Dec 21, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Health plans increasingly refuse to pay out-of-network providers who they claim often inflate their charges, leaving patients with unexpected medical bills
As health insurers narrow their provider networks in an effort to lower costs and hold down premiums, clinical laboratories and anatomic pathology groups may increasingly be designated as out-of-network providers and find themselves struggling to get paid.
This is particularly true in cases where a hospital is in-network and its hospital-based physicians—including its pathologists—are out-of-network for that same insurer. Following their discharge from the hospital and their insurer’s payment of the hospital bills, patients are surprised to get bills from the hospital-based physicians.
It is a problem that won’t go away soon. That’s because it is increasingly common for patients who are being treated in an in-network hospital to unknowingly receive care from out-of-network doctors, such as pathologists, anesthesiologists, emergency physicians, hospitalists and radiologists, who may not participate in the same plan networks as the hospital does. (more…)
Dec 18, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
AJMC study shows ACOs that allocate majority of shared savings to primary care providers are more likely to generate savings
When it came time to pay bonuses to Medicare’s Pioneer ACOs and Shared Savings Program (MSSP) ACOs based on 2014 results, a substantial proportion of the payments went to primary care physicians compared to hospitals and specialist physicians. Significantly, only a minority of these ACOs qualified for bonus payments.
Pathologists and clinical laboratory managers watching the growth of ACOs will find it notable that primary care doctors received 46% of the shared-savings bonuses in the program’s first two years. Hospitals received 27% of the incentives while 20% went to specialists, according to a Modern Healthcare report.
High Expectations That ACOs Can Help Control Healthcare Costs
Twenty Pioneer ACOs and 333 Medicare’s Shared Savings Program (MSSP) ACOs combined to produce more than $411 million in total savings in 2014, although only 29% of the organizations generated enough savings to earn a bonus, a CMS Fact Sheet indicated.
“These results show that accountable care organizations as a group are on the path towards transforming how care is provided,” stated CMS Acting Administrator Andy Slavitt in a statement. “Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending.” (more…)
Dec 16, 2015 | Coding, Billing, and Collections, Digital Pathology, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations, Uncategorized
Transition to value-based reimbursement tops Insigniam’s list of factors altering healthcare landscape
Management consulting firm Insigniam recently identified “10 Disruptive Forces in Healthcare”. Several of these development create significant implications for clinical laboratories and anatomic pathology groups that are navigating today’s rapidly-changing healthcare landscape.
ACA and Aging Population Reshaping Healthcare
“I have been doing healthcare for 33 years at this point. And there has been more change in the last three [years] than at any time, and it’s by a long shot,” declared Donald Casey, Jr., Chief Executive Officer of the Medical Segment of Cardinal Health in Ohio. He was quoted by Insigniam Quarterly.
Donald Casey, Jr., Chief Executive Officer of the Medical Segment of Ohio-based Cardinal Health, has firsthand experience responding to the fundamental changes taking place in healthcare today. Casey points to the Affordable Care Act (ACA) and an aging population as the two drivers behind what is a fundamental reshaping of American healthcare. (Photo copyright: Cardinal Health.)
(more…)
Dec 9, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Medical laboratories can get ahead of the trend by developing processes for serving younger healthcare consumers in different ways
Experts say that Millennials are rewriting the rules of healthcare. Rather than following in baby boomers’ footsteps, this new generation of young adults shops for healthcare in ways that may change the provider-patient relationship for all providers, including pathologists and medical laboratories.
Also known as Gen Y, this generation interacts with healthcare providers differently than earlier generations in at least three basic ways:
- When seeking medical advice, they first turn to websites;
- They prefer to ask friends for physician referrals; and,
- They are not shy about requesting discounts from providers to cut their medical costs.
Different Approaches to Choosing Doctors and Communicating Concerns
A recent survey by Nuance Communications showed how baby boomers and millennials are taking different approaches to their healthcare. It starts with how they choose their primary care physician. (more…)
Dec 4, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Yet financial pressures on insurers continue to increase premiums and potentially squeeze reimbursement rates for clinical laboratories and pathology groups
Walmart shoppers expect to find low prices on the retailer’s shelves, but the discounter’s full-time employees may be surprised to learn their company healthcare plan is also a low-cost leader. This is a significant finding and is significant for pathologists and clinical lab managers because the Walmart health benefit plan includes an expanded provider network, at a premium that is about half of the subsidized rate for a comparable health plan at Healthcare.gov.
A Washington Examiner analysis comparing Walmart’s employee health insurance program with Obamacare—more formerly referred to as the Patient Protection and Affordable Care Act (PPACA) or simply the Affordable Care Act (ACA)—found that “Walmart’s plan is more affordable and provides significantly better access to high-quality medical care than Obamacare.”
The report also noted that Walmart’s participation in a national healthcare network means employees typically choose from a list of participating providers and high-profile hospitals that dwarfs the number of options on Obamacare exchanges. (more…)
Nov 6, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Pathology
Nation’s largest gathering of clinical laboratory Lean, Six Sigma, and process improvement practitioners took place in New Orleans this week
DATELINE: NEW ORLEANS, LOUISIANA—More than 300 of the nation’s leading quality improvement practitioners in clinical laboratory operations came together this week to share, learn, and master the best approaches to improving the quality of medical laboratory operations in ways that improve performance and productivity even while delivering substantial reductions in cost.
The opening session of the Ninth Annual Laboratory Quality Confab featured three clinical laboratories that have aggressively used quality management methods, including Lean and Six Sigma. These are labs that are strategically committed to creating and sustaining a culture of quality and continuous process improvement. (more…)
