The Affordable Care Act: Glass Half Full for Clinical Laboratories

Changes in healthcare resulting from the Affordable Care Act (ACA) are unavoidable. Regardless of what these changes might mean for your business, it is important to stay positive and look for the silver lining. Not all change is bad and the long term goal of healthcare reform is to increase access to insurance and quality of care.

What Does this Mean for Laboratories?

Clinical laboratories are waiting for proposed changes to the Clinical Laboratory Fee Schedule (CLFS), which will likely decrease reimbursements payments for lab tests. The future of small independent labs may heavily rely on reimbursement changes. While these changes may be a potential barrier for running a successful clinical laboratory, there are some opportunities that will open up as a result of the ACA that the industry will see as a whole.

1.       Uncompensated Care

The ACA will expand health insurance based on a variety of measures like increased eligibility and by requiring individuals to purchase health insurance through the private sector or Medicaid. This expansion will increase access to coverage, giving those who were once uninsured the support they need to seek out care. Beyond expanding access to insurance, the goal of the ACA is to increase quality of care and efficiency throughout the healthcare industry. Currently, laboratory services rendered for uninsured patients result in uncompensated care. Having insurance helps to overcome this issue, but the industry is still curious as to what reimbursements will amount to over the next ten years. Regardless, the ACA will result in more patients with coverage and less patients whose testing might result in a total loss. Building efficient processes in billing management might be the key to overcoming uncompensated services.

2.       Bridge the Patient-Provider Gap

Access to insurance will increase the demand for care. Laboratories now have the opportunity to fill the gap between primary care givers and patients. With an increase of individuals with access to insurance – access to care becomes more competitive for patients. Laboratories have an opportunity to bridge this gap and work directly with patients for relaying and understanding lab results.

3.       Ignite Collaboration with the Pharmaceutical Industry

A major opportunity for industry progress is in cross-sector collaboration.  Across the healthcare industry, the ACA has spurred a need to decrease costs and increase efficiency. Collaboration is vital for unique problem solving with diverse teams of leadership and can increase the quantity and breadth of data to help make smart healthcare decisions. Collaboration between laboratories and pharmaceutical companies will help identify types of drugs needed and optimal dosage when prescribing. Advanced diagnostics testing by labs is a key component for determining course of treatment. Molecular testing can even help determine whether a patient will respond to treatments before they are even prescribed. When new drugs are released to the market there are diagnostic tests to monitor dose, toxicity, and effectiveness. Collaboration will increase efficiency in treatment plans while opening communication among pharmaceuticals companies, clinical laboratories, and providers.

Changes starting in 2014 will surely shake the healthcare industry today. The way laboratories approach change will deeply impact their ability to succeed. Embrace change, look for opportunities and think long-term. Contact Colaborate today and see how you can embrace change and prepare for these changes.

By Kevin Hunter