The problem is that many assays are break even at best under medicare rates (molecular etc..)..the medicare rates are illogical. (typical gov't run program)..some reimburse very well for simple, waived assays and some have horrible reimbursement(non profitable so why do it) for mod. or high complex. assays----my fear is if you as a business are left with only medicare rates..why would u stay in this business with increasing costs of running it (anyone running a small biz knows what I am talking about).....i'm afraid we might end up with a United States LAb like the US post office--imagine that!??..gotta wait a week or 2 for result that used to only take 24 hours..run by a bunch of gov't employees...worst case scenario...too many responses here from people who are not in the lab biz or any biz and don't understand the actual costs vs reimbursement for diag. testing.....
Assays are breaking even? According to what? The cost of testing Labcorp uses? Even when you include, in this “cost of testing,” everything from electricity to the flotsam of expenses from operational inefficiencies, Medicare still reimburses far more than a break even point. “Send out” molecular testing might not be profitable under any payor, but in-house molecular testing? Nah! Labcorp, Quest, Sonic and other national niche labs serve too many lives for this to ever happen.
Medicare rates are illogical, typical gov’t run program? Then, you must have to include ALL non-gove’t run programs, since every other payor uses Medicare as their yardstick – plus or minus 10%. The reason for this rate disparity found in all payors is due to the entire reimbursement paradigm – and that is currently being addresses. Soon, as many of you already know, reimbursements will not be “procedural-oriented” but “quality (patient outcome)-oriented.
“some reimburse very well for simple, waived assays and some have horrible reimbursement(non profitable so why do it) for mod. or high complex. Assays”
Sounds like you run a small lab and don’t perform enough in-house molecular testing for it to be profitable. Sounds to me like you’re blaming your shortcomings - the essence of free enterprise – on the government. Find a way to make your lab profitable. Compete in your niche area; try to stay small and lean … quit blaming the government.
“----my fear is if you as a business are left with only medicare rates..why would u stay in this business with increasing costs of running it (anyone running a small biz knows what I am talking about)”
Really? Name one commercial lab selling routine or esoteric testing (minus the small DTC labs) that would NOT have to close up shop if they were excluded from the Medicare program. Don’t blame Medicare. If you compare the reimbursements from UHC, Cigna BC/BC and client bill to those of Medicare, Medicare will always be higher. If you’re worried about being over negotiated, worry about Cigna, Aetna, UHC or other large entities taking risk for these giants.
“i'm afraid we might end up with a United States LAb like the US post office--imagine that!??..gotta wait a week or 2 for result that used to only take 24 hours..run by a bunch of gov't employees...worst case scenario”
Mr./Mrs. Doomsday … are you serious? The government, I don’t care how left-wing it could eve be, will never want to take on this responsibility. The lab lobbyists would never let this happen. Healthcare and mail is such bad analogy … this is paranoid rambling at this point. I don’t think you really thought this one through.
“too many responses here from people who are not in the lab biz or any biz and don't understand the actual costs vs reimbursement for diag. testing.”
I’ve been in this business a very long time and your post tells me you have not. But rest assured, the government is NOT going to take over the commercial laboratory industry, nor would they have any reason to do that.