How Healthcare Reform will affect the laboratory

Get new comments by email
You can cancel email alerts at anytime.
Comments (12)

CLS48 in California

57 months ago

community.advanceweb.com/blogs/al_3/archive/2010/03/29/what-does-healthcare-reform-mean-for-the-lab.aspx

"With the recent passage of the healthcare reform bill, many of us are wondering if reform is really possible. I hope it is. Those of us on the inside are hopeful but skeptical. We know that healthcare is fraught with problems and issues. The internal players have been patching it up, putting on bandages and sending it back out to play for what seems like an eternity. Is the current plan what we really need? We will likely have to take the "wait and see" approach to really know for sure, but in the interim, how will this impact those of us in the field?

I'm not much for "wait and see," so I asked Mary Ann McLane, PhD, current president of the ASCLS, to look in her crystal ball and give me her take on this new state of affairs. Here are some of her thoughts:

1. "One of the biggest impacts on the laboratory will be the increased numbers of Americans who will now have health insurance." Many of these individuals have been without insurance for variable amounts of time. This newly found insurance will allow these individuals access to routine types of healthcare, including lab tests, that were previously inaccessible. Hence, more work for the laboratory.

2."Increased access is good news/bad news for us." This will bring in increased revenue for the lab and consequently our hospitals/clinics, etc.

3. "For Medicare patients, these reimbursements are still only at 75% of levels they were in the 1980s." The bill did nothing to correct the level of Medicare reimbursement. Consequently, since private insurance follows Medicare, we will still be reimbursed at low rates for doing more work--no improvements or increases in reimbursement..."

- Was this comment helpful? Yes (2) / No (3) Reply - Report abuse

CLS48 in California

57 months ago

"4. "This increased testing has to be done with either the same number of lab professionals, or even more scary, a much smaller number as our CLS/CLT programs close and baby boomers (with all their years of experience) retire within the next 5-10 years." We've already been worrying about staffing shortages--reform may compound the problem for the clinical lab.

So, looking at Dr. McLane's thoughts on this bill, what should we be doing as laboratory professionals? We should be getting on our soap boxes and being heard. We as laboratory professionals have never been vocal enough. We have done more with less and many of us have "put up and shut up." Yikes! We can no longer do this. We have to continue to (in Dr. McLane's words) "provide the face of the lab profession to the general public and our legislators." We need to be certain that "our role in this healthcare reform becomes widely known and a recognized concern for the powers that be."

Personally, I am concerned (as I have been for some time) that doing more with less and "putting up and shutting up" will not only be our demise, but also the demise of the patient due to lack of staff to provide sufficient laboratory testing. We need to bring in Generation Y'ers and keep them with us as colleagues. We need to groom them to run the laboratory and we need to convince everyone all the way up to President Obama that we are primary players in healthcare and that we are VITAL."

- Was this comment helpful? Yes (1) / No (1) Reply - Report abuse

CLS48 in California

57 months ago

laboratory-manager.advanceweb.com/Web-Extras/Online-Extras/Pared-down-Points.aspx

"Now that the historic Healthcare Reform Bill is passed, many in the field of laboratory medicine may be quietly cheering that greater numbers of insured Americans will need ever more lab testing, but one association official suggests holding the applause until everyone reads the fine print.

"I don't know that there's gonna be this great bonanza, this overall windfall," says Vince Stine, director of Government Affairs for the American Association for Clinical Chemistry.

On March 23, President Barack Obama signed into law the Healthcare Reform Bill to extend health insurance coverage to 32 million uninsured Americans. The House had approved the $940 billion bill two days earlier, and the Senate passed a slightly altered "fixes" version on March 25. The legislation in totality is intended to cover nearly all Americans, crack down on insurance industry abuse and reduce federal deficits by about $143 billion over a decade.

The good news: An increase in the number of insured Americans is expected to translate to an increase in overall laboratory testing since lab services will be part of any minimum package insurers will be required to offer. And the bill's emphasis on preventive testing may also lead to more cholesterol and diabetes testing. But any positive effects may take time to realize since many provisions are being phased in or don't start until 2014. And enthusiasm about a run on testing should be measured when considering that clinical labs face two consumer price index (CPI) cuts to offset new expenses in the bill.

