UHC does an Anthem move starting in Texas

[AZpath]

UNITED HEALTHCARE EXERTS DOWNWARD PRESSURE ON LAB REIMBURSEMENT
Over the past month and a half, United Healthcare (UHC) has sent letters to some Texas pathology groups that are strikingly similar to those published by Anthem last year. UHC is notifying selective pathology practices of a new, reduced fee or price schedule. While the Anthem cuts have been implemented across the country, UHC’s new pricing schedule hasn’t been widely identified. However, concerns are growing that this update may be in step with the drastic cuts made by Anthem last year. Some Anthem cuts were up to 70% lower than previous fee schedules.
UHC is the largest private insurer in the country, followed by Anthem.
Attempts to stave off the drastic Anthem cuts were ineffective with some practices going out-of-network by cancelling their contract ties. It appears there may be room for negotiations with UHC to achieve reasonable rates, but this remains to be seen.
Balance billing legislation has opened the door, in many cases, to these reduction of fees. It encourages payors to avoid negotiating favorable provider rates while limiting what a provider can expect from patient balances. Balance billing can happen when patients utilize out-of-network labs.
In addition, UHC has launched a Preferred Lab Network to help encourage acceptance of reduced fees. Patients may still use labs that are not part of UHC’s network but patients that do use UHC’s preferred network see either reduced balances or no out-of-pocket expenses.

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[Thr0mbus]

PATHOLOGY IS A BIG DUMPSTER FIRE THANKS TO THE INEPT ACADEMICS WHO FLOOD THE FIELD WITH NINCOMPOOPS AND SCREW US OVER.

WE HAVE NO LEVERAGE.

FLEE PATHOLOGY NOW!!

 

[Alteran]

Pathology and family medicine are the two fields with the lowest average board scores.

I don’t know offhand about the board scores, but they are the two most uncompetitive specialties in medicine for sure. Except one is seeing it’s reimbursement go up and the other go down by 9% because it’s having its funds diverted to the other. Want to guess which one is getting shafted?

 

[KeratinPearls]

Low barrier to entry is never good.

 

[Alteran]

The US senior and FMG step one score distributions are basically mirror images of each other. I do find it rather disturbing that DO students with bottom quartile COMLEX scores are so highly represented. Would it be too much of a stretch to say that virtually any US medical senior can get into pathology and the remaining slots are preferentially filled in with the bottom quartile DO cohort and then IMGs whose scores are equivalent to US seniors? And if I do my math correctly, of the US medical graduates (MD and DO) almost a quarter are DO who appear to be in the bottom quartile of their cohort- and that number is going up year after year.

 

[Allegri]

Magic Man/Thrombus, you need to re-direct your ire away from academics. Academics is incentivized to train. That is part of its mission. It is not the mission of academics to manage the market. That is the role of our state and national societies.

 

[Alteran]

Magic Man/Thrombus, you need to re-direct your ire away from academics. Academics is incentivized to train. That is part of its mission. It is not the mission of academics to manage the market. That is the role of our state and national societies.

I don't see how you can have the state and national societies (USCAP, ASCP, CAP) regulate the market when so many of the society leadership positions are held by academic pathologists. Perhaps someone can educate me otherwise.

 

[Thr0mbus]

Magic Man/Thrombus, you need to re-direct your ire away from academics. Academics is incentivized to train. That is part of its mission. It is not the mission of academics to manage the market. That is the role of our state and national societies.

LMAO BIG ACADEMIA IS INCENTIVIZED TO GET FREE LABOR AND PUBLISH WHAT IS MOSTLY JIBBERISH BY THE TAXPAYER. Fixed it for you.

