Increased medical laboratory test utilization might result from this new policy

Last month, another Obamacare mandate took effect which may lead to an increased volume of laboratory tests referred to the nation’s clinical laboratories and pathology groups. Effective on September 23, 2010, health plans must cover a host of screening and preventive medical services for which patients are not to be required to pay any money out-of-pocket.

It would appear that this mandate was included in the 2,700-page healthcare reform law as a benefit to consumers—thus giving democratic lawmakers a positive feature that they could talk up with their voters. These 75+ preventative and screening services (thanks to the new health reform legislation) have the potential to increase the volume of laboratory testing specimens, if large numbers of consumers were take advantage of these “free” medical services.

 

No Co-Pay, No Deductible for Screening Services
Under the new law, “If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a co-payment or co-insurance or meet your deductible, when these services are delivered by a network provider.” (Dark Daily provides a list of these services at the bottom of this page.)

The U.S. Preventative Services Task Force already provides healthcare providers with guidelines for ordering such tests. What is interesting; however, is that this new healthcare reform law actually expands some of those recommendations.

For example, the American Cancer Society advises women over the age of 50 to undergo an annual mammogram, but advises that women in their 40s should not undergo such screening. Under the new Obamacare mandate, women in their 40s can now receive—free of any out-of-pocket charges—a mammogram every one to two years.

Utilization of Clinical Laboratory Tests
By Dark Daily’s  count, at least 27 preventative services on the government’s list require a medical laboratory test as some part of the clinical protocol. So it is quite possible that these new healthcare mandates might drive up utilization of laboratory tests. For example, it is estimated that 40 million adults have Type 2 Diabetes and only 20 million are diagnosed. Thus, increased screening for Type 2 Diabetes by the nation’s physicians could significantly boost utilization of Hemoglobin A1c tests.

By the way, would it be going out on a limb if Dark Daily were to connect the implementation of these 75+ screening and preventive care mandates in late September with recent headlines about premium rate increases by private health insurers? After all, if insurers already know, from actuarial experience, how much money from patient co-pays, deductibles, and/or out-of-pocket payments were offsetting some or all of the costs of these preventive and screening services, it is only logical that private payers would need to raise premiums by some amount to offset the revenue now lost because of the new healthcare reform law mandates that took effect on September 23.

Clearly, clinical laboratory managers and pathologists should be aware of this very important change in how health insurers must provide these commonly-used screening and preventive services. These developments may even open the door for innovative medical laboratories and pathology groups to design new ways to provide added value to physicians, payers, and patients.

At the bottom of this page, Dark Daily provides a list of the preventative services for which healthcare consumers will no longer have to pay any out-of-pocket fees, as mandated by The Affordable Care Act and effective on September 23, 2010:

Related Information:

To learn more detailed information on these preventive services and about the new healthcare reform laws, click on the links below:

Preventive Services Covered under the Affordable Care Act

U.S. Preventive Services Task Force Recommendations

Preventive Services Covered under the Affordable Care Act
Covered Preventive Services for Adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

• Alcohol Misuse screening and counseling

• Aspirin use for men and women of certain ages

• Blood Pressure screening for all adults

• Cholesterol screening for adults of certain ages or at higher risk

• Colorectal Cancer screening for adults over 50

• Depression screening for adults

• Type 2 Diabetes screening for adults with high blood pressure

• Diet counseling for adults at higher risk for chronic disease

• HIV screening for all adults at higher risk

• Immunization vaccines for adults–doses, recommended ages, and recommended populations vary

• Hepatitis A

• Hepatitis B

• Herpes Zoster

• Human Papillomavirus

• Influenza

• Measles, Mumps, Rubella

• Meningococcal

• Pneumococcal

• Tetanus, Diphtheria, Pertussis

• Varicella

• Obesity screening and counseling for all adults

• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

• Tobacco Use screening for all adults and cessation interventions for tobacco users

• Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

• Anemia screening on a routine basis for pregnant women

• Bacteriuria urinary tract or other infection screening for pregnant women

• BRCA counseling about genetic testing for women at higher risk

• Breast Cancer Mammography screenings every 1 to 2 years for women over 40

• Breast Cancer Chemoprevention counseling for women at higher risk

• Breast Feeding interventions to support and promote breast feeding

• Cervical Cancer screening for sexually active women

• Chlamydia Infection screening for younger women and other women at higher risk

• Folic Acid supplements for women who may become pregnant

• Gonorrhea screening for all women at higher risk

• Hepatitis B screening for pregnant women at their first prenatal visit

• Osteoporosis screening for women over age 60 depending on risk factors

• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

• Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

• Syphilis screening for all pregnant women or other women at increased risk

Covered Preventive Services for Children

• Alcohol and Drug Use assessments for adolescents

• Autism screening for children at 18 and 24 months

• Behavioral assessments for children of all ages

• Cervical Dysplasia screening for sexually active females

• Congenital Hypothyroidism screening for newborns

• Developmental screening for children under age 3, and surveillance throughout childhood

• Dyslipidemia screening for children at higher risk of lipid disorders

• Fluoride Chemoprevention supplements for children without fluoride in their water source

• Gonorrhea preventive medication for the eyes of all newborns

• Hearing screening for all newborns

• Height, Weight and Body Mass Index measurements for children

• Hematocrit or Hemoglobin screening for children

• Hemoglobinopathies or sickle cell screening for newborns

• HIV screening for adolescents at higher risk

• Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:

• Diphtheria, Tetanus, Pertussis

• Haemophilus influenzae type b

• Hepatitis A

• Hepatitis B

• Human Papillomavirus

• Inactivated Poliovirus

• Influenza

• Measles, Mumps, Rubella

• Meningococcal

• Pneumococcal

• Rotavirus

• Varicella

• Iron supplements for children ages 6 to 12 months at risk for anemia

• Lead screening for children at risk of exposure

• Medical History for all children throughout development

• Obesity screening and counseling

• Oral Health risk assessment for young children

• Phenylketonuria (PKU) screening for this genetic disorder in newborns

• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk

• Tuberculin testing for children at higher risk of tuberculosis

• Vision screening for all children