"You may see some uptake in testing, but we're paying for it in another way," Stine says.

Finer Points"

- Was this comment helpful? Yes (3) / No (1) Reply - Report abuse

CLS48 in California

57 months ago

"The first CPI cut that will be felt by clinical labs is a permanent "productivity factor" reduction of between 1.1-1.4% that will be calculated every year from hereon out. On top of that, laboratorians face a 1.75% cut in each of the next five years for a total of $10 billion over ten years.

"Recognizing that everyone was going to take a hit, $10 billion in Medicare cuts seems excessive given the size of our sector," Stine says, speaking in his official capacity with AACC.

The bill emphasizes comparative effectiveness research (CER), an evidence-based approach to help healthcare professionals evaluate what tests are most appropriate for specific health conditions and subpopulations and evaluate treatment options. However, the Senate amended an earlier draft of the bill to create a private-public entity to oversee the research despite the fact that the Agency for Healthcare Research and Quality (AHRQ) has been the lead federal agency conducting the research over the last decade.

AACC leaders had been pleased with the job the AHRQ has been doing, and Stine says, "It was our preference that they continue to go down that path."

A controversial provision that would have required the Secretary of the U.S. Department of Health and Human Services to convene a public meeting to discuss alternative payment systems for new clinical lab tests and make recommendations to Congress does not appear to have been included in the final version of the bill, Stine says. The underlying reason for the provision was to find a way to pay for increasing molecular tests. While some in the lab sector favored a new fee schedule that might provide higher reimbursements, others worried the changes could result in cuts to non-molecular tests."

- Was this comment helpful? Yes (1) / No (1) Reply - Report abuse

CLS48 in California

57 months ago

"One other controversial proposed change to the Medicare 14-day rule involving who could directly bill Medicare for certain genetic tests as part of a two-year trial period was included in the final bill but amended to make it more tolerable to hospitals. The initial proposal would have tweaked the rule in such a way that hospitals could not directly bill Medicare for certain esoteric genetic tests within 14 days of a hospital discharge, forcing them to pay out of their diagnosis-related group (DRG) payment, although independent clinical labs would have been allowed to do so if certain conditions were met.

"The final package said either one can bill directly to Medicare," Stine says. "Initially, the two-year demonstration was going to be funded by an across-the-board cut in laboratory payments. This concerned many laboratorians since it meant paying more for very specific types of tests that probably very few labs would be able to perform, but yet cutting everybody's reimbursement to pay for it. This idea that you cut one lab to pay for another lab wasn't sitting very well with people."

The money to pay for the rule change-amounting to $100 million over two years-will come from the Medicare trust fund, Stine says. He understands the new rule will take effect in 2011. After the two-year period, Congress will receive a report on any resulting impacts to access and quality relative to the tests and whether to continue the rule change.

With the President's focus in the bill on targeting fraud and abuse, Stine cautions clinical labs to stay vigilant about preventing these problems and alert to any official actions concerning this initiative since clinical labs already faced two CPI cuts and could be a target of future investigations."

- Was this comment helpful? Yes / No (1) Reply - Report abuse

CLS48 in California

57 months ago

www.stockbloghub.com/2010/04/01/dgx-why-healthcare-reform-should-help-the-diagnostics-industry/32633

"The Booming Diagnostics Industry: A $1 Billion Market and 25% Annual Earnings Growth

As a result, the diagnostics industry should boom…

Let’s take the two dominant players in the diagnostics field – Quest Diagnostics (NYSE: DGX) and Laboratory Corp. of America (NYSE: LH).

Combined, they generate over $12 billion in revenue and offer services ranging from routine bloodwork to molecular genetics and cancer detection.

In fact, molecular diagnostics is expected grow 19% per year to become a $7 billion a year industry by 2011. Oncology and genetic testing is expected to fuel the growth."

