Coming Soon: a Different Clinical Lab Industry

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ā€œKeep your eye on the ballā€ is an idiom that originated with baseball. TheĀ idea is that every player on the field should, at all times, know where the ballĀ 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 pathologistsĀ during the current pandemic. Thatā€™s because all lab managers should beĀ responding to the unique and pressing demands of the SARS-CoV-2 outbreakĀ while continuing to position the core routine testing activities of theirĀ labs to serve the needs of proactive care, value-based payments, and otherĀ healthcare trends.

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

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

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

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