CLINICAL LABS: Managed Care Pushes Cost-Cutting Practices
Cost-conscience managed care plans "are having a demonstrative impact" on clinical laboratories, according to a new report, and this impact has prompted concerns "that diagnoses may be missed or delayed." The San Diego Union-Tribune reports that the American Society of Microbiology released the report last week at its national meeting in San Diego. Lab directors warned that "the impact of managed care has meant delays in the prompt diagnosis of tuberculosis and has resulted in the failure to report sexually transmitted diseases." The directors said due to pressure from HMOs, lab facilities use "fewer experienced lab personnel," staffing levels are lower and personnel have less time to conduct research and verify test results. A statement released by the ASM said: "With this report, we call to the attention of legislators, third-party payers and the public the fruits of the molecular technology revolution will be much harder to realize with an undertrained and overburdened laboratory work force."
Several lab directors at the national meeting blamed HMOs' centralization of clinical lab services. John Counts, director of Washington state's public health lab, said "he has seen managed care cause delays of seven to 10 days in the diagnosis of tuberculosis in Medicaid patients," and he noted that one Seattle HMO sends patient specimens to the East Coast, causing delays. Alice Weissfeld, a Houston lab director, said the Houston-area saw the number of sexually transmitted diseases plummet in recent years, only to discover that the out-of-state laboratory performing the tests failed to report the cases to Texas public health authorities. Weissfeld "understood [the lab] did not feel obligated to report the disease" since the lab was beyond the state's boundaries. The Union-Tribune reports that San Diego health authorities "have not seen documented evidence of such managed care impacts on lab testing," although they remain wary. Dr. Robert Gunn, San Diego County's sexual disease control officer, said HMOs transfer the financial burden for STD tests to physicians in medical groups, and "because a test costs money, Gunn said, 'Doctors don't do it.'"
Managed Care Response
Donald White, spokesperson for the American Association of Health Plans, said he had not seen the ASM report but said it "confirms a number of positive effects of managed care -- including labs operating more efficiently and the implementation of quality-control programs." However, White conceded that managed care "undoubtedly" transfers "additional cost pressures" to labs (Dalton, 9/29).