THE DARK REPORT is first to report on the latest development as part of its ongoing coverage of how Florida physicians are reacting to the implementation of the UnitedHealthCare laboratory benefits management program and the requirement to use the BeaconLBS system before they can order any of 80 designated lab tests.
The response of the Florida medical community to UHC’s attempts to control lab testing costs is a bellwether for physicians everywhere, who may soon be facing the same requirements as cost control efforts become ever more popular with payers.
Now a bill to restrict how health insurers use systems such as BeaconLBS has been favorably received in the Florida Senate. But the bill may face opposition when presented to the Senate’s Appropriations Committee. In a report, the state Office of Insurance Regulation said that restricting the use of clinical decision support and laboratory benefit management programs could raise costs to the state Medicaid program.
What is your view of the conflict between controlling costs and leaving doctors free to make their own decisions? How will this conflict impact the clinical laboratory industry? Please share your thoughts with us in the comments below.
In recent weeks, two committees in the Florida Senate gave favorable votes to a bill to restrict the use of clinical decision support and lab benefit management programs.
Hearings on the bill were conducted by the Banking and Insurance Committee on January 20 and the Health Policy Committee on February 1.
Supporting the bill have been such state physician associations as the Florida Society of Pathologists, the Florida Society of Rheumatology, and the Florida Medical Association. FSP is working with lobbyist Amy Young of Ballard Partners, according to FSP President Margaret Neal, MD, FCAP, of KWB Pathology Associates in Tallahassee.
As currently written, the bill would limit how clinical decision support systems and laboratory benefit management programs—such as the program UnitedHealthcare introduced in Florida— can be used. On April 15, 2015, UHC required physicians serving its commercial HMO patients to use the Beacon Laboratory Benefit Solutions system when ordering any one of about 80 clinical lab tests. BeaconLBS is a business division of Laboratory Corporation of America.
Physicians must use BeaconLBS when ordering certain tests and wait for an authorization from BeaconLBS before sending lab test requisitions to one of 20 “labs of choice” that UHC and BeaconLBS designated as in-network labs. LabCorp owns eight of those 20 labs. (See TDRs, July 21 and November 3, 2014, and January 5 and March 9, 2015.)
Concern About Costs
Supporters of the bill may face opposition when SB 1084 is presented to the Senate’s Appropriations Committee in the coming weeks. The Department of Management Services in the state Office of Insurance Regulation, Division of State Group Insurance, has said that restricting the use of clinical decision support and laboratory benefit management programs could raise costs to the state Medicaid program.
In a report on this matter, the DMS wrote, “Further, the DMS states that the provision in the bill that prohibits HMOs from requiring healthcare providers to use a clinical decision support system or a laboratory benefits management program, to direct or limit provider’s decision-making ability could affect the state group health insurance program. Changes to current medical management procedures that cause an HMO’s medical costs to increase would result in higher negotiated premiums for the state-contracted HMOs.”
Robert W. Levin, MD, a rheumatologist in Dunedin, Florida, is prepared to defend the bill if there is any opposition. As the President-Elect of the Florida Society of Rheumatology, Levin is a staunch opponent of BeaconLBS.
“Rheumatologists are very much affected by the BeaconLBS system because the tests we order are needed for many reasons,” he said. “The most ridiculous example from the BeaconLBS program is the requirement to get authorization for testing for lupus, specifically, ANA testing.
“The diagnosis of lupus is very hard to make,” observed Levin. “It combines lab criteria with the patient’s signs and symptoms from a physical exam. I’ve been trained to do this diagnosis through medical school, internship, residency, and a rheumatology fellowship, and I can’t figure out how a computer or a decision support system would trump my clinical impression of whether the patient needs a workup for lupus. This diagnosis requires an objective evaluation combined with an expert opinion and there is no way a computer can do that. It’s absolutely insulting!”