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 delay in the date when it will begin to use BeaconLBS to make coverage decisions on certain lab tests.
THERE IS VISIBLE PHYSICIAN RESISTANCE to the new laboratory benefit management program implemented by UnitedHealthcare (UHC) in Florida. On October 1, the health insurer began requiring physicians in Florida to use the BeaconLBS system to obtain pre-notification or pre-authorization for selected clinical laboratory tests.
Some physicians find the BeaconLBS system to be so time intensive and onerous that they are leaving the health plan’s network, sources told THE DARK REPORT. Responding to those concerns, several Florida physician associations asked physicians to notify them about problems they experience when attempting to comply with UHC’s new laboratory benefits program.
For its part, UnitedHealthcare recently notified providers in Florida that it would delay the date when it begins basing payment decisions for lab tests via the BeaconLBS. Payment determinations will be based on whether physicians properly followed the BeaconLBS decision support procedures when ordering any of the 81 clinical laboratory tests that UHC has designated on its website as needing advance notification or prior approval. UHC moved that date back to January 1, 2015.
In a letter to Florida providers, Catherine E. Palmier, M.D., UHC’s Shared Services Chief Medical Officer in the East Region, wrote, “Although the laboratory benefit management program starts on October 1, 2014, claims and service impacts will not go into effect until January 1, 2015. [Italics by TDR.] This allows for additional time for physicians’ offices to acclimate to the program. As a pilot we will closely monitor progress and will make refinements based on data, experience, and input.”
In Florida, physicians and lab managers interpret the phrase, “claims and service impacts” to describe how UHC and BeaconLBS—its contractor for the laboratory benefits management program—will decide whether or not UHC will issue payment for lab test claims covered under the laboratory benefit management program.
Is There a Physician Revolt?
Meanwhile, UHC must deal with a physician revolt of some size. Jay Millson, the Executive Vice President of the Florida Association of Family Physicians, said that an unknown number of physicians are so upset about the hassles required to use the new laboratory benefit management system operated by BeaconLBS that they have said they will leave UnitedHealthcare.
“We have had at least a half dozen physicians simply indicate their intention to drop UHC from their practice,” Millson said. “We have not provided, nor will we ever provide, any guidance to our members relating to participation in any insurance plan.”
Florida physicians have asked UHC to pay them for the added time needed to use the BeaconLBS system. To date, no official at any Florida physician association reports receiving a response from UHC about physician requests for such payments. It is also believed that a hospital association in Florida has expressed its members’ concerns about this program to UHC.
Physicians serving patients in UHC’s commercial HMO can order most lab tests as they normally would. However, for 81 lab tests that UnitedHealthcare lists on its website, physicians are required to use BeaconLBS to notify Beacon when ordering one or more of these tests.
For two tests (BRCA1 and BRCA2), BeaconLBS and UHC require physicians to get prior approval. Without prior approval for these two tests, UHC has said it will not pay for these tests. BeaconLBS is a wholly-owned subsidiary of Laboratory Corporation of America.
For the 79 other tests—some of which are routine clinical tests—UHC requires physicians to use the BeaconLBS system to notify BeaconLBS that they are ordering these tests. In a letter UHC sent to providers in Florida, it said that, once Beacon receives such a notification, Beacon will issue clinical guidelines to the referring physician to help the doctor identify the best treatment options for his or her patient. On its website, UHC says it will not pay physicians who do not comply with the advance notification requirement.
In its letter to providers, UHC said: “UnitedHealthcare is implementing the laboratory benefit management program as a pilot to help enhance quality and affordability, while supporting appropriate use of outpatient laboratory services. The program includes multiple components designed to work together to achieve these goals. One of the components, physician decision support, is an interactive tool to help physician offices to: select laboratory tests using evidence-based guidelines and industry best practices; select in-network laboratories that have the expertise to perform these tests; and support program requirements such as advance notification and/or prior authorization.”
Routine Test Orders
But physicians who have seen the BeaconLBS system are confused about why they need to use it when ordering routine tests. “I don’t understand the purpose of this program other than to try to get out of paying for lab tests,” one physician wrote in an email to FAFP. “As a physician, I have completed four years of medical school, three years of residency, and 11 years of practice.
“I don’t need ‘decision support’ to know when my patients need a Pap smear or a TSH level,” continued this physician. “If they were requiring authorization for expensive or less commonly ordered tests it might make some sense, but a TSH costs about $3 for me, and I’m sure United pays even less. Given the cost in lost time spent on this, it would be cheaper for me to just pay the lab out of pocket and avoid the hassle. And this is truly a ridiculous alternative.”
Another complaint voiced by Florida physicians is the lack of functional interfaces between their EHRs and BeaconLBS. This requires them to leave their EHR and log into the BeaconLBS system before they can enter the information required to obtain pre-notification or pre-authorization for the lab tests that they want to order for their patients.
In her letter to a Florida physician, Palmier wrote, “While we understand physicians and their office staff may have concerns regarding the program, it is designed to offer multiple options. Physician decision support is already an integrated component of LabCorp’s online order entry system and is integrated with two electronic health record (EHR) systems, Emdeon and Liaison Technologies. Two additional EHRs, Aprima and eClinicalWorks, are in the plans to be integrated as well.”
