YOU SHOULD FIND THIS ISSUE OF THE DARK REPORT TO BE A USEFUL ROAD MAP to several of the major trends now confronting clinical labs and pathology groups across the United States. One trend involves payer efforts to control the cost of lab tests. A second trend centers upon accountable care organizations (ACO) and the national drive to create effective new models of integrated clinical care.
Of course, one surprise in a year that is just six weeks old is the list of molecular test prices posted by Palmetto GBA on January 28. As you will read here, several important new molecular CPT codes, such as for BRAF and EGFR, have a price that is below the cost of performing these tests. Blame this situation on many factors, including the complex web of bureaucratic requirements that must be followed by Medicare carriers.
Yet the consequence is financial distress—at least in the short term—to those labs which perform those tests while these problems are straightened out. At the same time, patient access to these tests may be negatively affected and that creates its own set of problems for a Medicare program that is attempting to improve patient outcomes and encourage early, accurate diagnosis.
Moving forward in this issue, in articles here and here, you will read about the current state of the marketplace for ACOs. I expect you to be as surprised as I was to learn that about 10% of the American population is already affected by an ACO program of one sort or another. This is a much faster pace of adoption than I would have predicted just 12 months ago! It is why the topic of ACOs will be front and center at our upcoming 18th annual Executive War College in New Orleans on April 30-May 1, 2013.
Those ACO intelligence briefings are followed on by a profile of the pan-health system effort at Intermountain Health in Salt Lake City, Utah, to cut costs across the system by $400 million over a five-year period. The clinical laboratory is to contribute to a $25 million cost reduction as its slice of the pie. What makes this notable is that Intermountain Health is a quality leader, so this huge cost-cutting program is a sign of how painful current and coming cuts in Medicare reimbursement will be to hospitals.
Once you absorb the significance of these intelligence briefings, I think you will agree that I am on safe ground to predict that much financial pain lies ahead for any clinical lab or pathology group that fails to respond to these trends.