CEO SUMMARY: THE DARK REPORT IS THE ONLY LAB INDUSTRY NEWS SOURCE to report on this important development. A hearing took place recently on a healthcare bill in the Florida senate. Physicians in Florida are working to get language inserted into a state law that would restrict the ability of health insurers to use a clinical decision support system or laboratory benefit management program in certain circumstances. Physicians are unhappy with the requirement by UnitedHealthcare that they use the BeaconLBS system to obtain pre-notification and pre-authorization for about 80 lab tests.
THE FLORIDA LEGISLATURE IS CURRENTLY CONSIDERING the clinical decision support systems and laboratory benefit management programs that health plans use to dictate how physicians may order clinical laboratory tests.
A Senate committee recently held a hearing on Senate Bill 1084, which contains language that would prevent health insurers in Florida from requiring physicians to use such systems each time they order a laboratory test for their patients.
It is believed that this language was inserted into the proposed legislation because many physicians in Florida are unhappy with the laboratory benefit management program instituted last year by UnitedHealthcare and administered by BeaconLBS, a company owned by Laboratory Corporation of America. This program requires physicians, when treating patients enrolled in commercial UnitedHealthcare HMOs, to obtain pre-notification or pre-authorization for approximately 80 tests. (See TDRs, July 21 and November 3, 2014, and February 17, 2015.)
Over the past 18 months, many physicians and their state medical associations expressed serious criticisms of UHC’s laboratory benefit management program and what they considered to be detrimental aspects in the design and operation of the BeaconLBS system they are required to use.
Florida Senate Bill 1084 includes language that would restrict the ability of health insurers to use systems designed to direct how physicians order laboratory tests in specific situations. The current language in the bill says, “…prohibiting a health maintenance organization from requiring that a healthcare provider use a clinical decision support system or a laboratory benefits management program in certain circumstances…”
It is significant that this language is included in the bill. It is evidence that the physician community remains unhappy with the design and operation of the BeaconLBS program and the requirement that they use the BeaconLBS system to obtain pre-notification or pre-authorization for as many as 80 lab tests.
The issue of control over how physicians order lab tests is just part of a greater battle that has existed in recent decades between health insurers—looking to control costs and encourage more appropriate utilization of clinical services—and physicians, who want the freedom to exercise their professional judgment when caring for their patients.
Are you a Florida lab or doctor who is directly affected by this legislation? Please share your thoughts with us in the comments below.