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R. Lewis Dark: Medicare To Publish Its Fees on the Web
IN A FEW WEEKS, the Centers for Medicare and Medicaid Services (CMS)
will publish its reimbursement prices for common procedures on its Web site
at www.medicare.gov. The objective is to allow consumers to see the fees
Medicare currently pays to hospitals and physicians and allow uninsured
patients to negotiate comparable discounts for services provided to them.
This is not the only step that federal healthcare officials will take to
make the prices they pay for healthcare services accessible to the public.
Within a few months, federal Web sites will publish the negotiated prices
for healthcare services provided to the Department of Defense, the
Federal Employees Health Benefits Program, and private health plans
in six communities.
These actions have a common goal: to create transparency in the discounted
prices federal agencies pay for healthcare and to allow consumers
to use this information to make informed decisions about their
care. Health and Human Services (HHS) Secretary Mark Leavitt has
dubbed this initiative"payer power." During the next couple of years, his
agency plans to require hospitals to publicly report data on mortality
and outcomes on a variety of diseases, ranging from heart attacks to
infection. It is expected that consumers, including senior citizens, will
use price and outcomes data to shop hospitals and physicians in advance
of elective surgeries and other procedures.
I hope most of you grasp the implications of this development. Federal
healthcare officials are irrevocably moving the American healthcare system
towards a"consumer first" environment. As Leavitt told the press, the
immediate goal is to give patients the same full range of information available
to them as when they go out to buy a car or a refrigerator.
Consumer-directed health plans give patients a powerful economic
motive to know all the costs of their care–and negotiate discounts in advance
of elective services. In my view, as the federal government puts healthcare
prices paid by Medicare, the Department of Defense and the Federal
Employees Health Benefits Program into the public domain, it won't be long
before labs and pathology groups get these types of phone calls from customers.
For this reason, it is timely and smart for laboratories to develop policies
and procedures to meet the needs of price-shopping consumers.
CMS Defers MUE Edits Until After Jan. 1, 2007
Implementation date of July 1, 2006 changed,
No action to occur before January 1, 2007
CEO SUMMARY: Medicare officials have granted a temporary respite on the troubling proposal to institute service
restrictions per patient on some 80 pathology CPT codes
and 1,100 clinical laboratory codes. These proposals are
part of a new round of Medically Unbelievable Edits (MUEs).
CMS has yet to answer questions about the rationale and
motive behind these proposed edits.
Geisinger's Coag Clinics
Located in Docs' Offices
In-office coagulation clinics provide
lab tests and consultations in 30 minutes
CEO SUMMARY: It was six years ago when Geisinger Health System pushed laboratory testing and pharmacy services
closer to the patients and referring physicians. By establishing
coagulation clinics in six multi-specialty clinic sites, Geisinger
has allowed pharmacists to use point-of-care testing to provide
coag consults, therapy, and patient counseling in real
time–often in as little as 30 minutes from a physician's order.
Christian Hospital Laboratory Goes Lean with Solid Results
Used in Phlebotomy and Chemistry
CEO SUMMARY: As part of a major restructuring
program under way at Christian Hospital in St.
Louis, Laboratory Administrator Bette J. Stanley
decided to apply Lean quality management methods
in projects to improve work processes in phlebotomy
and the chemistry department. Using internal
quality consultants from the parent health system,
the laboratory staff applied Lean methods and
significantly reduced average lab test turnaround
time while posting major gains in productivity.
Middleware Is Hot Topic
At LabinfoTech Meeting
Labs are pushing for middleware solutions
to support a variety of management objectives
CEO SUMMARY: Middleware is a growing component in the market for laboratory information services. Labs are asking
vendors to provide targeted software solutions to address a
growing list of needs and functions. To fill this demand, specialty
software companies and IVD firms are introducing new
middleware products. It remains unclear whether traditional LIS
vendors will compete vigorously with their own middleware.
INTELLIGENCE:
VIRUS DISCOVERED IN
SOME PATIENTS WITH
PROSTATE CANCER
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