Family physicians concerned about UnitedHealthcare's new protocol on the use of nonparticipating laboratories can breathe a little easier. After clarification of some key points of the protocol, Academy leaders are convinced that the policy is not as onerous as it first appeared.
AAFP Clarifies UnitedHealthcare's New Lab Protocol
By Sheri Porter
3/7/2007
"At first glance, UHC's new protocol looked like it might be bad for physicians and bad for patients, but after further investigation and follow-up discussion with UHC, our biggest concerns have been addressed," said AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky.
For the record, here are some facts about UHC's lab policy:
For the record, here are some facts about UHC's lab policy:
- Physicians will not be penalized for out-of-network lab choices made by patients.
- Physicians are required to refer laboratory services to a participating provider in the UHC network.
- The protocol does not apply to lab services provided by physicians in their offices.
- UHC has more than 1,500 in-network reference labs across the country, not including labs in hospital facilities and physicians' offices.
Concerns about access to labs within the UHC network began with an announcement late last year that UHC would drop its contract with Quest Diagnostics on Jan. 1, leaving LabCorp as UHC's only national reference lab. More recently, UHC announced its lab protocol -- effective March 1 -- that required physicians to use participating labs.
The back-to-back actions troubled AAFP leaders. In a Feb. 13 letter (MS Word file: 3 pages/350 KB. More about downloading files.) to Reed Tuckson, M.D., UHC's EVP and chief of medical affairs, Fields said the protocol raised concerns for AAFP and its members, "including a seemingly anti-physician policy that contradicts consumer-directed healthcare, interferes with open access to services, and may negatively impact the quality of care."
The letter spearheaded further AAFP communications with UHC, including a conference call about the lab protocol.
Michael Ile, UHC's vice president of physician network management, encouraged physicians to check UHC's online lab locator and to call UHC with any concerns about lab access (the phone number for network management is listed on the front page of every physician contract). "We'll work with physicians to either find a participating lab or to have lab work done in a non-par lab if that's the thing to do," said Ile. He promised quick action.
"We're not asking physicians to compromise their judgment or … not use a service that they need," said Ile. "What we're asking physicians to do is to be mindful of our roster of participating labs when the physicians make decisions about where they're going to send their lab work."
Ile went on to say, "We think our lab network is more than adequate, and we have yet to hear from a physician that it is not," adding that UHC has called more than 65,000 physicians since the announcement about Quest was made. "The response from physicians has been enormously and consistently positive," he said.
The Academy will keep the UHC lab issue on its radar screen. "They've promised to work in a timely manner with any physician who has a problem of any kind, be it lab access or computer connectivity. We will hold them to their word," said Fields.
According to Ile, on March 1, UHC began a new process of looking at physicians with significant numbers of nonparticipating lab claims. "Our medical directors and other staff will call those physicians and talk to them to try to understand the situation," said Ile. "The whole point of the protocol was to put into place some intermediate steps that would be far short of terminating a physician entirely from our network and disrupting the physician-patient relationship."
Other administrative actions listed in the lab protocol are
The back-to-back actions troubled AAFP leaders. In a Feb. 13 letter (MS Word file: 3 pages/350 KB. More about downloading files.) to Reed Tuckson, M.D., UHC's EVP and chief of medical affairs, Fields said the protocol raised concerns for AAFP and its members, "including a seemingly anti-physician policy that contradicts consumer-directed healthcare, interferes with open access to services, and may negatively impact the quality of care."
The letter spearheaded further AAFP communications with UHC, including a conference call about the lab protocol.
Michael Ile, UHC's vice president of physician network management, encouraged physicians to check UHC's online lab locator and to call UHC with any concerns about lab access (the phone number for network management is listed on the front page of every physician contract). "We'll work with physicians to either find a participating lab or to have lab work done in a non-par lab if that's the thing to do," said Ile. He promised quick action.
"We're not asking physicians to compromise their judgment or … not use a service that they need," said Ile. "What we're asking physicians to do is to be mindful of our roster of participating labs when the physicians make decisions about where they're going to send their lab work."
Ile went on to say, "We think our lab network is more than adequate, and we have yet to hear from a physician that it is not," adding that UHC has called more than 65,000 physicians since the announcement about Quest was made. "The response from physicians has been enormously and consistently positive," he said.
The Academy will keep the UHC lab issue on its radar screen. "They've promised to work in a timely manner with any physician who has a problem of any kind, be it lab access or computer connectivity. We will hold them to their word," said Fields.
According to Ile, on March 1, UHC began a new process of looking at physicians with significant numbers of nonparticipating lab claims. "Our medical directors and other staff will call those physicians and talk to them to try to understand the situation," said Ile. "The whole point of the protocol was to put into place some intermediate steps that would be far short of terminating a physician entirely from our network and disrupting the physician-patient relationship."
Other administrative actions listed in the lab protocol are
- assessment of a $50 fine,
- changes in eligibility for UHC's Premium Designation and Practice Reward programs, and
- decreases in the physician's fee schedule.
"We will consider our lab program an enormous success if none of the actions in that protocol is ever applied to anybody, and we are optimistic that will be the case," said Ile.
