CLN Article

Federal Insider

AACC Warns of Deeper Cuts Under PAMA

The Centers for Medicare and Medicaid Services (CMS) proposal for implementing the Protecting Access to Medicare Act of 2014 (PAMA) could mean even deeper cuts to clinical laboratories than Congress intended, while at the same time limiting a provision to pay for new, advanced tests by eliminating biomarkers not based on DNA or RNA, according to AACC’s official comments on the proposed rule. Overall the association is concerned that “PAMA authorizes additional cuts in laboratory payments that may adversely affect patient access to care, particularly in underserved communities.”

Based on the law passed by Congress, the Congressional Budget Office (CBO) estimated that PAMA would save Medicare about $2.5 billion over 10 years—put another way, about $2.5 billion in cuts to laboratories. However, CMS appears to have pushed this further, and estimates that under its proposed rule, laboratory payments will be cut $2.94 billion over just 5 years, more than twice CBO’s calculation.

“AACC is concerned that CMS is making steeper cuts than Congress intended and that these unwarranted reductions may cause less precise healthcare…with no benefit to the health of our nation’s citizens,” the comment letter reads. “We strongly advise CMS to reduce the size of the proposed cuts.”

The proposed rule also errs in its description of advanced tests. How these advanced tests are defined is important because one benefit from the law is better reimbursement for this category. The law defines them as Food and Drug Administration-approved tests that analyze “multiple biomarkers of DNA, RNA, or proteins combined with a unique algorithm to yield single patient-specific results.” But CMS proposes removing the term “proteins” from this definition, a critical mistake, according to AACC.

“Many proteins are well established biomarkers that, when used in combination with other parameters, including other proteins, DNA, and/or RNA gene expression markers, can yield unique and valuable clinical information,” the association noted. AACC also is urging CMS to delay implementation of the law by 1 year, to 2018. The full comment letter is available on www.myadlm.org/health-and-science-policy.

Hospital-Acquired Conditions Decline

A report released by the Department of Health and Human Services (HHS) shows that hospital-acquired conditions (HAC) have declined by 17% over a 4-year period. An estimated 87,000 fewer patients died in hospitals and nearly $20 billion in healthcare costs were saved as a result of a reduction in HACs from 2010 to 2014.

This report shows progress over results from 2014, which showed 50,000 fewer patients died in hospitals and $12 billion in healthcare costs were saved between 2010 and 2013. HHS emphasized that these improvements occurred during a period of “concerted attention” by hospitals throughout the country to reduce adverse events as part of the Affordable Care Act, including Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.

HACs measured in the report include adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, pressure ulcers, and surgical site infections, among others. About 40% of the reduction in HACs in the latest report comes from adverse drug events, 28% from pressure ulcers, and 16% from catheter-associated urinary tract infections. These HACs constituted about 34%, 27%, and 8%, respectively, of the HACs measured in AHRQ’s 2010 baseline. The report, Saving Lives & Saving Money: Hospital-Acquired Conditions Update, is available from www.ahrq.gov/professionals/quality-patient-safety.

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