Outsourcing lab services can have long-term risks, and other letters

Regarding “Evaluating lab outsourcing”, several points should have been included in the article. First, hospital executives typically do not solicit to sell their labs. Independent, commercial lab entities or investor groups generally approach hospital leaders based on expansion interests of their own businesses. Second, few outsourced laboratory arrangements survive longer than five years. And finally, the cost in time, talent and capital to reinstate laboratory services is a considerable institutional risk. The decision to outsource laboratory services has long-term consequences that often outlive the tenure of the hospital executive who makes the original decision to sell.

Joe Miles

Regarding “Groups press FDA to encourage medical-device registries”, device registries are challenged by their inability to track patients over time. Unlike drugs, devices aren't generally “renewed/refilled,” so tracking them with ongoing claims is not possible. Also, the relationship between the implanting surgeon and the patient is often transient. Until a device's Unique Device Identification number is a required field in the electronic health record and provided on behalf of the patient for longitudinal follow-up, institutional-based registries will have limited abilities to track devices and essentially no ability to notify all device recipients in the event of a recall/problem.

Dr. Edward Fotsch

Regarding the article “Reform Update: Facing ACA mandates, insurers diversify into technology”, commercial insurance companies should not complain about the requirements of the 80/20 rule. When you consider the administrative costs related to the management of Medicare and Medicaid programs is 6% or less, the commercial carriers really have little to complain about.

It is inevitable that commercial insurers will continue to migrate away from their core business model because of their own inefficiencies. To remain relevant in the healthcare underwriting and payer market, they will need to invest hundreds of millions of dollars to completely restructure their aging legacy systems. The greatest challenge will be behavior modification inside an industry that is steeped in legacy market perceptions and structure.

New players in this market are beginning to emerge. They do not have the overhang of the legacy systems and operating practices. Their administrative cost structures are lower, and the operating practices are far more streamlined, while providing easier access to healthcare management information to the carrier and providers.

Most important is more transparency between the payer, provider and the patient. We will not turn back the tide of rising out-of-pocket costs to the patient, but we can and should remove the mystery.

B.P. Fulmer

Regarding “Narrow-network controversy spurs tougher rules for California plans” , as with most issues related to healthcare reform and how to best serve patients, it's complicated. In this case, the problem is very real—how to improve access to care without increasing costs.

This bill attempts to solve the “narrow-network problem” by allowing patients to get care outside of the network, which undermines the very mechanism designed to keep rates lower. If passed, the law could reverse the favorable medical-cost trend California is finally enjoying and cause rates to increase as more care is accessed by higher-cost, lower-quality providers. Like Proposition 45 (a rate-regulation initiative), it appears to solve one problem by creating a new and larger one.

These initiatives are supported by single-payer advocates who prefer to dismantle the private health insurance system in favor of a Medicare-for-all model. While I don't favor a single-payer system, if that is what the bill sponsors want, then let Californians vote on it instead of packaging a bundle of bills and calling it something else. If the governor wants to protect affordable health insurance, he will not sign the bill and, hopefully, will listen to the experts who are already implementing solutions for ensuring network adequacy.

Michael Lujan