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The first step in UnitedHealthcare's implementation of its laboratory benefit management program in Texas begins in January 2017 with voluntary participation before mandatory compliance is enforced in March.

Voluntary compliance preceding mandatory is consistent with how UnitedHealthcare initiated the laboratory benefit management pilot program in Florida in 2015. In October 2016, UnitedHealthcare announced it would expand its program to include its members enrolled in commercial plans in Texas. The CAP opposed the pilot in Florida and remains actively engaged with UnitedHealthcare on the impact to patients and physicians in Florida and the planned expansion into Texas.

UnitedHealthcare announced in its October 2016 network bulletin (see page 19) that it would expand the pilot program to Texas on March 1, 2017 indicating participating providers could begin to use the decision support tool on January 1, 2017 in advance of the program effective date. The decision support tool is operated by Beacon Laboratory Benefit Solutions (BeaconLBS), a subsidiary of LabCorp.

In Florida, the pilot program affects just under 80 laboratory services ordered by network providers in the state for patients insured by most UnitedHealthcare commercial plans. Ordering and rendering care providers are required to use the BeaconLBS Physician Decision Support tool to order and secure prior notification for nearly 80 tests covered by the program. The program also includes secondary review and “claims impact” components. The latter refers to denial of pathologists’ claims under certain circumstances. Despite opposition from the CAP, Florida Society of Pathologists, the Florida Medical Association, the American Medical Association and several other national physician organizations, UnitedHealthcare fully implemented the pilot program including "claims impact" in April 2015 after announcing implementation effective October 1, 2014 and incorporating some adjustments to the program in response to input from CAP and other stakeholders.

The CAP will keep its members updated on this issue in future editions of STATLINE.

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On November 8, the CAP hosted the webinar "The Final 2017 Medicare Physician Fee Schedule's Impact on Pathology Services." During this presentation, CAP experts discussed how the final 2017 fee schedule affects Medicare reimbursement for pathology services and the CAP’s advocacy efforts to impact these changes.

Watch the webinar recording and download the presentation's slides. The CAP also has published its initial analysis of the 2017 fee schedule and an impact table comparing 2017 and 2016 Medicare payment years.

Our presenters for the webinar were Patrick Godbey, MD, FCAP; Jonathan Myles, MD, FCAP; Mark Synovec, MD, FCAP; and John Scott, VP of CAP Policy and Advocacy.

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As part of the CAP's ongoing efforts to educate policy influencers—members of Congress, congressional staff, regulatory agency officials and health policy experts—an advertising campaign will run in the Washington, DC area from mid-November through December 16. The purpose of the advertisements is to bring greater attention to the role of pathologists in patient diagnosis.

The ads will appear on digital media platforms and carry messages about the pathologist’s diagnosis driving health care decisions and the pathologist as the physician who makes diagnoses for diseases such as cancer.

The advertisements align with, and build upon, previous campaigns by the CAP that target the policy influencer audience.

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