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.)
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Dec 14, 2015 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Example is a big data-based study involving Optum and Mayo Clinic that indicates diabetes management can be too aggressive for some patients
Mayo Clinic has tapped Optum Labs’ huge data set to fuel research suggesting diabetes management can be too aggressive among those diabetics who don’t have problems controlling their glucose level. Optum Labs’ data is also being mined to investigate dozens of research initiatives, including a major fight against Alzheimer’s disease. These projects provide a glimpse into the growing role of big data in healthcare.
Because more than 70% of a typical patient’s permanent medical record consists of clinical laboratory test data, pathologists and medical laboratory scientists have a stake in the growth of big-data analytics, which are a core component in healthcare’s journey toward personalized medicine. (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 7, 2015 | Compliance, Legal, and Malpractice, Digital Pathology, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
Pathologists and clinical laboratories could help reduce error rate through greater collaboration with providers
Expect the topic of diagnostic mistakes to get more media attention in coming years. That is consistent with the efforts of healthcare policymakers to improve patient safety while making it easier for consumers to access information about the quality and cost when selecting hospitals, physicians, and medical laboratories.
One opening salvo in this campaign is a new report from the Institute of Medicine (IOM) titled “Improving Diagnosis in Health Care.” It concludes that Americans will receive at least one wrong or late diagnosis in their lifetime. The rate of diagnostic errors is a patient-safety issue in which pathologists and clinical laboratories could play an important role in reducing.
Pathologists often know which physicians in their community routinely order inappropriate or wrong tests for patients. That is why pathologists could be instrumental in reducing diagnostic errors through better communication with providers to ensure doctors not only order the correct clinical laboratory tests, but also select the appropriate therapies based on test results. (more…)