Integration with other EHRs
BeaconLBS is also working with other EHR vendors. “BeaconLBS … continues to work with additional EHR companies to expand the list of applications integrated with physician decision support,” Palmier added.
It was not known how many Florida physicians in UHC’s HMO network use these two EHR systems, but there are hundreds of EHRs that are not integrated with the BeaconLBS. To ensure that the lab test order is part of the patient’s EHR, physicians using an EHR not integrated with the BeaconLBS would need to enter lab orders twice: once online via the BeaconLBS website and once in their EHR.
Some Predictions of Chaos
Across the clinical laboratory industry, those who knew the details of the UHC–BeaconLBS scheme have generally predicted that its implementation would cause chaos for all the reasons identified by those Florida physicians irate enough to publicly complain.
That seems to be the case, based on events during during the first two weeks of that UnitedHealthcare has required physicians to use the BeaconLBS system as part of its laboratory benefit management program. On the one hand, there are indications that several Florida physician associations and possibly one hospital association in the state are communicating the dissatisfaction of their members about the BeaconLBS system to UHC.
On the other hand, the letters sent by UHC to providers and UHC beneficiaries in Florida in recent weeks indicate that the health insurer knows it has a tough fight to gain acceptance for this lab test utilization management scheme.
Claims Adjudication Delayed
The best evidence of substantial physician resistance is the fact that UHC has backtracked on its plans—beginning on October 1—to use BeaconLBS pre-authorization and pre-notification procedures to determine which lab claims to pay and which lab claims to deny. UHC has notified providers that it won’t implement that aspect of the laboratory benefits management program until January, 1, 2015. Because of the national implications of this lab test utilization scheme, lab executives across the nation are watching developments in Florida.
UnitedHealth Tells Florida Patients They May Need to Pay if Tests Don’t Meet Evidence-Based Guidelines
PATIENTS IN UNITEDHEALTHCARE’S HMOs in Florida may be required to pay for their own clinical lab tests under the payer’s laboratory benefits program.
UHC is introducing Beacon Laboratory Benefit Solutions (BeaconLBS) and requiring physicians treating patients in UHC’s Florida HMOs to use the system to get prior approval for two tests (BRCA1 and BRCA2) and notify BeaconLBS in advance when ordering any of 79 other tests. (See TDR, July 21, 2014, and September 2, 2014, here and here.)
UHC members in Florida were sent a letter dated September 15 from Linda Stewart, Vice President, National Lab Program. She explained what will happen after physicians notify BeaconLBS of their intention to order one of these lab tests.
“At the time of notification, UnitedHealthcare will give the doctor evidence-based guidelines (medical treatments that have been shown to have the best results that will help them choose the best test(s) for you) and identify laboratories that are best qualified to perform the test(s)based on quality criteria and industry best practices,” she wrote. “The select network laboratories are called ‘Laboratories of Choice.’”
In essence, the advance notification is similar to a prior approval because if BeaconLBS or UHC denies the physician’s request to run the planned tests, the patient would need to pay for the test, the letter says. “Certain laboratory services may not be covered by your benefit plan based on evidence-based guidelines. If your doctor orders a laboratory service that is not covered, he or she may ask you to sign a form confirming that you are aware of the potential cost to you.”
About advance notification, a UHC spokesperson said, “Advance notification applies to decision support tests (it’s not all lab tests) and provides UnitedHealthcare a heads up when a test has been ordered for one of our members. It does not require clinical review and the notification must be completed within 10 days from the date of service.”
Physicians Complaining to their State Associations
PHYSICIANS IN FLORIDA ARE VOICING their concerns about the Unitedhealthcare laboratory benefit management program. One example comes from the Florida Association of Family Practitioners (FAFP).
A solo physician in Miami said he was concerned about the time and expense required to use the BeaconLBS in his practice. “In order to keep my practice financially viable, I keep my overhead low by performing all patient care services myself,” he wrote in an email to FAFP. “I have only one employee, my office manager, who has plenty to do on the administrative side.”
The physician went on to write, “I struggle to keep up with charting, drawing and processing lab [tests], and dealing with crises throughout the day when I see my patients. I have no idea how I am going to have time to do prior authorizations for labs that should be routine. This is a real burden on me, because almost one third of my patient population right now is on United.”
THE DARK REPORT published a more detailed critique of the BeaconLBS system that was provided by Dennis Saver, M.D., a family physician, geriatrician, and founder of Primary Care of the Treasure Coast, in Vero Beach, Florida. His staff determined that a single test order requires five to seven extra minutes to process through BeaconLBS. Staff also estimated that between 20 and 30 mouse clicks and multiple computer screen changes will be needed to enter the information for each patient requiring lab testing through the BeaconLBS portal.
Saver’s conclusion was direct and to the point: “As a contracted physician for UnitedHealth, I find this whole idea that we need to do more work for no additional pay to be extraordinarily objectionable!” he declared. “And, frankly, I find UnitedHealthcare’s argument that this will create better medicine to be unsupported. This simply means that UnitedHealth will pay less in lab fees.” (See TDR, September 2, 2014.)