Anthem should restore pathology reimbursement rates

By Michael Powell

The COVID-19 pandemic has shown us that nothing is more critical than our health – and the health professionals who risk their own safety and lives, to save ours.  The pandemic has exposed a shortage of healthcare workers, and of physicians in particular, throughout this country.  Here in Nevada, it is critical.  Recent numbers published by the Nevada Health Workforce Research Center illustrate the severity of Nevada’s physician shortage.  Our state is currently ranked 45th in the country for active physicians per capita and 48th for primary care physicians.  In the specialty of pathology, we are tied for 49th.  

Pathology practices are in serious jeopardy across Nevada right now, not only for the same reasons related to the COVID-19 pandemic that presently threaten many healthcare providers, but also because of vastly increased demand for laboratory directorship services that pathologists provide.  Pathologists are on the frontline of the COVID crisis, responsible for ensuring prompt and accurate testing for patients and healthcare workers alike.  More broadly, as much as 80 percent of all medical decision-making is based on the results of one or more laboratory tests. Now is not the time to jeopardize access to diagnostic testing, quality of care, and overall fairness of the current healthcare system. This is why I struggle to understand a recent decision made by Anthem Blue Cross-Blue Shield Insurance (“Anthem”).

Anthem has unilaterally decided to dramatically reduce reimbursement for pathology services in Nevada by as much as 60 percent.  It is hard to believe that this is for any other reason than to boost its bottom line. In many circumstances, these rates are below the cost of delivering these critical services. They have refused to negotiate in good faith up to this point and, most concerning, are no longer willing to contract or credential our doctors on a physician services agreement. What medical practice in Nevada would agree to such terms? This threatens the financial viability of a critical service needed every day in our hospitals and in the Las Vegas community in general, and increase “surprise billing” of patients.

Doctors in Nevada are already battling lower than average reimbursement rates, which have led to challenges to recruit and keep pathologists in our state. Recently published studies have revealed an oncoming future shortage of pathologists as more pathologists retire and fewer medical school graduates enter the field. Anthem’s reductions in payments for pathology services will only further exacerbate this problem. Most doctors face overwhelming financial debt upon graduation from medical school. Why would one spend the time, money, and effort to become a pathologist when a major national health insurance provider will no longer provide adequate reimbursement for their services? 

It would be difficult to find someone who does not think reducing medical costs is a good idea, but the negative consequences of these financial decisions must not be ignored. Because pathologists have the primary role in the diagnosis of cancer and contribute to the selection of appropriate treatments, Anthem’s actions will reduce the ability of pathology practices in Nevada to provide essential diagnostic services that often guide therapy. This will have a particularly devastating effect on rural and smaller hospitals in Nevada whose communities rely on them to ensure access to care for the most vulnerable patients. 

Anthem’s actions may benefit its stock price and shareholders, but they will harm the specialty of pathology and, more importantly, the patients and communities of our state.  

 Michael Powell, M.D. is the Managing Director of Western Pathology Consultants.