WHAT’S WRONG WITH THIS PICTURE? National health insurer has exclusive national contract with a single billion-dollar lab company. Billion-dollar lab company creates a business division to manage how physicians order lab tests.
This lab test order system requires physicians to follow the lab test order algorithms established by the national health insurer (and its national contract lab provider), even for routine tests with ordering guidelines already established from such credible bodies as the CDC. This system also restricts (or “guides”) these physicians to refer only to “approved labs” and these labs are vetted by the business unit of the national lab and—once in this provider network—these labs will be paid by the business division of their national lab competitor. (See related article.)
All of this refers to UnitedHealthcare (UHC) and its exclusive national lab provider Laboratory Corporation of America, along with LabCorp’s BeaconLBS subsidiary. UHC is now implementing its laboratory benefit management program pilot in Florida. And to say that physicians in the Sunshine State are unhappy about this development would be an understatement. One Florida physician association wrote a letter to UHC asking that “UHC suspend this test program as a requirement for Florida providers immediately and indefinitely.”
As you will read in this issue, Florida physicians question not just the requirement that they order tests through the BeaconLBS system, which some call “burdensome and time-consuming.” They also object to the requirement that they obtain a prenotification number before ordering any of 79 designated tests, many of which are frequently ordered and have well-established clinical guidelines.
This causes me to wonder where pathologists in Florida (and nationally) are on this issue of appropriate lab test utilization. Shouldn’t pathology associations be issuing statements that support the role of local laboratories and local pathologists in providing the consultative support that helps local physicians select the right test at the right time for their patients?
Yet, to my knowledge, no pathology or clinical laboratory association has spoken publicly about the obvious ethical and financial issues associated with the attempt by two public stock companies—an insurer and a lab—to have Florida physicians order lab tests under restrictions designed by these companies, while limiting their choice of local labs in a way that competing labs complain is arbitrary and anti-competitive. What might change if patients and the press in Florida were informed about these developments because of press releases and interviews issued by pathologists?