Coming Soon: a Different Clinical Lab Industry

“Keep your eye on the ball” is an idiom that originated with baseball. The idea is that every player on the field should, at all times, know where the ball is so that they can be ready to do their job when the ball comes their way.

This is excellent advice for clinical lab administrators and pathologists during the current pandemic. That’s because all lab managers should be responding to the unique and pressing demands of the SARS-CoV-2 outbreak while continuing to position the core routine testing activities of their labs to serve the needs of proactive care, value-based payments, and other healthcare trends.

All the major forces of change in healthcare and the clinical lab marketplace that were visible before the pandemic continue to reshape healthcare today. Take reimbursement as an example. In recent years, government and private payers steadily forged ahead with the introduction of different, value-based forms of reimbursement. The best example of that is Medicare Advantage, which pays health plans a set fee per Medicare beneficiary. In turn, a health plan then contracts with a hospital or a physician to provide services for a per-member, per-month payment. Of 60 million Medicare beneficiaries, 21 million currently are enrolled in Medicare Advantage plans.

What’s changed with how payers contract and settle lab test claims since the advent of the pandemic? Not much. The Dark Report has regularly briefed clients and readers on the efforts of some major private payers to deny COVID-19 test claims and to continue excluding labs as providers by narrowing networks and by instituting new requirements for lab claims to be paid. For example, UnitedHealthcare is requiring labs to register every test and panel under its Laboratory Test Registry Program, which goes into effect on Jan. 1, 2021. (See “UHC Ready to Implement New Lab Test Registry” and “UHC Issues Details about How Labs Register Tests,” TDR, Aug. 3, 2020.)

The pre-pandemic trend of altering reimbursement to be value-based and discouraging fee-for-service arrangements is an important example, because the fastest way to change the behavior of people and organizations is to change how they are paid. This illustrates why pre-pandemic trends in healthcare and the clinical lab marketplace are still active today. Even as the COVID-19 pandemic interrupted many things in healthcare, all the major drivers of change before the pandemic continue to reshape our profession, today and into the future. That is why we should all “keep our eyes on the ball!”