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CMS physician fee schedule: Will hospital labs be excluded again from PAMA price reporting?

CEO SUMMARY: Publication of the draft CMS Physician Fee Schedule on July 12 brought unwelcome news for the clinical lab industry, at least as it pertains to that perennial question: Should hospital lab outreach data be included in a PAMA market study? The federal Centers for Medicare and …

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Québec’s Laboratory Consolidation Plan Aims to Save $13.5M

CEO SUMMARY: In the Province of Québec, an ambitious project is under-way to consolidate the clinical laboratory testing of 123 laboratories into 11 centralized lab clusters. It is one of the largest lab consolidation projects nowhappening in the world. Among the goals of this project is…

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Attorney Explains 70/30 Rule, Pass-Through Bill Arrangements

HOW THE LAB OUTREACH BUSINESSES of rural hospitals originate lab specimens and bill for lab tests is getting increased scrutiny. The reason for this rise in interest is that a growing number of rural hospitals are generating almost as much revenue from laboratory outreach testing as they get from all…

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Dartmouth-Hitchcock Builds Strong Lab Outreach Business

CEO SUMMARY: As health networks and hospitals consider outsourcing their lab outreach programs, the lab team at Dartmouth-Hitchcock Medical Center (D-H) offers lessons about the value of retaining outreach. D-H is now in the eighth year of a sustained expansion of its laboratory outreach …

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Rural Hospital Spokesman: Hospital Lab Outreach Programs Are Legal

CEO SUMMARY: As the debate grows more heated, supporters of hospital outpatient department (HOPD) billing schemes have ramped up their defense of the practice. The president of the National Association of Rural Hospitals tells THE DARK REPORT that rural hospitals…

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Coming Soon to a Doctor’s Office Near You!

IT’S TIME FOR ALL CLINICAL LABS AND ANATOMIC PATHOLOGY GROUPS to pay closer attention to the advances in genetic medicine and precision medicine. Events are moving even faster than most experts have predicted. As you will read on pages 3-4, two innovative health networks are on the verge of offeri…

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Rural Hospital Group Says Lab Billing Model Is Legal

CEO SUMMARY: In recent years, many rural hospitals have entered into agreements to expand their laboratory outreach businesses. In an interview, the president of the National Association of Rural Hospitals said rural hospitals often bill for lab outreach services under Medicare’s 70/30 …

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Theranos’ Elizabeth Holmes Prepares to Meet Justice

IT’S NOW CLEAR THAT TWO CLINICAL LABORATORY EXECUTIVES COMMITED one of the largest corporate fraud schemes in the past century. Reading the federal indictments against Elizabeth Holmes and Ramesh “Sunny” Balwani unsealed Friday provides insights into the extensive scale and wide scope of the a…

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Did National Labs Sign Value-based Payer Contracts?

IT IS AN IMPORTANT SIGN OF THE TIMES when press releases about the two new national lab services agreements that UnitedHealthcare just announced with Laboratory Corporation of America and Quest Diagnostics emphasize how value-based programs will be a…

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Big Insurers Seek Value-Based Deals with LabCorp, Quest

IT’S THE END OF AN ERA for the strategy of being the exclusive national lab provider for a major health insurer. Last week, the two largest clinical laboratory companies announced that the 10-year-old exclusive lab testing deals each had with a different big health insurer had crumbled. In 2007, …

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