Congress Must Fix PAMA, Protecting Patient Access to Laboratory Testing Services
America’s clinical laboratories deliver screening and diagnostic test results that serve as the foundation for early diagnosis, disease prevention, and personalized care for millions of patients each day. From routine blood tests to innovations resulting in ground-breaking genetic testing, clinical laboratories foster improved patient outcomes and quality of life while delivering value to the health care system, including by often reducing costs. Further, the nation’s clinical laboratory infrastructure is essential to protecting public health when regional, national and global emergencies arise, from COVID-19 to other pathogens of concern. But Medicare beneficiaries and all patients across the country could soon face a preventable risk: compromised access to these critical laboratory tests.
Without congressional intervention, come January 2023, laboratories across the country will face a fourth round of Medicare reimbursement cuts authorized by the Protecting Access to Medicare Act (PAMA). PAMA was enacted in 2014 to establish a uniform reimbursement system for laboratories nationwide. However, due to an inadequate data reporting system, which only collected rates from less than 1 percent of the nation’s laboratories, clinical laboratories have already faced three years of compounding cuts to the most common tests, including the top 25 tests most used by seniors.
This next round of Medicare reductions would cut reimbursement up to 15 percent for over 800 lab tests. These cuts would undermine our nation’s clinical diagnostic infrastructure and could jeopardize access for seniors and all patients who rely on laboratory tests to diagnose, treat, and monitor their health on a regular basis, all while chilling innovation. Rather than weaken the health care system with further PAMA cuts, the nation’s clinical laboratory infrastructure should be strengthened, ensuring laboratories have the tools and resources necessary to continue serving patients, innovate, and prepare for and respond to future public health challenges.
Thanks to the leadership of longstanding bipartisan champions, this year Congress is poised to permanently improve implementation of the PAMA reimbursement model and protect the more than 50 million seniors and all patients who rely on screening and diagnostic tests to manage their health through the Saving Access to Laboratory Services Act. The bill, introduced by Sens. Sherrod Brown (D-OH) and Richard Burr (R-NC), along with Reps. Bill Pascrell (D-NJ), Scott Peters (D-CA), Richard Hudson (R-NC), Gus Bilirakis (R-FL), and Kurt Schrader (D-OR), would permanently ease Medicare cuts, addressing the consequences of PAMA by collecting representative private market data to achieve accurate and sustainable rates for laboratory services.
Because of the leadership of the Saving Access to Laboratory Services Act sponsors, Congress has previously come together three times to deliver bipartisan short-term relief that has delayed further implementation of PAMA. Most recently in 2021, Congress passed the Protecting Medicare and American Farmers from Sequester Cuts Act, which provided relief from another year of laboratory reimbursement cuts and received praise from leading organizations representing patients, health care professionals, hospitals, public health, laboratories, and diagnostic manufacturers.
By alleviating the PAMA cuts, setting Medicare reimbursement for laboratories on a sustainable pathway, Congress can protect seniors and all patients from potentially losing access to critical tests and support innovation for the next generation of screening and diagnostics while keeping our nation’s laboratory infrastructure healthy. Congress must pass the Saving Access to Laboratory Services Act.