July 23, 2024- When the alarm clock sounds on Monday morning, one of the first decisions the experienced distribution account manager needs to make is: Which customers will I call on this week where I can make the most impact as a consultant, maximize my efficiency and grow my business most successfully? This has never been a simple question to answer, but it has also changed dramatically in the 21st century.
The healthcare payment paradigm
There are several factors complicating the question, most related to changes in who pays for healthcare costs. The evolution of Medicare now includes traditional Medicare (Part A and Part B) as well as Medicare Advantage programs (Medicare Part D) which cover services traditionally not paid under Medicare and Medicare supplement plans. The Affordable Care Act went into effect in 2010 and added a few subsidies intended to lower the cost of healthcare and improve access to healthcare insurance coverage, primarily for patients not covered under an employer health plan. In addition, there are numerous private healthcare insurance plans, many of which are also payers under various government programs.
From a physician practice viewpoint, these options provide a wide amount of complexity in providing services and assuring the practice will be paid. At the same time, it complicates patient decision making about selection of healthcare insurance and healthcare providers.
From a lab perspective, add the complications of the Protecting Access to Medicare Act, passed in 2014 and enacted in 2018, which was intended to lower the cost of lab tests provided under Medicare to the level of private insurance and the complications become truly complex for patients and healthcare providers alike.
Read More in the latest issue of Repertoire Magazine.