Statement on CMS Proposed Physician Fee Schedule Rule

July 09, 2013 Categories: ACLA News, All News, Reimbursement and Coverage

WASHINGTON, DC – The American Clinical Laboratory Association (ACLA) issued the following statement on the proposed rule published today in the Federal Register by the Centers for Medicare and Medicaid Services (CMS), “Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions for Part B for CY 2014” (the “Proposed Rule”):

ACLA is deeply concerned with two provisions in the Proposed Rule which would reduce payments to clinical laboratories and could threaten patient access to life enhancing and life-saving laboratory services.

First, absent any discussion with clinical laboratories, patients, and other stakeholders, CMS proposes to identify codes and propose revised payments in the Clinical Laboratory Fee Schedule (CLFS) due to ”technological changes.” This provision was unexpected in the Proposed Rule, since CMS has maintained until now that once payment for a test under the CLFS is established, it does not change.
Second, the Proposed Rule would severely reduce payments for pathology codes when services are provided by independent laboratories. These cuts to payment – 25% in the aggregate according to the proposed rule – come on the heels of a series of devastating cuts already experienced by clinical laboratories in last year’s Physician Fee Schedule Final Rule.

Despite clinical labs only accounting for 1.6% of annual Medicare spending, payment for lab services have been cut by over 11% since 2010 and face double that amount over the next 9 years. In 2013 alone, Medicare payment for lab services under the Clinical Laboratory Fee Schedule was cut by 5 percent. The cuts to surgical pathology services in the 2013 PFS rule were 33%.

Clinical lab tests provide invaluable information used to diagnose and treat patients for everything from cancer and infectious disease to diabetes and heart disease – influencing 70% of all medical decisions. These cuts to life-saving testing are occurring while labs, of which most are independent and community-based, still must meet the demand to provide quality lab services critical for early detection of disease and preventative care. Further reductions to payments to clinical labs threaten their ability to maintain access to high quality care for Medicare patients.

ACLA continues to review the proposed rule, and will continue to advocate aggressively for clinical laboratories and the patients they serve throughout the rulemaking process.

Print page / Save as PDF