As seniors brace for a new set of cuts to clinical lab services in January, Congress takes decisive action to halt faulty data collection process responsible for year-over-year cuts to Medicare lab benefits
Independent study will assess how to improve data reporting under PAMA
WASHINGTON, D.C. – In a victory for 53 million seniors who depend on clinical laboratory diagnostics for their health, Congress today passed the Laboratory Access for Beneficiaries (LAB) Act, bipartisan legislation to address critical data collection deficiencies resulting in year-over-year cuts to Medicare lab benefits.
The LAB Act paves the way for additional reforms to the 2014 Protecting Access to Medicare Act (PAMA) by delaying the upcoming data reporting period by one year and commissioning a study on how to improve data collection and rate setting to better reflect Congress’ original intent of a market-based fee schedule for clinical laboratory services.
The passage follows a multi-year effort by ACLA and other stakeholders to raise the alarm about the urgent threat facing seniors who rely on lab tests to manage, diagnose and treat disease. Eighty percent of seniors have at least once chronic condition, according to the CDC, and routine monitoring is an essential component of care for this demographic.
While PAMA aimed to protect beneficiary access by establishing a market-based system for determining lab reimbursement rates, the Centers for Medicare and Medicaid Services (CMS) instituted a flawed data collection methodology that excluded information from the vast majority of laboratories and instead relied on a tiny, non-representative sample to determine rates. As a result, reimbursement for key tests that seniors use to manage chronic disease have been drastically cut over the past several years.
The consequences have been severe. According to a survey by the Infectious Disease Society of America (IDSA), over 79% of respondents will be unable to provide the full range of testing needed to rapidly diagnose infectious diseases following the PAMA cuts of 2018 and 2019. In addition, over 32% of respondents have changed their test menus and nearly 40% now refer more tests to another laboratory, which can cause life-threatening delays in diagnosis and care for patients.
“While we join with laboratories and the patients they serve to celebrate today’s victory, we also acknowledge the ongoing harm facing seniors who rely on lab services as a key element of their routine care and who will endure yet another new round of cuts next month,” said ACLA President Julie Khani. “Fortunately, Congress’ decisive action today puts us on the path to enact meaningful PAMA reforms that will protect seniors’ access to essential lab services, as the law originally intended.”
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ACLA is a not-for-profit association representing the nation’s leading clinical and anatomic pathology laboratories, including national, regional, specialty, hospital, ESRD and nursing home laboratories. The clinical laboratory industry employs nearly 295,000 people directly, and generates over 117,000 additional jobs in supplier industries. Clinical laboratories are at the forefront of personalized medicine, driving diagnostic innovation and contributing more than $106 billion to the nation’s economy.