Our goal is to help physicians thrive in the private practice environment through joint collaborations, and direct in LAB SERVICES
The clinical laboratory industry was recently shaken to it's foundation when major payers notified both hospitals and labs, that hospitals would no longer be paid for work sent out to reference. All work must be done within the lab confines to be paid under hospital contracts. Work sent out to reference must be billed and paid by the reference labs. This presents a huge problem to both parties as hospitals have been able to collect handsome surcharges, while passing the work on to reference labs. The reference labs, who are mostly out of network or hold very low paying legacy in network contracts, cannot survive billing under their present relationship with payers. We have a comprehensive set of strategies that benefit all parties. CURRENT STATE OF THE LAB INDUSTRY
Just when you thought you had seen the complete dismantling of the lab industry as we know it, giants are about to fall, as the major payers are changing the rules for reference work. Like compounding a few years before, the lab industry was ripe for an overhaul. Suddenly, guessing the future became a business strategy. Hospitals, who for the most part have been passing these high complexity specimens to their reference partners, and keeping a 30% “surcharge”, must now do the work themselves. Anything they send out now they can’t bill. If not equipped already, these hospitals must now set up a high complexity lab, or buy a lab that they wholly own, or lose this cash cow that has saved them during times where many hospitals have struggled. Labs were generally seen by hospitals a “Distribution Partners”, because they brought business the hospital would not otherwise have seen. Based on the quality and capacity of their national or regional contracts, they could attract a ton of business and rake in lucrative fees without doing a single test. Now it’s the lab’s turn. They can run their business through us and be paid as a distributor without ever having to do the test. This is somewhat like the government paying farmers not to farm. The cost shift for actually running the test now moves from the reference lab to the hospital. The lab remains in business for specialty testing and other lower margin business the hospital doesn’t offer. Gone were the out of network players billing 10 - 12 times Medicare, and chasing patients for the balance. Left were those labs seeking in network or legacy payer contracts with minimal reimbursements, labs “brokering” the provider numbers of small hospitals with no real relationship. Then we had reference relationships where specimens either passed through a hospital or a hospital employee within the lab. Not anymore, this is done! THE PROBLEM
The major payers have sent letters to hospitals and labs stating that all work sent to a hospital must be completed within the hospital lab itself to bill for those services. Anything referenced out may no longer be billed by the hospital. This isn’t just a game changer, but a lab killer. Add to it that BCBS in Alabama says these same rules apply, but that a specimen taken in Alabama must be tested in Alabama. Look for more of this in the future. Compliant strategies have steep costs and many limitations. Many companies are trying to build labs within the hospitals themselves. The inherent problem with these strategies is that the work must now be onsite, and smaller hospitals have small testing capacities. Who wants to invest $1 million in a lab or $3-5 million in a hospital to find out you have a 3,500-5,000 specimen capacity? THE SOLUTION
We are helping established labs create relationships where they can move their labs into hospitals for a synergistic win for both parties. How do we find these hospital partners and what gives us the priority edge when others are looking for the same? Firstly, we are already working with networks of 44, 20, 9, 4 and 2 hospitals. We fully expect this list to be well over 100 by the end of the year, so our approach works well. We work with multiple lab management companies and lab owners that presently account for 60+ in-network hospitals who match the compliance requirements of the new landscape. We have several ways to leverage this to benefit all parties, especially the labs who are now shut out of these once lucrative relationships. We recently placed over 100K monthly specimens into our networks in the last 30 days. Let’s talk and see how we can help you. THE FUTURE OF MGM PARTNERS
Growing Our Hospital Networks
We currently work with an accounting firm that has 200 hospital clients, and another group that provides HR and Billing for 400 hospitals. By offering these entities our revenue recovery program for their hospital clients, we can convert these hospitals into lab partners. Once we have established this relationship, we scrub their contracts for payment history for both national and regional reach, understanding that if we need to cross state lines it should be with an adjacent state. Lightening Growth
We are daily approached by interested hospital networks and individual hospitals. Big labs are coming to us daily for solutions. In our first month since this crisis hit, we have placed accounts with just under 100K specimens, and received orders to place another 88K, 49K, 12K, 2 X 10K and 8K. Our solutions work to benefit all parties. For more information, and to discuss options and potential, please feel free to reach out to our team at info@mgmpartnersconsulting.com. Thank you in advance. We sincerely looking forward to working with you.
