Bipartisan Group of Senators Urge Medicare Officials to Drop Proposal to Cut Payments for Anatomic Pathology Services

Washington, D.C. — The American Clinical Laboratory Association (ACLA) praises U.S. Senators Amy Klobuchar (D-MN) and Johnny Isakson (R-GA), and 38 of their colleagues for sending a letter this week urging Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner to reconsider cuts to Medicare payments for anatomic pathology services that diagnose breast, prostate, leukemia, and other cancers. Specifically, the letter argues that the recommendation in the CY 2014 Medicare Physician Fee Schedule Proposed Rule issued by CMS is based on inadequate data.

The proposal would cap payments for independent laboratories to rates under the Hospital Outpatient Prospective Payment System (OPPS) and result in cuts as much as 80% for some of the most common anatomic pathology services that aid in the diagnosis and treatment of deadly cancers.

The letter expresses concern that OPPS rates do not “reflect the actual cost of pathology services” and that use of inadequate cost data could cause unintended consequences, including loss of patient access to critical cancer diagnostic services and increased costs elsewhere in the Medicare program.

“We have heard from our constituents that some of the proposed payment rates will fall well below the cost of providing these diagnostic tests,” said Senators in the letter. “Implementing cuts that average 26 percent across the board, and exceed 75 percent for some anatomic pathology services, could have a severe impact on the ability of laboratories, particularly independent laboratories in our local communities, to continue to provide these services to Medicare beneficiaries.”

The letter further points out that the proposal does not take into account the overall cost of treating patients in different settings and may result in more patients receiving treatment in a hospital setting where the overall cost of care is higher.

The letter also argues that reduced access to diagnostic services that help patients and physicians choose the most appropriate care may result in some patients never receiving a treatment that could help them, while others may receive expensive treatments that are ineffective for their particular condition.

CMS is expected to finalize its proposed rule – which would take effect in 2014 – by November 1st.

To view the letter, please click here.

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