Anthem Blue Cross Blue Shield Rate Cuts

On November 8th, NSH sent a letter to Anthem Blue Cross Blue Shield urging them to reverse plans to reduce payment rates for pathology and laboratory medicine services, a plan outlined in Anthem Blue Cross and Blue Shield’s recent amendment to its agreements in several states.

NSH felt that action was necessary, as these cuts will have an adverse financial impact on pathology and laboratory medicine communities resulting in reduced access to patient care. Anthem Blue Cross and Blue Shield’s announced rates for many high-volume pathology and anatomic pathology laboratory services are extraordinarily low in comparison to the 2018 Medicare published payment amounts. As reported in the October issue of Laboratory Economics, Anthem’s reimbursement for 88305-26 was $66. Between November 2018 and July 2019, the rate was reduced to $14, almost an 80% reduction. Medicare’s rate of $39.64 is almost three times as much as the initial reimbursement cut. The new rate of $34 is still lower than Medicare’s published rate.

According to Laboratory Economics October 2019 issue, pathologists in Ohio are terminating their contracts en masse with Anthem in response to the rate cuts. There has also been strong push back in Virginia, where smaller pathology groups are being encouraged to send their pathology specimens to larger contracted labs.

Why is this Important to Histotechnicians and Histotechnologists?

Laboratory testing plays a significant role in quality patient care. It provides physicians and patients with essential information necessary to diagnose disease, treat the illness, and monitor the results. Technological advancements and innovation have greatly expanded the scope, quality, and complexity of laboratory services, providing quantifiable benefits to patients and healthcare. These innovations have helped to establish personalized medicine as the standard of care, enabling scientists and providers to detect disease at earlier stages, to identify a person's susceptibility to disease before symptoms arise, and to predict which treatments will optimize outcomes, all through the use of gene-based and molecular diagnostic laboratory tests.

Cuts such as those proposed by Anthem Blue Cross Blue Shield adversely affect the implementation pace of technological innovations by limiting laboratories' ability to take on new clinical diagnostic tests and the capacity to employ appropriate technical staff. The proposed reimbursement hardly covers the current ability to maintain services, let alone pursue advances in the healthcare field.

More simply, without funds provided by reimbursements, labs are limited in the number of staff they can hire, and how many cases they can take on. In places like Virginia, where the Anthem cuts are in effect, this has led to outsourcing of testing, which increases the amount of time to diagnosis. As laboratories and hospital elect not to participate in the Anthem plan because of low reimbursements, patients are left with reduced access to in-network healthcare services, making finding local, affordable healthcare more difficult.

Anthem Blue Cross Blue Shield has received our letter and acknowledged our concerns. NSH is working on scheduling a meeting with them to discuss in more detail, the potential impact of these cuts on laboratory professionals and the patients they serve.

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