Seniors’ return to health could be jeopardized by upcoming lab cuts

November 18, 2021 Categories: ACLA Blog, Protecting Access to Medicare Act, ACLA News

Over the past two years, seniors have had to be extra vigilant when it comes to protecting their health, especially those with existing health issues or those who are immunocompromised. Just as we’re turning a corner on another wave of the pandemic, looming cuts to Medicare lab services send the wrong message to millions of Medicare beneficiaries who depend on lifesaving diagnostics for their health. 

The National Council on Aging reports that approximately 80% of older adults have at least one chronic condition, and approximately 50% have at least two chronic conditions. Access to lab tests and services is a key component in coordinating their comprehensive care – be it prevention or maintenance.

Data consistently show that timely access to clinical testing can help stop the progression of chronic conditions like cancer, diabetes and heart disease in their earliest stages and protect patients from serious and costly interventions in the future. For example, high blood pressure, high cholesterol and smoking are key risk factors for the leading cause of death in the U.S., heart disease, which can be controlled by lifestyle changes and medications when caught early through routine and recommended lab testing. 

Despite the vital role that lab tests play, more than 56 million seniors across the country are at risk of losing access to critical lab services as a result of the misguided implementation of the 2014 Protecting Access to Medicare Act (PAMA). The U.S. Department of Health and Human Services (HHS) has routinely cut reimbursement rates for some of the most common lab tests that seniors rely on. In fact, with the new year, nearly 600 clinical laboratory tests and diagnostic services – including the top 25 tests most used by America’s seniors – will see their Medicare reimbursement cut. These tests screen for and monitor common conditions like diabetes, heart disease, liver disease, kidney disease, prostate cancer, anemia and hypothyroidism. Early diagnosis is key for any disease, and losing access to these important tests can have a devastating impact on patient health. In the wake of the pandemic, where routine care was put on hold for so many vulnerable Americans, these tests are even more important. 

Collectively, these cuts can have a drastic impact on labs across the country and their ability to perform the routine testing that seniors need. According to the Centers for Medicare & Medicaid Services (CMS), hundreds of routine low-cost tests have been cut by 10% per year, every year, from 2018 through 2020 and face up to an additional 15% cut on January 1st, 2022.  These extreme reductions in reimbursement also limit the types of tests a provider can offer. For example, a 2018 survey of laboratories by the Infectious Disease Society of America (IDSA) showed that more than 79% of respondents reported they would be unable to provide the full range of testing needed to rapidly diagnose infectious diseases following the 2018-2019 PAMA cuts.

Congress acted last year in the throes of the pandemic to ensure seniors wouldn’t face access issues, but they have yet to address this next cliff. America’s seniors deserve better. 

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