Michael Shepherd, what is happening at UAMS?
Michael Shepherd, MBA, service line administrator, University of Arkansas for Medical Sciences: At UAMS in Little Rock we’re seeing big growth intrinsically. There’s a lot of surgery; there’s a big push to make sure we’re getting patients in in a timely manner. That has pushed up our volumes on histology, IHC, some AP-driven items. We’re still trying to grow our outreach volume. One challenge is space: Finding more places to put people, equipment, and tests in our older building is challenging. We’re embarking on a journey to find space that will work for what we need not just right now as we think about outreach, but in the next five to 10 years to position ourselves from a financial and patient care perspective. Arkansas is one of the lower-rated states from a health perspective, so we’re beginning to grow our outreach and see where we can expand and bring in other volumes and tests.
Greg Sossaman, space can be a major expense, but most systems that have presented sound planning and convincing futures have, on the whole, seen space accommodations made for them. Is that true in your experience?
Greg Sossaman, MD, senior medical director, pathology and laboratory medicine, Intermountain Health, Murray, Utah: In general, I would agree that where you can show increasing volume and work, particularly with outreach, you’re able to keep up more easily with space needs.
Given your experience as a recent past president of the American Society for Clinical Pathology and your roles involved in planning and national oversight for the development of labs, does this ring true to you in those settings? In other words, we have to get bigger and better and solve labor and space shortages to survive.
Dr. Sossaman (Intermountain): Yes. We have to be aware of the economic realities and health system environments we’re in. I was in a medical leadership meeting recently and an executive team member was talking about where we are with Medicare Advantage plans now. Many of us have significant Medicare populations in our areas, and Medicare Advantage is going to be very challenged in the next couple of years. There may be changes for us. We still play a volume game with fee for service, but we also are in the risk-based area. We have to have an eye on both and be attuned to and able to react to the health system economics as those change. It’s still very much a volume game for labs in whichever way we’re talking about compensation coming in.
The government proposal to fund Medicare Advantage plans managed to tank a few stocks of providers, particularly at UnitedHealthcare. The volume game may not succeed if there’s stingy funding for programs like Medicare Advantage, which is a difficult insurer, usually, when you’re trying to run a pathology practice. Stan Schofield, can you comment on that?
Stan Schofield, VP and managing principal of the Compass Group (formerly of NorDx/MaineHealth): It’s true. The government is cutting back everywhere. With the current administration, the idea of health care charity and rich benefits is in the crosshairs. We’re going to have Medicaid and Medicare Advantage problems. This is the first of two or three more years of the government trying to rebase the cost of health care and reduce its balance sheet. It was not well received by the stock market. UnitedHealthcare was under investigation the past three years for upcoding, code jamming, and inappropriate utilization codes overcharging the government. This is one avenue where the government will say, “If you’re going to keep playing these games and we can’t catch you, we’ll cut the money off the top.” It’s similar to what insurance companies have done to us in the lab. You get 10 viruses in a respiratory panel, and they say you can run all 10 but they’re going to pay you for only three. Same thing with flow cytometry codes and markers—they take it off the top. It’s going to be a strong effort by the federal government not to raise the deficit or to improve the position on the balance sheet on the number of dollars spent per person in this country. It wasn’t just UnitedHealthcare that took the hit. Humana and Cigna took a hit. Everyone that has a significant Medicare Advantage program is taking a hit.