CEO SUMMARY: Given the specific news stories that make up THE DARK REPORT’S list of the “Top Ten Lab Stories for 2011,” it might be said that 2011 was a rather quiet year overshadowed by anticipation of the coming reforms mandated by the Accountable Care Act of 2010. For the clinical lab testing industry, 2011
CEO SUMMARY: Interest by office-based physicians in creating an in-clinic medical testing laboratory is on the increase. This has direct consequences for independent commercial labs, hospital lab outreach programs, and anatomic pathology groups, since office- based physicians are a primary source of lab test referrals. One consultant says that 60% to 70% of the volume
CEO SUMMARY: What makes 2010 a watershed year for the laboratory testing industry is enactment of the 2,700-page Patient Protection and Affordable Care Act (PPACA). Even if parts of this bill are repealed, the remaining parts of the massive legislation will trigger major changes to the healthcare system as it operates today. Other stories in
DURING OCTOBER, three laboratory informatics companies were acquired or obtained new capital funding. It is an indication of the growing importance that laboratory informatics will play as healthcare moves toward the goal of the universal patient health record (EHR).
The first of the three transactions came on October 7. Halfpenny Technologies, Inc., of Blue Bell, Pennsylvania,
CEO Summary: Pre-authorization of expensive genetic and molecular tests is a threat to local clinical laboratories and pathology groups if payers exclude them from provider networks in favor of labs which bid the lowest prices. But one major healthcare corporation believes there is now an opportunity for clinical labs and pathology groups to deliver added
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Editor’s Note: For almost 20 years, Pat Wolfram has worked to develop electronic medical record systems at companies like MedicaLogic and GE Healthcare. His firm specializes in developing effective electronic interfaces that allow a physician’s EMR system to handle lab test orders and lab test results with that physician’s clinical laboratory provider.