The American Hospital Association (AHA) recently expressed its displeasure with UnitedHealthcare (UHC) in a letter to CMS outlining a host of upcoming policy changes the advocacy group believes will only serve to harm both patients and providers.
Primarily, the AHA said it has significant concerns over UHC’s new Designated Diagnostic Provider (DDP) Program, which will move to restrict outpatient lab payments for labs who are not selected for the program, including those who are currently in-network. While the move primarily serves to further narrow the payers lab network, AHA also pointed out that UHC could be attempting to game the system by redefining what in-network means.
“If a patient obtains care at a non-designated laboratory – even those supposedly “in-network” – coverage for their services will be denied, and the patient will be responsible for payment in full,” AHA said in its Feb. 4 letter. “In short, the DDP program is attempting to redefine the concept of an “in-network” provider and limit patient access to a much smaller pool of laboratory service providers. Because the enrollees’ plan materials still will identify these non-designated labs as “in-network” providers, this policy will create significant confusion for those seeking care and could result cost-sharing obligations beyond the limits established under federal law.”
Currently, hospital-affiliated and freestanding labs have until Feb. 28 to complete a survey that will determine whether they’re eligible for DDP status. However, the College of American Pathologists is meeting with UHC reps on Feb. 19 to discuss the program and its implications in more depth.
Additionally, AHA also took issue with new specialty pharmacy policies that will mandate providers to accept drugs purchased and handled by OptumRx owned and affiliated pharmacies.
“Traditionally, the acquisition of and payment for drugs administered in a hospital setting was managed using the “buy and bill” model, which requires a provider to purchase, store and administer drugs, after which payers reimburse providers for both the cost of the drug and the administration of the drug,” AHA outlines. “UnitedHealth Group is upending the traditional system, potentially sacrificing patient safety and quality care to benefit its profit margins.”
AHA notes these changes are coming at a time when UHC has seen significant growth as its parent company, UnitedHealth Group, posts annual revenues above $250 billion.