TODAY I WANT TO CALL YOUR ATTENTION to a major issue in the lab testing industry that doesn’t get the full attention it deserves at most clinical labs and pathology groups. It is the fact that labs of all types and sizes are losing access to patients.
Without access to adequate numbers of patients, a lab cannot generate the number of specimens it needs to sustain a high level of clinical services while remaining financially viable. Several healthcare trends are working collectively to make it tougher for local laboratories to protect their existing access to patients, along with their the ability to increase market share. One such factor is the narrowing of provider networks that deny local and regional labs access to patients.
As you will read here, Humana is the latest of the national health insurers to exclude regional laboratories from its network. Lab executives in Ohio and Texas report that, over the spring and summer, they learned that Humana had narrowed its lab networks in those states.
Another issue that has gone unremarked is that, as of 2014, almost one-third of Medicare beneficiaries are now enrolled in Medicare Advantage plans. I’ll bet that most of you didn’t know that fact. It’s significant, since the private health insurers operating these plans tend to contract almost exclusively with national labs that offer the cheapest prices. Because of these developments, it can be argued that local labs across the nation have lost access to 15 million of the nation’s 49 million Medicare beneficiaries.
What has also gone unremarked in this regard is that the nation’s billion-dollar lab behemoths face their own challenges to protect and expand their access to patients. Yes, the two blood brothers hold exclusive contracts with most national and big regional health insurers. But the trend of doctors selling their medical practices to hospitals, health systems, and insurers puts the national labs at a disadvantage in situations where the new hospital or health system wants those office-based physicians to use the new owner’s laboratory.
These trends and market dynamics continue to play out. For that reason, the clinical lab industry has not reached the end game that will be shaped by these forces. If there is good news in all of this, it is that community labs and regional labs still have time to develop strategies that improve their access to patients in their service regions.