Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Large lab companies contribute to high patient bills

David P. Smith, MD
Physician
October 10, 2014
Share
Tweet
Share

It used to be that the greatest cost at a doctor’s visit was paying for the visit itself. Nowadays, the office visit is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help with the un-Affordable Care Act. In the last few years, add the rising cost of laboratory testing to that list.

Most people can remember the days when lab testing was done in the physician’s office and the cost was reasonable in most instances. If the lab prices got too high, patients could choose to go elsewhere. Competition took care of any price gouging problem with no government intervention needed. How all of this morphed into the current problem started with the introduction of CLIA  (Clinical Laboratory Improvement Amendments).  CLIA laws were created with the intention to improve laboratory standards, but one of the consequences was increased costs. After CLIA went into place, some physicians stopped offering in-house lab work due to the increased costs and regulation, but many did continue to operate labs in their practices.

Medicare then decided that if a patient had lab testing which they determined was not medically necessary, Medicare would not pay and patients couldn’t be charged either. This was the last nail driven into the coffin of most physician office labs. While physician labs were declining in numbers, the large reference lab companies were growing by leaps and bounds. Eventually, most lab work was done by these lab companies and still is. After this transition, Medicare reversed course, allowing patients to be billed for any lab work that Medicare didn’t approve. Apparently the large lab corporations are a much more powerful lobby than the individual physicians.

Unfortunately, the near monopoly these laboratory corporations now have makes that bill incredibly high for patients.  Previously, in the physician’s lab,  a much lower price, or even a negotiated amount, could be charged for a non-approved lab test.  Now there is hardly an option,  as larger and larger lab companies without any personal relationship or responsibility to the patients charge outrageous prices and make it difficult for patients and physicians to avoid these companies and their policies.

As an example, patients are restricted to how many lipid profiles that they can have within a year.  If there are medication complications requiring adjustments, the lipid recheck may not be approved as medically necessary.  Clearly, it is necessary to know if a medication is working or not. A lipid profile is reimbursed by Medicare at just under nineteen dollars, but if Medicare denies it, these companies are sending bills to patients for over one hundred dollars. If lab corporations can make 500 percent more money instead of the usual payment, it’s not a stretch to think these companies would not have much interest to help patients get their lab work covered through Medicare. Medicare has gone from one extreme to another and patients are being put into financial jeopardy. One common sense solution is for anyone performing lab tests is to be able to charge the patient what they would have gotten from Medicare had it been approved, but allowing over five times as much to be charged is allowing inflated pricing to occur.

Upon learning about what these reference lab companies are being allowed to do, I contacted one of Congressman Gregg Harper’s (R-MS) offices and discussed my concerns with one of his staff members. I had thought that there would be interest in protecting people from being charged such outrageous prices for inexpensive lab work. However, I was accused of not being a “capitalist” and questioned about how could I possibly “desire for (them) to tell these lab companies what (they) can charge.” I was stunned at such indifference and at being made to feel as though I was out of the mainstream, maybe even not American in my thoughts, according to their viewpoint.

I replied to them that Medicare, which is regulated by Congress, certainly does not mind telling physicians what we can charge and restricts us all so severely that hospitals and clinics are having trouble making ends meet now. If it is good enough for the doctors, hospitals, and other health care suppliers and workers, why should these large reference lab companies be exempted from price regulation? I could not get an answer to that question and was left frustrated that Congress is OK with the fleecing of Medicare patients.  Just as Congress is allowing this to occur, they can also decide to not allow it to occur.

Concerned citizens should contact their U.S. representatives and U.S. senators and let them know that they should reign in this unnecessary extra expense being placed on the backs of those who are already overloaded.

David P. Smith is a family physician who blogs at Rebel.MD.

Prev

Treating Ebola patients in Uganda: The dilemma of a doctor's touch

October 10, 2014 Kevin 3
…
Next

MKSAP: 48-year-old man with urinary frequency

October 11, 2014 Kevin 2
…

Tagged as: Medicare, Primary Care

Post navigation

< Previous Post
Treating Ebola patients in Uganda: The dilemma of a doctor's touch
Next Post >
MKSAP: 48-year-old man with urinary frequency

ADVERTISEMENT

More by David P. Smith, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Requiring a prescription for pseudoephedrine: How effective is that?

    David P. Smith, MD

Related Posts

  • A universal patient medical record

    Michael R. McGuire
  • A patient waits. And waits.

    Michele Luckenbaugh
  • Treating the patient’s body is not synonymous with treating the patient

    Steven Zhang, MD
  • Physicians are trapped between patient satisfaction and unnecessary prescribing

    Richard Young, MD
  • Every patient has a story

    Michele Luckenbaugh
  • Bilateral empathy lowers patient expectations

    Kevin R.R. Williams
  • Osler and the doctor-patient relationship

    Leonard Wang
  • A patient imagines a conversation with Alexa

    R. Lynn Barnett
  • A patient’s perspective on genetic testing

    Erin Paterson
  • A patient’s COVID-19 reflections

    Michele Luckenbaugh
  • An patient’s ode to healers

    Michele Luckenbaugh
  • Building a bond of trust between patient and physician

    Michele Luckenbaugh

More in Physician

  • Why so many doctors secretly feel like imposters

    Ryan Nadelson, MD
  • Why enterprise risk management is key to value-based health care success

    Olumuyiwa Bamgbade, MD
  • Rethinking physician resilience for sustainable well-being

    Sarah Webber, MD
  • How shared language saved a patient from isolation

    Syed Ahmad Moosa, MD
  • The shocking risk every smart student faces when applying to medical school

    Curtis G. Graham, MD
  • The physician who turned burnout into a mission for change

    Jessie Mahoney, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Large lab companies contribute to high patient bills
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...