LAB Act would delay PAMA reporting period in order to improve data collection process for market-based rates
WASHINGTON, D.C. – With 53 million Americans facing steep year-over-year cuts to vital clinical diagnostics, 26 national groups representing patient, provider, diagnostic and laboratory organizations called on Congressional leadership to delay a flawed data collection process that continues to erode Medicare lab benefits for the country’s most vulnerable seniors.
The letter comes as the House Energy & Commerce Committee considers several legislative proposals that would provide critical access to health services for patients. Advancing the bipartisan Laboratory Access for Beneficiaries (LAB) Act,which would suspend data reporting for a year, is a common-sense approach to address the continued faulty implementation of the Protecting Access to Medicare Act (PAMA).
In 2014, Congress passed PAMA to ensure millions of seniors could maintain access to critical health services, including laboratory tests. As part of PAMA implementation, Congress directed the HHS Secretary to establish market-based rates for clinical laboratories; however, the Secretary deliberately disregarded Congress’ instruction and cherry-picked payment data from less than 1% of laboratories nationwide.
As a result, millions of Medicare beneficiaries who are highly dependent on routine lab tests for their health may lose access to these important tests as laboratories cannot provide these services in the face of unsustainable cuts of more than 30 percent across a range of diagnostic tests. Absent immediate Congressional action, HHS is set to repeat the same flawed process to set reimbursement rates again in 2020, posing a direct threat to seniors’ access to essential medical care for diabetes and other chronic conditions.
The letter states, “The consequences [of PAMA] have been severe. According to a survey by the Infectious Disease Society of America (IDSA), over 79% of survey 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. Over 32% of respondents have changed their test menu, and nearly 40% now refer more tests to another laboratory, which can cause life-threatening delays in diagnosis and care.”
The Laboratory Access for Beneficiaries (LAB) Act, introduced by Rep. Scott Peters (D-CA), Rep. Gus Bilirakis (R-FL), Rep. Bill Pascrell (D-NJ), Rep. Kurt Schrader (D-OR), Rep. Richard Hudson (R-NC) and Rep. George Holding (R-NC), woulddelay the next round of data reporting by one year to ensure that all applicable laboratories required to report private payor data have the necessary time to do so. The bill also calls for the National Academy of Medicine to provide recommendations to Congress on less burdensome data collection methods and representative reimbursement rate calculations that result in the reliable, sustainable, market-based system originally intended by Congress.
Suspending data reporting in 2020 accomplishes two critical goals: it allows a more representative share of labs to report private market data; and provides valuable time for stakeholders and policymakers to determine how to reform PAMA and ensure a truly market-based system that will protect Medicare beneficiary access.