The Problem with UHC’s New Program

Out in Florida, the battle rages on between one of the country’s largest health insurance corporations and physicians, clinical laboratory managers and pathologists.  This fight started because of the restrictive, burdensome requirements imposed last fall by UnitedHealthcare (UHC) and administered by BeaconLBS on medical laboratory test ordering.  For one Florida rheumatologist, Olga Kromo, this new decision-support system that physicians currently have to use when ordering clinical laboratory tests is highly flawed.

Michael Weilert MD Ogla Kromo

Olga Kromo, the physician who has become an outspoken opponent of the new system imposed by UHC.

Other Florida physicians have begun to rally around Kromo, pointing out that the new system is time-consuming, onerous and difficult to use.  Kromo, however, has gone even further, claiming that the BeaconLBS system could have an adverse effect on patient care and increase negative outcomes across the board.  In a recent interview with “The Dark Report”, Kromo has explained that patients with connective tissue disease are at higher risk for other serious health conditions such as lymphoma.  This is true for patients with systemic lupus and Sjögren’s syndrome.  If ordering medical laboratory tests is overly complicated or time-consuming, she said, then patients may not get tested as much as needed for their physician to properly identify complications and spot the signs of ailments such as lymphoma early on.  Kromo is one of four doctors at the Arthritis and Rheumatic Care Center in Miami.

Among patients with lupus and Sjögren’s, Kromo says, there’s a high risk of developing lymphoma.  A clinical laboratory test is recommended for timely monitoring these patients, although UHC says that BeaconLBS needs to pre-authorize the test before doctors can run it.  If long-established clinical guidelines specify that a test is recommended for lupus patients with Sjögren’s, Kromo argues, why would physicians need to request authorization from a health insurer?  Kromo’s argument has raised a serious issue as to why UHS and its contractor, BeaconLBS, are interposing themselves between physicians and patients when physicians are ready to order medical lab tests that UHC requires to be pre-authorized.  Various state and national medical societies have written letters to UHC objecting to this interference with established medical standards of practice.

It takes a particularly long time to use the newly-required system and, since there’s a limited number of electronic interfaces between BeaconLBS and electronic health record systems, physicians need to enter orders for tests twice: once to obtain pre-notification ,and a second time to enter the order in the EHR.  As well as patient care concerns, Kromo has found the BeaconLBS system to be so difficult that those in her four-physician practice aren’t even using it, and instead are having a workaround with another lab.  If Kromo’s practice were to use the BeaconLBS system, she estimated that the phlebotomist on her team would need to stay an extra hour or two every day; just the paperwork for Beacon tests takes about 20 minutes per patient.  And since such a large percentage of Kromo’s patients (95%) need lab tests on almost every visit, this system significantly disrupts patient flow.