How Medicare's Market-Based Payment System Is Upending the U.S. Clinical Laboratory Market

Why Should You Attend:

This webinar will discuss how the lab payment cuts imposed by PAMA is shifting the competitive landscape for the U.S. laboratory industry. Specifically, the program will cover how the fallout from PAMA is altering the competitive dynamics between national and hospital outreach labs as well as providing a financial advantage to certain specialty labs offering proprietary tests and other labs performing advanced diagnostic laboratory tests (ADLTs).

Meantime, the very survival of small community labs along with some regional labs that serve niche markets, such as nursing homes, skilled nursing facilities and home bound patients is at stake. That’s because its these labs that are being hit the hardest by PAMA since they mostly perform a limited number of high-volume tests which are suffering the biggest cuts under the new Medicare market-based payment system. Finally, the webinar will discuss how the competitive reset will impact the trend toward industry consolidation.

Learning Objectives:

• Prepare your organization now for the changing competitive landscape surrounding the clinical laboratory industry.
• Understand how the current market reset is directly impacting major lab segments plus find out what they must do to remain viable.
• learn why labs in different practice settings will be forced to assess their strategic options to reorganize, restructure, merge, consolidate or sell altogether.
• Find out why hospital outreach labs may have to reprice their testing services to remain competitive with independent labs.
• Learn why Medicare’s market based payment system is having a ripple effect on commercial rates.
• Discover why labs offering differing testing services can have either a competitive edge or be at a disadvantage because of Medicare payment policies in today’s volatile market.
• Gain new insights into what strategies labs will have to consider to remain competitive and how the shifting market dynamics will impact industry consolidation trends.

Areas Covered in the Webinar:

• Find out how the Medicare’s market-based payment methodology and resulting payment reductions is fundamentally shifting the laboratory industry’s competitive dynamics
• Learn what legal and legislative initiatives are pending to modify the impact of future PAMA payment cuts under Medicare
• Assess how competition between independent & hospital outreach labs is being reset by Medicare payment policies
• Explain why lab outreach programs must be more transparent in their pricing and competitive in their pricing
• Discover why lower Medicare pricing will affect lab rates for commercial payers
• Understand why labs offering proprietary testing have a competitive advantage in today’s market
• Determine why community and regional labs face the most danger from reduced Medicare rates and what steps they should consider in order to remain in business
• Reveal how outreach lab programs can retain more advantageous reimbursement from commercial payers
• Explore why labs should renegotiate future contracts with all outside suppliers including reagent and equipment vendors
• Identify specific business strategies labs should consider to remain competitive in the volatile lab space
• Discuss why Medicare payment policies are creating access problems for lab services in rural and inner city areas
• Learn how the fallout from Medicare rate cuts will affect the future consolidation of the lab industry

Who Will Benefit:

• Clinical Laboratory Founders
• presidents,
• CEOs, COO, CIOs, VPs,
• Medical and Administrative Laboratory Directors
• General Managers and other senior executives including Director of Business Development & Director of Planning;
• Head of Reimbursement,
• Billing and Finance;
• Legal & Compliance Executives

Dennis Weissman
President, Dennis Weissman and Associates LLC

Dennis Weissman, A nationally recognized, independent analyst and thought leader in the diagnostic field for over three decades, Dennis is President of Dennis Weissman & Associates, LLC, Falls Church, VA, a consultancy which provides market intelligence, M&A advisory services, business leadership and public policy advice to diagnostic and life science companies and organizations. He has expertise in Medicare and health care reform policies and trends; clinical lab and pathology payment & compliance policies as well as business trends affecting the diagnostic sector. Dennis founded and served as publisher of Washington G-2 Reports (now G2 Intelligence) through 1999, an information company that reports on and analyzes the U.S. clinical laboratory industry via newsletters, research reports and conferences. Prior to G2, he served as the Director of the Washington Office of the American Society for Medical Technology (now ASCLS) and before that, Special Assistant to the Deputy Assistant Secretary for Health, Department of Health, Education & Welfare (now HHS).

Topic Background:

Starting in 2018, Medicare reimbursement for most high-volume and many other laboratory tests saw 10 percent reductions as required by the Protecting Access to Medicare Act (PAMA). Many common lab tests will see an another 10% reduction in both 2019 and 2020 followed by up to an additional 15% for each of the next three years as required by PAMA. All clinical labs in the U.S. — from the largest national reference labs to hospital outreach labs to physician office labs are being impacted by these substantial cuts. Moreover, reduced Medicare payments are also in lower payments to state Medicaid programs and are having a ripple effect on commercial payers which are moving to adjust their rates downward as part of revised contract terms.

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