Revenue risk and price transparency in hospital-based laboratories

Area of Science:

• Health Economics
• Laboratory Medicine
• Hospital Administration

Background:

• Hospital-based laboratories face pricing disparities compared to commercial alternatives, potentially deterring patient utilization.
• Statutory payment reductions for high-volume tests under the Clinical Laboratory Fee Schedule (Part B) are set to impact hospital revenue starting in 2017.

Purpose of the Study:

• To highlight critical revenue-impacting developments for hospital laboratory financial leaders.
• To inform financial strategies in response to market pricing and regulatory changes.

Main Methods:

• Analysis of pricing structures between hospital and commercial laboratory services.
• Review of statutory payment changes affecting the Clinical Laboratory Fee Schedule (Part B).

Main Results:

• Significant price differences create patient disincentives for using hospital-based laboratory services.
• Anticipated deep payment cuts for high-volume tests will substantially affect hospital operating revenue.

Conclusions:

• Hospital finance leaders must address pricing strategies and prepare for reduced Medicare reimbursement.
• Proactive financial planning is essential to mitigate the impact of these laboratory revenue challenges.