WASHINGTON – Today, AACC sent a letter to the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s proposed 2018 rates for clinical test reimbursement under the Protecting Access to Medicare Act (PAMA). In its statement, AACC expresses concern that the new payment rates could significantly limit patient access to crucial medical tests, and urges CMS to revise the rates in order to preserve high quality healthcare.
It is important to understand that skewed data has led CMS to propose drastic cuts to test reimbursement that could force many rural hospitals, small health clinics, and physician office laboratories (POLs) to severely curtail or even stop their testing. PAMA was enacted in 2014 and aims to overhaul reimbursement for clinical laboratory tests by establishing market-based pricing for tests. In 2017, CMS began requiring certain clinical labs to periodically report how much private insurers pay them for tests so that the agency could set a market rate. However, although hospitals and POLs receive 44% of all Medicare payments for lab services, more than 90% of the test payment data that CMS collected came from large commercial laboratories, which typically receive lower payments from private insurers due to their economies of scale.
AACC therefore urges CMS to delay implementation of the new clinical test reimbursement rates and to recalculate them using comprehensive payment information gathered from hospitals and POLs. Along with revising the proposed rates, AACC recommends that CMS analyze and publish the impact that new reimbursement rates could have on clinical labs and healthcare overall. Most importantly, this analysis should look at how new rates would affect patient access to testing—particularly in vulnerable geographic areas and patient populations—while also examining how new rates could alter the menu of testing services that different types of labs are able to provide.
“AACC recognizes the difficulty of the task that CMS has undertaken, but we are deeply concerned by the agency’s plan to base new reimbursement rates on data that do not reflect the full spectrum of clinical labs,” said AACC CEO Janet B. Kreizman. “AACC strongly recommends that the agency update its proposal to protect hospital and physician office laboratories from crippling cuts and to safeguard patient access to clinical tests that play an integral role in diagnosis and treatment.”
Dedicated to achieving better health through laboratory medicine, AACC brings together more than 50,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, AACC has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit www.myadlm.org.