CMS proposals on Medicare payment cuts worry industry leaders

Oct. 24, 2017
As a lifelong Chicago Cubs fan, and as a journalist for, well, more than a few years, I used to joke with friends that I had an article “How the Cubs finally won the World Series” all ready to go, just hadn’t had a chance to use it yet. Then, last year, the Cubs finally did win the World Series, and I had to put my money where my mouth was. In fact, I did write about that, albeit not for the pages of MLO.

During the past few months, a somewhat similar situation has begun to occur with regard to the long-awaited (with anticipation or dread, depending on your politics) repeal of the Affordable Care Act by the U.S. Congress. As you know if you’ve been reading the papers, the Republican-led Congress has promised to repeal Obamacare for years, as soon as there was a Republican president in the White House to sign a repeal-and-replace bill into law. But the Senate has failed several times since President Trump took office to cobble together a majority to pass a bill for him to sign.

And several times, I planned to write a “From the Editor” or “Washington Report” on the effects of the demise of Obamacare, and its replacement with another law, on the clinical lab—but I’ve had to scrap those plans each time. You can’t write about the effects of something that hasn’t happened.

But another important federal regulatory event did happen, on September 22, and industry experts are writing about the ramifications it may have for clinical labs. On that day, the Centers for Medicare and Medicaid Services, as required under the Protecting Access to Medicare Act (PAMA) of 2014, released the 2018 Clinical Laboratory Fee Schedule. PAMA directs the CMS to collect data from labs about private insurance reimbursement for lab tests. CMS is then to use data submitted by certain laboratories to set Medicare payments for specific tests.

It sounds fair, but many lab leaders—including the accrediting organization COLA—say that there are flaws in the methodology that cause CMS to set its Medicare payment amounts too low. The pricing schedule does not accurately reflect the market, and if it goes into effect, many labs will have to cut services or risk going under.

COLA has asked Congress “to consider how the anticipated steep cuts will harm access to critical, rapid, life-saving clinical laboratory testing for Medicare beneficiaries, especially in rural communities.” COLA continues: “The proposed CMS reimbursement cuts for lab tests, which are commonly performed in patient care settings including physician offices, nursing homes, rehabilitation centers and urgent care centers, will impose burdens on the frailest Medicare beneficiaries and will harm patient care. Near patient testing offers many benefits, including rapid, accurate results in the treatment of diabetes; same day laboratory information for oncologists to treat their patients undergoing chemotherapy; and the quick detection of infectious diseases.”

Among laboratory stakeholders, COLA is far from alone in decrying the CMS cuts. In fact, many individuals and organizations have spoken out against the new fee schedule. The formal comment period to CMS on the Clinical Laboratory Fee Schedule ended October 23.

You can read a more detailed analysis, with facts and figures, in this month’s “Washington Report,” written by three members of the CLMA Legislative Compliance and Regulatory Committee (LCRC).

MLO will continue to cover this ongoing story. And, if and when the Affordable Care Act is repealed and replaced, we will cover that too, and consider the implications for the clinical lab community.