BIG NATIONAL PATHOLOGY SOCIETY IS INCENTIVIZED TO EXTORT WHATEVER THEY CAN OUT OF THE WORKING PATHOLOGIST AND LABORATORIAN AND TAXPAYER/PAYING HEALTHCARE CONSUMER

 

[SunBakedTrash]

Academic institutions will always accept the subsidized low-wage labor that is offered, and for the most part will not accept responsibility for the poorly-trained product it so often produces after 4-6 years of minimal responsibility or autonomy. The problem is the idea of this pathologist shortage that doesn’t and will never exist. Obviously it’s being perpetuated to the ACGME, otherwise they would shut down half the programs in this country and direct funds to specialty positions we actually need, like primary care.

Most of the reports of this pathologist shortage come from academic papers, which until very recently were being propagated as fact until the news came out that the data was all wrong and that they forgot to include 40% of the people in this field. For this, they deserve a portion of the blame for destroying this specialty. Hopefully this motivates ACGME to cut pathology funding by 40% at least.

Also a dishonorable mention to the American Board of Pathology, where competency is determined via 50 worthless autopsies and a bunch of poorly-written questions from the 1970s.

 

[Allegri]

It appears to me the shortage idea was propagated by CAP and their commissioned workforce studies until relatively recently, when a few questionable reports came out in the academic literature. And the "news" that came out about incorrect workforce data also came from an academic paper, so there's that. I just think if you're looking for academics to make their lives more difficult in order to improve the private practice market, you're not being realistic. It makes more sense to lay this at the feet of an organization whose raison d'etre is to advocate for the profession as a whole.

 

[y2k_free_radical]

It appears to me the shortage idea was propagated by CAP and their commissioned workforce studies until relatively recently, when a few questionable reports came out in the academic literature. And the "news" that came out about incorrect workforce data also came from an academic paper, so there's that. I just think if you're looking for academics to make their lives more difficult in order to improve the private practice market, you're not being realistic. It makes more sense to lay this at the feet of an organization whose raison d'etre is to advocate for the profession as a whole.

Who do you think controls these organizations ?????????????????HINT-it ain't community pathologists.P.S.-DR. ROBBOY is a nice guy who has practiced for over 55 years and is 79-he is just wrong in his conclusions.

 

[Allegri]

Big Academia controls CAP? Well, the current president seems more like a business than an academic guy, and so does the president-elect.

Dr. Robboy's conclusions that previously published numbers of pathologists are an undercount are wrong? Not sure what you're saying here. It seems to me he just published a very helpful paper to support the argument that there are too many pathologists.

Look I agree with reducing the number of trainees. But I think expecting academic departments to act contrary to their short term self-interest is not a winning strategy. We need to reduce the financial incentive.

 

[KeratinPearls]

Yes

Big Academia controls CAP? Well, the current president seems more like a business than an academic guy, and so does the president-elect.

Dr. Robboy's conclusions that previously published numbers of pathologists are an undercount are wrong? Not sure what you're saying here. It seems to me he just published a very helpful paper to support the argument that there are too many pathologists.

Look I agree with reducing the number of trainees. But I think expecting academic departments to act contrary to their short term self-interest is not a winning strategy. We need to reduce the financial incentive.

Godbey is head of SEPA. Dr Volk the incoming President is an academic. Yeah academics aren’t only to blame. Private practice folks will lowball you as well. Evil doesn’t only exist in academics.

 

[y2k_free_radical]

Big Academia controls CAP? Well, the current president seems more like a business than an academic guy, and so does the president-elect.

Dr. Robboy's conclusions that previously published numbers of pathologists are an undercount are wrong? Not sure what you're saying here. It seems to me he just published a very helpful paper to support the argument that there are too many pathologists.

Look I agree with reducing the number of trainees. But I think expecting academic departments to act contrary to their short term self-interest is not a winning strategy. We need to reduce the financial incentive.

Before his last paper,DR. ROBBOY was the loudest voice concerning the impending shortage of pathologists.DR. GODBEY is an ex OB-GYN professor,turned pathologist,turned big businessman who founded SEPA.SEPA had 45 or so pathologists actively competing in my area for business before joining PATH GROUP.Hardly a small community pathology group.

