AACC is urging the Government Accountability Office (GAO) to examine the effect of the Protecting Access to Medicare Act (PAMA) reimbursement cuts on patient access to testing.

While the GAO issued a report on PAMA in November 2018, it failed to deal with any questions about patient access to care. “Monitoring the effect on patients is part of the mandate Congress gave to the agency,” AACC wrote in a letter to GAO. “Legislators specifically asked GAO to study the impact of PAMA implementation on beneficiary access as well as the impact of the new payment system on laboratories that provide a low volume of services and laboratories that specialize in a small number of tests.”

AACC believes GAO research on these issues could offer Congress a clearer understanding of the consequences of PAMA reimbursement cuts. The association is recommending that in subsequent reports, GAO cover not only patient access but also how small laboratories are faring, the effect on patients in underserved areas, and whether low-volume laboratories have had to change their test menus.

In its letter, AACC cited data from the National Independent Laboratory Association and COLA, a laboratory accrediting organization. For example, a 2018 COLA survey found that 39% of responding laboratories expected to refer more tests to other laboratories because of PAMA, while 33% planned to alter their test menu. “These data indicate that patient access to testing will diminish under new payment law and that patient care will thereby deteriorate,” AACC wrote.

The association also recommended that in assessing the impact on patients and smaller laboratories, GAO employ statistically valid data collection methods to make sure that Congress can use evidence-based data to inform its decisionmaking.

AACC Supports Newborn Screening Legislation

AACC is urging Congress to pass the Newborn Screening Saves Lives Reauthorization Act of 2019.

This legislation would renew federal newborn screening programs for 5 years and also help these programs contend with new conditions and use new technologies. The bill also would commission a report from the National Academy of Medicine to make recommendations for modernizing newborn screening.

AACC has worked with a coalition of healthcare organizations for many years to ensure that the nation’s newborn screening program continues to receive federal funding. AACC contributed to efforts that led to the passage of the Newborn Screening Saves Lives Reauthorization Act of 2014 by holding a congressional briefing, visiting individual congressional offices, and releasing a position statement that affirmed AACC’s endorsement of public and private efforts to maintain, improve, and expand newborn screening programs.

New Payment Model Drives Value-Based Payment for Primary Care

A new proposal from the Trump administration reflects the bipartisan consensus in Washington that the federal government must move away from fee-for-service payment models to contain healthcare costs. The Centers for Medicare and Medicaid Services (CMS) has announced a renewed effort to bring value-based reimbursement and capitated payment to primary care after a steady expansion of this approach for inpatient hospital care.

Called the CMS Primary Cares Initiative, the new payment scheme aims to reduce costs, cut the administrative burden on primary care providers, and nudge providers to spend more time caring for patients.

Beginning in January 2020, the initiative will roll out five new payment options that the agency hopes will appeal to a broad swath of providers. The models allow providers to receive a single, capitated monthly payment and earn higher reimbursement for specializing in care of patients with complex, chronic needs and seriously ill populations. Some of the models also reward providers with higher payments based on patient outcomes such as controlling high blood pressure, managing diabetes, and screening for colorectal cancer.

Included in the program is a direct contracting model for organizations such as accountable care organizations and managed care organizations so that various groups of providers can participate. These models are “designed to create a competitive delivery system environment where organizations offering greater efficiencies and better quality of care will be financially rewarded,” according to CMS.