For Seniors in Rural Communities, Erosion of Lab Benefits is an Urgent Threat

One in four seniors in the United States lives in a rural area—a notable statistic considering the unique set of health challenges these communities face. Nearly 80% of rural America is “medically underserved,” according to the federal government. Seniors living in these parts of the country have far fewer options for care and are often required to travel significant distances just to get the treatment they need. Compared to those living in urban areas, rural communities face higher death rates from heart disease, cancerandstroke, and are 17 percent more likely to have diabetes.

With these factors in mind, it should seem obvious to policymakers that we need to work harder to ensure that the health of seniors in rural America is protected and promote better access to essential health services. Instead, due to flawed policy implementation out of Washington, D.C., the opposite is occurring. Seniors living in these underserved communities are disproportionately bearing the brunt of cuts to clinical lab services.

Over the past two years, more than 53 million seniors all across the country have faced continued erosion of their lab benefits. By setting rates that do not reflect market realities—ignoring data from more that 99 percent of the nation’s laboratories—the Centers for Medicare and Medicaid Services’ (CMS) is engaging in a faulty data collection process. As a result, the agency has implemented dramatic cuts to reimbursement rates for lab tests, which will undoubtedly restrict Medicare beneficiaries’ access to these vital clinical tools.

Labs serving rural communities were largely excluded from the data collection process used to establish the new rates. Per CMS’ own analysis, only 36 rural laboratories in the entire United States reported data. In other words, CMS relied on data from just 2 percent of rural laboratories to set rates, even though 23 percent of Medicare beneficiaries live in rural areas.

These cuts—which will exceed 30 percent for many high-volume tests when fully phased in—will have staggering consequences for patient care, especially in underserved communities. In fact, the very same tests used to manage conditions that disproportionately affect patients in rural areas (such as cancer, heart disease and diabetes) are slated for the most significant cuts.

For example, the glycosylated hemoglobin A1c test—one of the tests used by providers caring for seniors with diabetes—will be cut by 36 percent. This test is particularly valuable because it utilizes a single sample to reveal a patient’s average glucose levelover the course of 2 to 3 months. Information gleaned from this test can help providers evaluate how well a patient’s diabetes is controlled over time and reduce complications and costly interventions down the road.

Basic panel tests, which are an essential component of care in rural communities, also face steep cuts. The Comprehensive Metabolic Panel (CMP), used to monitor the liver, kidneys and electrolyte and acid/base balance in a patient’s blood, is slated for a 37 percent cut. The Complete Blood Count (CBC), which is used to help diagnose infections, anemia and several other disorders, is slated for a 35 percent cut. Ultimately, these cuts threaten seniors’ access to a vital lifeline and compromise the quality of care available to our most vulnerable populations, including rural communities.

Finally, these cuts will not only hurt seniors, they will initiate negative ripple effects across the broader health system. After all, labs are the starting point for successful disease management, which has the power to reduce hospitalizations by 24 percent and reduce Medicare costs by 20 percent. Research has shown time and time again that prevention is critical to controlling costs and deterring costly interventions that could have otherwise been avoided. In the case of lab services specifically, stakeholders from across the health system agree that reducing access to clinical lab services will ultimately drive up costs for beneficiaries and taxpayers and result in delays in care as well as adverse health outcomes.

Fortunately, Congress has the chance to course correct. The bipartisan Laboratory Access for Beneficiaries Act(LAB Act) would put a pause on the faulty data collection process for one year and give CMS more time to get it right. To protect seniors—especially those living in rural communities—CMS must establish a more representative data set. Passing the LAB Act is an important step forward toward that goal, and seniors are counting on Congress to act now.

Print page / Save as PDF