CEO SUMMARY: Laboratory benefit management companies that offer a range of services to health insurers are gaining influence over clinical lab testing in important ways. On behalf of health insurers, LBMs will select labs for a payer’s network, then manage that network. They also manage claims and lab-test utilization, often reviewing medical necessity. A primary
Tag: outpatient laboratory services
In the Protecting Access to Medicare Act of 2014 (PAMA), the Center for Medicare and Medicaid Services (CMA) is directed to collect market price data and use the data to establish prices for the Part B Clinical Laboratory Fee Schedule, starting on January 1, 2017.
CEO SUMMARY: Under the Protecting Access to Medicare Act, CMS must collect market price and volume data from certain labs beginning January 1, 2016. CMS will use this data to establish Part B clinical laboratory fees beginning in 2017. One lab association representing community and regional laboratories points out that CMS has complex issues that must be appropriately addressed if the resulting rules are to avoid favoring some types of labs over others, whether intentional or not.
CEO SUMMARY: Some Florida physicians are declaring their intent to leave UnitedHealthcare’s network because they find the insurer’s new BeaconLBS laboratory benefit management system to be time consuming and onerous. The defections come as the program goes through a soft launch that began on October 1. Apparently in response to physician complaints, UHC announced a
CEO SUMMARY: Independence Blue Cross in Philadelphia decided to select Laboratory Corporation of America for its new eight-year managed care contract that took effect on July 1. However, the real story is the aggressive bidding war between the two national labs. Sources say LabCorp bid an aggressively low price of between $1.00 to 1.60 per
CEO SUMMARY: Many independent laboratories serving patients in Florida are unhappy about the decision by UnitedHealth (UNH) to initiate a pilot program that calls for LabCorp’s BeaconLBS subsidiary to handle prior authorization for certain lab tests. UNH’s laboratory benefit management program will commence on October 1, 2014. Just 13 laboratories are currently listed as network
CEO SUMMARY: Business intelligence is on the verge of becoming the next “big thing” in clinical laboratory management. Lab teams are using real-time data dashboards to quickly identify problems and take proactive steps to raise service levels to clients. South Bend Medical Foundation says these software systems and related tools are helping it raise the
CEO SUMMARY: When HCA purchased the MDS partner share in Integrated Regional Laboratory of Ft. Lauderdale, Florida, it marked the end of MDS Laboratories’ ten-year “United States Adventure.” It also put HCA in full ownership of an automated core laboratory and a laboratory outreach testing program full of promise. Efforts are underway at IRL-FLA to
CEO SUMMARY: Government healthcare officials in British Columbia are taking definitive steps to recast the existing status quo between private commercial laboratory companies and public (government) hospital laboratories in the province. Although the stated goals are to reduce the cost of laboratory testing, the proposed means to realize these savings may prove disruptive and counter-productive.
CEO SUMMARY: Joint ventures and collaborative business relationships between hospital laboratories and commercial laboratories continue to be a difficult business model. Recent events in Seattle demonstrate the challenges and frustrations of establishing such ventures, then making them successful. One footnote to the Seattle story is the success of a regional laboratory network at grabbing market