Strong opposition from organized medicine pushed UnitedHealthcare (UHC) to put on hold an expansion of its Laboratory Benefit Management Program, which would have been extended to fully insured commercial plan patients in Texas effective March 1.
TMA and the Texas Society of Pathologists (TSP) received confirmation of UHC's decision in January after meeting with UHC in December. According to the UHC website, the program aimed to "improve the quality of outpatient laboratory services, support evidence-based guidelines for patient care, and lower costs" for UHC members. TMA, TSP, and 20 Texas medical specialty societies have serious reservations about the program.
In a Feb. 6 letter to Texas legislators, TSP President Tim Allen, MD, JD, and 20 Texas medical specialty societies say the "program will add new incremental costs to every patient treated by Texas physicians," adding a call for lawmakers to "prevent or delay implementation of this inappropriate program."
The program began and is still running in Florida in collaboration with Beacon Laboratory Benefit Solutions (BeaconLBS), a subsidiary of LabCorp, which specializes in laboratory management services. All outpatient lab services for patients who are part of the program are subject to new requirements, including advance notification and medical policies. Ordering and rendering physicians use BeaconLBS Physician Decision Support (PDS) technology for lab services, which UHC made available Jan. 1 to physicians in its Texas networks.
These physicians continue to have access to the PDS tool, and UHC encourages them to use it when ordering Decision Support Tests, but it is not required. UHC says the PDS tool technology makes it easier to choose the right tests and labs for patients based on evidence-based guidelines and industry best practices. To register, visit BeaconLBS.com, and select Physician Login.
When the program first rolled out as a pilot in Florida, Texas was also going to be a pilot state. TMA fought to get Texas removed from that original pilot program and discussed the issue regularly in meetings with UHC officials. TMA staff will continue to discuss the association's concerns about the impact of the program on ordering physicians and pathologists and will work with TSP and the other specialty societies to make UHC aware of the concerns.
TMA agrees with TSP physician members' concerns about UHC's program. They worry it:
- Creates a new administrative burden for the referring physician;
- Takes away physicians' right to choose a consultant (pathologist or laboratory);
- Creates "network within network" steerage based solely on payment;
- May deny payments to contracted physicians who present a "clean claim" for reasons outside their control; and
- Starts medicine down a slippery slope: If they can do this to one specialty, they can do this to all specialties.
TSP Immediate Past President Kevin Homer, MD, notified specialty society members in a Nov. 14, 2016, letter that the organization was gathering information about BeaconLBS, including a phone meeting with key UHC representatives, BeaconLBS, and LabCorp. Additionally, in communication with the Florida Society of Pathologists, Dr. Homer wrote that TSP learned referring physicians in Florida "are commonly non-compliant with BeaconLBS, and that laboratories are simply not being paid for testing performed on UHC patients in those cases. UHC has not provided detailed data regarding Beacon's success in achieving its quality, utilization, or physician experience goals."
Dr. Homer added: "Cost alone should never drive health care choices independently of quality. While UHC claims the Beacon program is beneficial, TSP believes it ignores the negative consequences that BeaconLBS will have on patients, doctors, and quality of care. We believe that the fundamental right of a physician to choose the most appropriate laboratory for his or her patients results in better outcomes for patient care, test quality, and total cost of care."
Talking points UHC recently shared with TSP state that UHC "is committed to supporting physicians as we implement the Laboratory Benefit Management Program in Texas. We will continue to work with physicians by providing access to the Lab Physician Decision Support tool while delaying claim denials associated with the Texas program initially communicated to begin March 1, 2017." UHC indicated the delay gives the insurer "time to make further refinements to the program based on data, experience, and feedback from Texas care providers. We encourage you to leverage the Physician Decision Support tool now to help you gain familiarity with the process and to enhance coordination when ordering tests."
Action, Feb. 15, 2017