 

[Allegri]

It does seem like a problem if community pathology is underrepresented in CAP leadership. Maybe CAP should have some sort of quota for career diversity in the Board of Governors
And Emily Volk is not really an academic. Her LinkedIn page shows this trajectory:
JJ Humes and Associates -> William Beaumont Hospital ->Clinical Pathology Associates ->Baptist Health System ->Tenet Healthcare -> Senior VP of Clinical Operations, UTSA University Health System

One of her few papers is on "Cap Advocacy: the effort to preserve fair payment"
She may be receptive to the concerns of many posters here. You should send her an email!

 

[path24]

Been a problem for freaking decades lots of blame to go around.

No one (academics, CAP, program directors....etc) has been honest about the pathology job market. No honesty in a field for decades. Seriously.

The lying will continue and things will just get worse. There is some honesty for you.

 

[y2k_free_radical]

UNITED HEALTHCARE EXERTS DOWNWARD PRESSURE ON LAB REIMBURSEMENT
Over the past month and a half, United Healthcare (UHC) has sent letters to some Texas pathology groups that are strikingly similar to those published by Anthem last year. UHC is notifying selective pathology practices of a new, reduced fee or price schedule. While the Anthem cuts have been implemented across the country, UHC’s new pricing schedule hasn’t been widely identified. However, concerns are growing that this update may be in step with the drastic cuts made by Anthem last year. Some Anthem cuts were up to 70% lower than previous fee schedules.
UHC is the largest private insurer in the country, followed by Anthem.
Attempts to stave off the drastic Anthem cuts were ineffective with some practices going out-of-network by cancelling their contract ties. It appears there may be room for negotiations with UHC to achieve reasonable rates, but this remains to be seen.
Balance billing legislation has opened the door, in many cases, to these reduction of fees. It encourages payors to avoid negotiating favorable provider rates while limiting what a provider can expect from patient balances. Balance billing can happen when patients utilize out-of-network labs.
In addition, UHC has launched a Preferred Lab Network to help encourage acceptance of reduced fees. Patients may still use labs that are not part of UHC’s network but patients that do use UHC’s preferred network see either reduced balances or no out-of-pocket expenses.

Just received my new contract for UNITED in GA.Fee schedule 60% of medicare similar to BC-BS ANTHEM.I would like imput on how those not participating are faring.

 

[LADoc00]

Just received my new contract for UNITED in GA.Fee schedule 60% of medicare similar to BC-BS ANTHEM.I would like imput on how those not participating are faring.

why not just go non-par?

 

[y2k_free_radical]

why not just go non-par?

I know you will not understand,but when i don't participate the patients complain to those who biopsy and to the hospital administration causing stress in my relationship to the latter.GEORGIA also just passed a bill prohibiting balance billing.

 

[Dave CX]

I know you will not understand,but when i don't participate the patients complain to those who biopsy and to the hospital administration causing stress in my relationship to the latter.GEORGIA also just passed a bill prohibiting balance billing.

This is correct. Basically not an option for a hospital based group.

 

[WEBB PINKERTON]

We have went non-par in the past. It is very much an option.

 

[Alteran]

I know you will not understand,but when i don't participate the patients complain to those who biopsy and to the hospital administration causing stress in my relationship to the latter.GEORGIA also just passed a bill prohibiting balance billing.

I remember LADoc saying a while ago that administrators are loathe to replace pathology groups in hospitals, and that's been my experience as well. For all their bluster, you'd have to really go out of your way, as in personally and constantly insult and yell at the CEO, to get replaced as a group. So going non-par with an insurer isn't going to be that much an issue in the long run I think.

But I'm not familiar with Georgia's balance billing law. Does that mean that the insurer automatically cuts a check for a set rate of medicare to the patient which they then have to fork over to the biller or you don't get paid squat from anyone?