FOR MORE THAN TWO DECADES, leaders and forward-thinkers in the pathology profession bemoaned the fact that lab tests and anatomic pathology services were priced as commodities. From the podiums of various lab and healthcare conferences, they urged their peers to identify, document, and educate health insurers and others about the true value of lab tests.
All of this talk about why it was important for pathologists to demonstrate the value of their services started in the early 1990s. At that time, health maintenance organizations began using capitated, full-risk contracts to slash prices paid to providers, including payments to anatomic pathology (AP) groups and clinical laboratories. Payers also used narrow networks to exclude many pathology groups, resulting in further revenue losses for these groups and labs.
Over the past 20 years, pathologists have made little progress educating payers and the public about the substantial value that AP services contribute. Pathologists know how their services improve patient care and help reduce the overall costs as well. But few hospital administrators or health insurance executives understand how they could leverage anatomic pathology services in useful ways—and pay pathologists more because of these contributions.
However, there is good news for the pathology profession. The health system is transforming, giving pathologists a once-in-a-career opportunity to educate payers, patients, and other providers about their value. As health insurers and employers experiment with value-based payment models, pathologists have a chance to educate decision-makers about the specific ways that pathology services add value.
For this educational effort, THE DARK REPORT is doing its part. On pages 10-13, Robert H. Tessier, an experienced reimbursement consultant with HPB Services, explains how his clients are educating hospital administrators about the value of the pathology services they provide and he identifies simple steps every group can take. One such step is to be diligent about preparing an annual report for the hospital that details the time and contributions made by the group, along with its proposals on how the group can add value and be paid for it.
But Tessier also has a warning. Failure to act now means that hospitals and health plans will decide, on their own, how to pay pathologists for value. For all these reasons, it’s now time for the pathology profession to seize the day!