- Was this comment helpful? Yes / No (1) Reply - Report abuse

mellowyellow in Long Beach, California

56 months ago

Hi CLS48,

I am interested in pursuing a career as a Clinical Laboratory Scientist as well. You seem very informed and up-to-date on the career. Would you please give a picture of a typical day for you at work? I have recently been exposed to this field so I do not know much. However, I do enjoy science especially lab so this career seems ideal since I would be using my science background to help doctors make diagnoses on their patients. I plan to volunteer in a lab to find out more. Do you know of any labs that would take up volunteers? Thank you in advance.

- Was this comment helpful? Yes / No Reply - Report abuse

CLS48 in California

56 months ago

A typical day depends on which department I work in since I'm a generalist. For example, if I'm in hematology, a typical day is as follows. I check the QC on the instruments making sure the lab assistants performed maintenance on the cell counters and that the QC is all ok. I then release some leftover CBCs and auto diffs in the computer. I run and release coag specimens. I run a few manual ESRs and peform some slide reviews on CBCs that needed manual diffs releasing criticals and notifying client services to call criticals as appropriate. I then do some UA microscopics and manuals when needed.

That day differs if I'm in chemistry or immunology. As far as volunteering, I don't think anyone allows that or haven't seen it. Since you're from Long Beach, I'd recommend the Cal St. Dominguez hills CLS program. If you have your bachelors already, check the UCI 1 year CLS program which is only an internship but is competitive. Your last option I think is the Loma Linda 2 year program. It's an excellent program but costs almost 60k now so you'll be in debt with student loans from it.

- Was this comment helpful? Yes / No (1) Reply - Report abuse

CLS48 in California

56 months ago

www.genomeweb.com/blog/clinical-labs-face-reimbursement-cuts-under-obamacare

"The [clinical] laboratory, like all other segments of health care, is going to have to take some cuts in reimbursement to pay for healthcare reform, but we need to be sure we have input as to how they are applied," according to a recent ASCLS e-mail.

The April e-mail from the ASCLS' Government Affair Committee said that "[f]or the [clinical] laboratory community, the Bill includes an across-the-board clinical laboratory fee schedule cut of 1.75 percent for 5 years, scheduled to begin in 2011," according to an Advance blog post on Saturday.

Meantime, the Senate bill "includes a 'productivity adjustment' to the annual CPI update for labs which replaces the 0.5 percent reduction to updates implemented just last year," Advance reports. "The productivity adjustment would reduce the laboratory fee schedule further."

- Was this comment helpful? Yes / No (2) Reply - Report abuse

CLS48 in California

56 months ago

www.darkreport.com/dark/current.htm

"2.3% Medical Device Tax Hits Clinical Labs in 2013

Newly-enacted health reform bill requires medical device companies to pay excise tax

CEO SUMMARY: One aspect of the massive new health bill is that medical device companies will pay a 2.3% tax, effective January 1, 2013. Students of economics know that it is customers who invariably end up paying such direct taxes. Thus, clinical laboratories in the United States should prepare to see this 2.3% tax show up as a line item on sales contracts and in the form of higher prices for in vitro diagnostics analyzers, lab equipment, reagents, consumables, and even medical software."

- Was this comment helpful? Yes (1) / No (1) Reply - Report abuse

Tim S. in Chicago, Illinois

56 months ago

Possible with upcoming elections (2010 + 2012) that a lot of things in the bill can be repealed by republican lawmakers. Even the best experts can only speculate what the long term ramifications will be.

- Was this comment helpful? Yes / No (1) Reply - Report abuse

Angrywolf in Jackson, Tennessee

56 months ago

Won't happen
The repubs are just talking out of their hats..to get their base excited.
But it won't happen.Maybe be mdofied to cost less but that's it.
The repubs won't get enough seats and Obama would veto any repeal.
So you need to be realistic about this.

I doubt this will affect med techs in any way anyway.So it's a red herring as far as we are concerned.

- Was this comment helpful? Yes (1) / No (1) Reply - Report abuse

» Sign in or create an account to comment on this topic.