| R. Lewis Dark:
New Jersey Suspends UnitedHealth's Fines for Docs
THERE’S AN INTERESTING TWIST IN THE ONGOING KERFUFFLE between Quest
Diagnostics Incorporated and Laboratory Corporation of America over the
UnitedHealth Group business. Last Friday, news spilled out that the New Jersey
Department of Banking and Insurance had asked the insurer to suspend its
plans to fine doctors who continue to refer UnitedHealth patients to Quest
Diagnostics for their laboratory tests.
The department issued a statement to explain that it was “not satisfied
with the legality of these protocols.” UnitedHealth spokesperson Tyler
Mason acknowledged that his firm would comply with the voluntary suspension,
also noting it was temporary and his company expected the department’s
review would likely prove favorable to UnitedHealth.
I invite you to read these tea leaves with me.What is the story behind this
story? Government regulators generally take these types of actions for one of
three reasons. Either, 1) there is a clear and obvious violation of law that cannot
be ignored; or, 2) there is great public relations to be gained by “protecting
the public interest”; or, 3) influential, powerful interests are pressuring
the regulators to act. This latter can include public outcry that reaches an
intensity which impels regulators to action.
I believe we can ignore the first two scenarios involving clear violation of
the law and acting for public relations value. I’ll bet that some volume of formal
complaints filed with the Department of Banking and Insurance created
enough pressure for its regulators to publicly request that UnitedHealth suspend
its plans to fine physicians $50 anytime they refer a patient outside the
laboratory provider network.
This pressure could include not just complaints from physicians and
patients, but also pointed requests for action by large employers in New
Jersey, as well as state legislators. Also, don’t overlook the fact that Quest
Diagnostics employs a large number of people in New Jersey. It has a motive
to marshall its supporters to act in ways that can help it deal with its exclusion
from UnitedHealth’s national contract. What is true about this latest
development is that a large number of physicians and employers are now
thinking about the upsides and downsides of exclusionary provider networks
versus “any willing provider” arrangements. Wouldn’t it be ironic if
one consequence of this UnitedHealth contract is that it triggers a
groundswell of support for open provider networks?
Aetna Says: LabCorp Is Out & Quest Diagnostics Is In
Effective July 1, 2007, Quest becomes
the only national laboratory in Aetna’s network
CEO SUMMARY: January 1, 2007 can be considered the
start of a new epoch in managed care contracting for lab test
services. News of Aetna’s decision to favor Quest Diagnostics
Incorporated with a five-year contract as its only national laboratory
provider shows the direction this new epoch is apt to
take. Eventually it may become increasingly more difficult for
regional laboratories to renew contracts on favorable terms.
Mobile Pathology Service Fuels Increased Revenue
Mobile anatomic pathology laboratory allows
pathologists to deliver real time diagnoses
CEO SUMMARY: When pathologist Raman Sukumar, M.D.
founded a generalist pathology practice in 2003, he was convinced
that local doctors would support his vision of pathology
at the point of care. That vision was validated by rapid acceptance
of his mobile pathology laboratory and a steady flow of
new specimens. Doctors Pathology Services now employs 30
people and has enough work to support 3.5 FTE pathologists.
Pumping Up Performance Of Lab Billing & Collections
IMPROVING MANAGEMENT OF THE LAB REVENUE CYCLE
CEO SUMMARY: Coding, billing, collections,
and compliance continue to grow in complexity,
making management of the lab’s revenue cycle
ever more difficult. One by one, a number of the
nation’s largest laboratories are taking steps to
automate management of their revenue cycle by
utilizing “Software as a Service” (SaaS). Intrigued
by this new market trend, THE DARK REPORT spoke
with Lâle White, the entrepreneur who is behind
this new approach to AR management.
Siemens Executive Speaks On Integration Strategies
First presentation to laboratory audience reveals plans for in vivo and in vitro testing
CEO SUMMARY: Siemens has a vision of tight integration
of in vitro and in vivo diagnostics with informatics to support a
single goal with two themes: enhancing work flow in healthcare.
Theme one is that these technologies can support better
productivity of clinical, operational and administrative
processes. Theme two is the advancement of “knowledge
medicine” to improve health outcomes.
New Rules to Boost
Cancer Test Accuracy
Breaking new ground, oncodiagnostics are
changing how pathologists test for breast cancer
CEO SUMMARY: Recent developments in breast cancer
testing are leading to changes in pathology. Oncologists and
pathologists have issued new guidelines regarding HER2 testing
and new research suggests changes may be coming for
estrogen-receptor testing as well. For the first time, the new
guidelines require a certain level of testing and new procedures
for pre-analytical processing.
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