Changes in reimbursement models and federal compliance, as well as tougher payer audits, make it critical clinical laboratory managers are fully informed and prepared for what lies ahead in 2020
Not only does January 1st bring the new year of 2020, but it also brings tough challenges for leaders of the nation’s clinical laboratories and anatomic pathology groups. Most of these challenges are triggered by the ongoing transformation of the American healthcare system.
“Healthcare’s transformation in this country has two primary elements,” said Robert L. Michel, Editor-in-Chief of The Dark Report, sister publication of Dark Daily. “One is the integration of medical care to meet the related goals of keeping people out of hospitals—the most expensive site of care—and to proactively manage patients to keep them healthy.
“The second is reimbursement reform,” he continued. “Healthcare policymakers want to eliminate fee-for-service payments and move providers to different forms of value-based reimbursement. The federal Medicare program seems to be taking the lead over private payers as it introduces different pilot programs that reimburse physicians and hospitals through such methods as bundled payments, shared-savings arrangements, and per-member per-month (PMPM) arrangements.”
Michel predicts that both the integration of care delivery and the shift away from fee-for-service payment will become more urgent challenges for clinical laboratory managers and pathologists during 2020.
“Take the integration of care, for example. Clinical laboratories, since their inception, have been organized to serve the different provider silos,” Michel stated. “Each client—whether it was a primary care physician, a specialist doctor, a hospital, or a nursing home—could be served as a stand-alone customer. That client ordered tests and the lab performed those tests, submitted the results to that client, then billed insurance as appropriate.
“Integration of clinical care changes that laboratory service model in significant ways,” he continued. “Now, when a provider within an integrated health system orders a medical laboratory test, the lab will want those lab test results to be available, via the electronic health record (EHR) system, to other providers within that health system.
“That is one example of how integrated care requires clinical labs to realign their service model,” Michel added. “Combine that need to change with the steady transition away from fee-for-service to reimbursement based on value and you can see why all labs in the United States will be uniquely challenged, not just in 2020, but in the succeeding years.”
Even Minor Changes in Care Require Major Responses by Medical Laboratories
It is important for clinical laboratory managers, pathology practice administrators, and the pathologists who are the business leaders of their groups to understand the width and depth of the changes happening in healthcare and laboratory medicine in the United States today. Even little changes in how care is delivered can require a major response in how medical laboratories are organized and how they deliver lab testing services.
For example, here are distinct trends associated with how providers are responding to healthcare’s current transformation:
- Formation of integrated healthcare networks to provide seamless care.
- Consolidation of providers, with hospitals and insurers buying up physicians’ practices.
- Billion-dollar acquisitions associated with consolidation, such as the Advocate-Aurora Merger ($11 billion), CVS Pharmacy’s purchase of Aetna ($70 billion), and Cigna’s acquisition of Express Scripts ($71 billion).
Meanwhile, the clinical laboratory industry is undergoing its own transformation. Three major trends illustrate how labs are responding to the new healthcare marketplace realities:
- More use of Lean, Six Sigma, and process improvement techniques as labs strive to cut costs while protecting quality and maintaining top-flight service levels.
- More collaboration with providers, payers, and even consumers, as innovative medical laboratory organizations move to deliver more value, consistent with the Clinical Lab 2.0 business model.
- Acquiring more robust information technologies and analytics tools needed to leverage the lab’s clinical test data in ways to provide increased value, not just to hospitals and physicians, but to payers, patients, and a new class of care management companies that want to use big data and machine learning to help payers and providers improve patient outcomes.
All of these trends will not only be high profile during 2020, but they will be driving forces throughout the decade of the 2020s.
This is why The Dark Report’s 25th anniversary Executive War College on Lab and Pathology Management, which takes place April 28-29, 2020, in New Orleans, will feature essential sessions and expert speakers who have the answers you need to guide your lab through the challenging times yet to come.
Narrowing networks that exclude your lab from access to patients? Executive War College has health plan lab network managers to share insights with you, along with experienced lab managed care contracting executives who can challenge these payers and teach you the secrets of winning and keeping status as an in-network laboratory.
Concerned about new compliance issues—such as EKRA (Eliminating Kickback in Recovery Act of 2018) and Medicare’s recent affiliation disclosure rule for tougher government and private payer audits—that challenge your lab’s financial integrity? Executive War College is bringing together the nation’s smartest minds in compliance, billing/collections, and lab accreditation to give you first-hand updates on the must-dos and the must-avoids, so your lab is always inspection ready and compliant.
Because this is the 25th anniversary of the Executive War College, we are pulling out all the stops to put on the biggest and best conference on lab and pathology management that the nation has seen. There will be more than 125 speakers and 90 sessions, along with our always-popular two-roundtables for Lab CFOs, Academic Pathology, Lab CIOs, and Lab Quality/Compliance Managers.
Most importantly for you, this year’s Executive War College may be the most important lab management meeting you attend in 2020, because there is no other place that puts you face-to-face with experts in every aspect of clinical laboratories and anatomic pathology group management, while—at the same time—giving you unparalleled networking with the lab profession’s innovators.
This is the best investment you can make in both your professional management career and the successful operation of your laboratory.
Register today at https://dark.regfox.com/executive-war-college-2020 to reserve your seat and save $200 off regular registration rates, but act now while it’s fresh on your mind as these super-early-bird savings end January 31.
—M.A.McBride
Related Information:
25th anniversary Executive War College on Lab and Pathology Management
Post-Acute Care Cheat Sheet: Integrated Delivery Networks
Big Mergers Dominate Healthcare Headlines
