Dive Temporary:
- A coalition of greater than 30 commerce teams from throughout the healthcare trade is asking on Congress to go laws that may forestall steep Medicare reimbursement cuts for laboratory testing providers from taking impact in January.
- In a letter despatched final week to congressional leaders, teams together with AdvaMed, the American Medical Laboratory Affiliation, the American Medical Affiliation and the American Hospital Affiliation mentioned the laws is required to stabilize Medicare funds for diagnostics set below the Medicare Medical Laboratory Payment Schedule, or CLFS.
- The organizations assist a invoice referred to as the Reforming and Enhancing Sustainable Updates to Laboratory Testing Companies Act, or RESULTS, that may direct the CMS to contract with an unbiased, not-for-profit business claims database to set CLFS charges for broadly out there assessments.
Dive Perception:
The RESULTS Act was launched in September in each the Home and Senate with bipartisan assist. It goals to reform the CLFS rate-setting course of established below the 2014 Defending Entry to Medicare Act, or PAMA, and thereby cease cost reductions of as much as 15% which might be scheduled to take impact Jan. 1 for about 800 lab assessments.
Such cuts threaten affected person entry to routine and life-saving diagnostic assessments, the teams mentioned.
PAMA was meant to create a nationwide charge schedule, primarily based on non-public market information, reflecting a spread of labs that serve Medicare beneficiaries. Nevertheless, trade teams contend that PAMA created a course of that units reimbursement charges artificially low, leading to practically $4 billion in cuts from the CLFS within the first three years.
Congress has acted to delay cost cuts in every of the final 5 years. The healthcare teams argue it’s time to enact everlasting reform by means of the RESULTS laws. Their plea comes amid a federal authorities shutdown that’s on monitor to grow to be the longest in U.S. historical past.
ACLA mentioned CLFS charges for broadly out there assessments can be primarily based on sturdy non-public payer claims information, whereas scientific labs can be required to report business charge information on to the CMS for assessments that aren’t broadly out there, corresponding to proprietary diagnostics and people for uncommon illnesses.
Along with revamping the rate-setting course of to replicate up-to-date market info, the invoice is meant to scale back the information assortment and reporting burden on scientific labs and the executive burden on the CMS by extending the rate-setting cycle to each 4 years.
It could additionally set up limits on annual cost reductions and exclude artificially low Medicaid managed care cost charges from the information used to set reimbursement ranges.
